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Thyroid disorders and connective tissue disease

Lesley D Hordon, MD
Section Editor
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD


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 [1]. 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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Literature review current through: Sep 2016. | This topic last updated: Jun 16, 2015.
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  1. Vanderpump MJ, Tunbridge WMG. The epidemiology of thyroid disease. In: The Thyroid: A Fundamental and Clinical Text, 7th ed, Braverman LE, Utiger RD (Eds), Lippincott-Raven, Philadelphia 1996. p.474.
  2. Wiseman P, Stewart K, Rai GS. Hypothyroidism in polymyalgia rheumatica and giant cell arteritis. BMJ 1989; 298:647.
  3. Bowness P, Shotliff K, Middlemiss A, Myles AB. Prevalence of hypothyroidism in patients with polymyalgia rheumatica and giant cell arteritis. Br J Rheumatol 1991; 30:349.
  4. Barrier JH, Abram M, Brisseau JM, et al. Autoimmune thyroid disease, thyroid antibodies and giant cell arteritis: the supposed correlation appears fortuitous. J Rheumatol 1992; 19:1733.
  5. Dasgupta B, Grundy E, Stainer E. Hypothyroidism in polymyalgia rheumatica and giant cell arteritis: lack of any association. BMJ 1990; 301:96.
  6. Dent RG, Edwards OM. Autoimmune thyroid disease and the polymyalgia rheumatica-giant cell arteritis syndrome. Clin Endocrinol (Oxf) 1978; 9:215.
  7. Ferraccioli G, Cavalieri F, Salaffi F, et al. Neuroendocrinologic findings in primary fibromyalgia (soft tissue chronic pain syndrome) and in other chronic rheumatic conditions (rheumatoid arthritis, low back pain). J Rheumatol 1990; 17:869.
  8. Neeck G, Riedel W. Thyroid function in patients with fibromyalgia syndrome. J Rheumatol 1992; 19:1120.
  9. Pamuk ON, Cakir N. The frequency of thyroid antibodies in fibromyalgia patients and their relationship with symptoms. Clin Rheumatol 2007; 26:55.
  10. Vianna JL, Haga HJ, Asherson RA, et al. A prospective evaluation of antithyroid antibody prevalence in 100 patients with systemic lupus erythematosus. J Rheumatol 1991; 18:1193.
  11. Magaro M, Zoli A, Altomonte L, et al. The association of silent thyroiditis with active systemic lupus erythematosus. Clin Exp Rheumatol 1992; 10:67.
  12. Kausman D, Isenberg DA. Thyroid autoimmunity in systemic lupus erythematosus: the clinical significance of a fluctuating course. Br J Rheumatol 1995; 34:361.
  13. Pyne D, Isenberg DA. Autoimmune thyroid disease in systemic lupus erythematosus. Ann Rheum Dis 2002; 61:70.
  14. Miller FW, Moore GF, Weintraub BD, Steinberg AD. Prevalence of thyroid disease and abnormal thyroid function test results in patients with systemic lupus erythematosus. Arthritis Rheum 1987; 30:1124.
  15. Baker JR Jr, Miller FW, Steinberg AD, Burman KD. Thyroid stimulating and thyrotrophin binding-inhibitory immunoglobulin activity in patients with systemic lupus erythematosus having thyroid function abnormalities. Thyroid 1991; 1:229.
  16. Al Saleh J, El Sayed M, Jassim V, et al. Hypothyroidism determines the clinical and immunological manifestations of Arabs with lupus. Lupus 2008; 17:215.
  17. Antonelli A, Mosca M, Fallahi P, et al. Thyroid cancer in systemic lupus erythematosus: a case-control study. J Clin Endocrinol Metab 2010; 95:314.
  18. Kumar K, Kole AK, Karmakar PS, Ghosh A. The spectrum of thyroid disorders in systemic lupus erythematosus. Rheumatol Int 2012; 32:73.
  19. Quintanilla-Flores DL, Hernández-Coria MI, Elizondo-Riojas G, et al. Thyroid nodules in Hispanic patients with systemic lupus erythematosus. Lupus 2013; 22:1509.
  20. Boelaert K, Newby PR, Simmonds MJ, et al. Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease. Am J Med 2010; 123:183.e1.
  21. Namjou B, Kelly JA, Kilpatrick J, et al. Linkage at 5q14.3-15 in multiplex systemic lupus erythematosus pedigrees stratified by autoimmune thyroid disease. Arthritis Rheum 2005; 52:3646.
  22. Scofield RH, Bruner GR, Harley JB, Namjou B. Autoimmune thyroid disease is associated with a diagnosis of secondary Sjögren's syndrome in familial systemic lupus. Ann Rheum Dis 2007; 66:410.
  23. Stagnaro-Green A, Akhter E, Yim C, et al. Thyroid disease in pregnant women with systemic lupus erythematosus: increased preterm delivery. Lupus 2011; 20:690.
  24. Lazarus MN, Isenberg DA. Development of additional autoimmune diseases in a population of patients with primary Sjögren's syndrome. Ann Rheum Dis 2005; 64:1062.
  25. Anaya JM, Tobon GJ, Vega P, Castiblanco J. Autoimmune disease aggregation in families with primary Sjögren's syndrome. J Rheumatol 2006; 33:2227.
  26. Hansen BU, Ericsson UB, Henricsson V, et al. Autoimmune thyroiditis and primary Sjögren's syndrome: clinical and laboratory evidence of the coexistence of the two diseases. Clin Exp Rheumatol 1991; 9:137.
  27. Shiroky JB, Cohen M, Ballachey ML, Neville C. Thyroid dysfunction in rheumatoid arthritis: a controlled prospective survey. Ann Rheum Dis 1993; 52:454.
  28. Magnus JH, Birketvedt T, Haga HJ. A prospective evaluation of antithyroid antibody prevalence in 100 patients with rheumatoid arthritis. Scand J Rheumatol 1995; 24:180.
  29. Liao KP, Kurreeman F, Li G, et al. Associations of autoantibodies, autoimmune risk alleles, and clinical diagnoses from the electronic medical records in rheumatoid arthritis cases and non-rheumatoid arthritis controls. Arthritis Rheum 2013; 65:571.
  30. Bengtsson C, Padyukov L, Källberg H, Saevarsdottir S. Thyroxin substitution and the risk of developing rheumatoid arthritis; results from the Swedish population-based EIRA study. Ann Rheum Dis 2014; 73:1096.
  31. Antonelli A, Delle Sedie A, Fallahi P, et al. High prevalence of thyroid autoimmunity and hypothyroidism in patients with psoriatic arthritis. J Rheumatol 2006; 33:2026.
  32. Emmungil H, Erdogan M, Kalfa M, et al. Autoimmune thyroid disease in ankylosing spondylitis. Clin Rheumatol 2014; 33:955.
  33. Hämeenkorpi R, Hakala M, Ruuska P, et al. Thyroid disorder in patients with mixed connective tissue disease. J Rheumatol 1993; 20:602.
  34. Biró E, Szekanecz Z, Czirják L, et al. Association of systemic and thyroid autoimmune diseases. Clin Rheumatol 2006; 25:240.
  35. Marasini B, Ferrari PA, Solaro N, Selmi C. Thyroid dysfunction in women with systemic sclerosis. Ann N Y Acad Sci 2007; 1108:305.
  36. Antonelli A, Ferri C, Fallahi P, et al. Clinical and subclinical autoimmune thyroid disorders in systemic sclerosis. Eur J Endocrinol 2007; 156:431.
  37. Gordon MB, Klein I, Dekker A, et al. Thyroid disease in progressive systemic sclerosis: increased frequency of glandular fibrosis and hypothyroidism. Ann Intern Med 1981; 95:431.
  38. Kahl LE, Medsger TA Jr, Klein I. Prospective evaluation of thyroid function in patients with systemic sclerosis (scleroderma). J Rheumatol 1986; 13:103.
  39. Antonelli A, Fallahi P, Ferrari SM, et al. Incidence of thyroid disorders in systemic sclerosis: results from a longitudinal follow-up. J Clin Endocrinol Metab 2013; 98:E1198.
  40. Danielides S, Mavragani CP, Katsakoulas I, et al. Increased prevalence of anti-thyroid antibodies in patients with limited scleroderma. Scand J Rheumatol 2011; 40:299.
  41. Katakura M, Yamada T, Aizawa T, et al. Presence of antideoxyribonucleic acid antibody in patients with hyperthyroidism of Graves' disease. J Clin Endocrinol Metab 1987; 64:405.
  42. McDermott MT, West SG, Emlen JW, Kidd GS. Antideoxyribonucleic acid antibodies in Graves' disease. J Clin Endocrinol Metab 1990; 71:509.
  43. Morita S, Arima T, Matsuda M. Prevalence of nonthyroid specific autoantibodies in autoimmune thyroid diseases. J Clin Endocrinol Metab 1995; 80:1203.
  44. Spence D, Hornberger L, Hamilton R, Silverman ED. Increased risk of complete congenital heart block in infants born to women with hypothyroidism and anti-Ro and/or anti-La antibodies. J Rheumatol 2006; 33:167.