Thyroid disorders and connective tissue disease
- Lesley D Hordon, MD
Lesley D Hordon, MD
- Consultant in Rheumatology
- University of Leeds, United Kingdom
The frequency of thyroid disease, particularly chronic autoimmune thyroiditis (Hashimoto's thyroiditis), may be increased in patients with connective tissue diseases. However, it is important to remember that chronic autoimmune thyroiditis, manifested by positive tests for antithyroid antibodies, is common in the general population (occurring in 10 to 20 percent of women and 1 to 2 percent of men) and hypothyroidism (subclinical or overt) is only slightly less common . In addition, both hypothyroidism and connective tissue diseases often cause muscle and joint aches, pains, and stiffness, and common treatments for connective tissue diseases and the illnesses themselves may affect thyroid function or thyroid function tests.
Given the high frequency of chronic autoimmune thyroiditis and hypothyroidism in patients with no other problems, the literature describing the occurrence of thyroid disease in patients with a connective tissue disease should be viewed with considerable caution. Most of the studies were performed in specialty clinics, so the likelihood of selection bias is high. Diagnostic criteria for thyroid disease may also vary between studies. Furthermore, there is only limited evidence that the concurrence in the same patient of thyroid disease and connective tissue disease alters the clinical manifestations or natural history of either disorder. Examples are scleroderma, in which fibrosis of the thyroid gland can occur and cause hypothyroidism independently of chronic autoimmune thyroiditis, and complete congenital heart block in children of hypothyroid, anti-Ro-positive mothers.
Another part of this relationship is that the drugs used to treat connective tissue diseases and the underlying illness can affect thyroid function. (See "Drug interactions with thyroid hormones" and "Thyroid function in nonthyroidal illness".)
●Glucocorticoids inhibit thyroid-stimulating hormone (TSH) secretion and slightly reduce serum thyroid hormone concentrations.
●Aspirin and some nonsteroidal antiinflammatory drugs lower serum total thyroid hormone concentrations by interfering with thyroid hormone binding to its carrier proteins; serum free thyroid hormone concentrations do not change.
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- THYROID DISORDERS IN CONNECTIVE TISSUE DISEASES
- Polymyalgia rheumatica/giant cell arteritis
- Systemic lupus erythematosus
- Sjögren's syndrome
- Rheumatoid arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- Mixed connective tissue disease
- Antinuclear antibodies in patients with thyroid disease