학술논문
Autoimmune Thyroid Disorders in Autoimmune Addison Disease
Clinical Research Article
Clinical Research Article
Document Type
Academic Journal
Author
Stokland, Ann-Elin Meling; Ueland, Grethe; Lima, Kari; Gronning, Kaja; Finnes, Trine E.; Svendsen, Margrethe; Tomkowicz, Aneta Ewa; Holte, Synnove Emblem; Sollid, Stina Therese; Debowska, Aleksandra; Singsas, Hallvard; Rensvik, Marthe Landsverk; Lejon, Helle; Sormo, Dag-Erik; Svare, Anders; Blika, Sigrid; Milova, Petya; Korsgaard, Elin; Husby, Oystein; Breivik, Lars; Jorgensen, Anders P.; Husebye, Eystein Sverre
Source
Journal of Clinical Endocrinology & Metabolism. June 2022, Vol. 107 Issue 6, pe2331, 8 p.
Subject
Language
English
ISSN
0021-972X
Abstract
Autoimmune Addison disease (AAD) is associated with a high frequency of organ-specific endocrine and nonendocrine manifestations. More than half of patients have an autoimmune polyendocrine syndrome (1). A report from [...]
Context: Autoimmune thyroid disease is the most common endocrine comorbidity in autoimmune Addison disease (AAD), but detailed investigations of prevalence and clinical course are lacking. Objective: This work aimed to provide comprehensive epidemiological and clinical data on autoimmune thyroid disorders in AAD. Methods: A nationwide registry-based study including 442 patients with AAD and autoimmune thyroid disease were identified through the Norwegian National Registry of Autoimmune Diseases. Results: Of 912 registered AAD patients, 442 (48%) were diagnosed with autoimmune thyroid disease. A total of 380 (42%) had autoimmune hypothyroidism. Of the 203 with available thyroid function tests at time of diagnosis, 20% had overt hypothyroidism, 73% had subclinical hypothyroidism, and 7% had thyroid levels in the normal range. Negative thyroid peroxidase antibodies was found in 32%. Ninety-eight percent were treated with levothyroxine, 5% with combination therapy with liothyronine or thyroid extracts, and 1% were observed without treatment. Seventy-eight patients (9%) were diagnosed with Graves disease (GD), of whom 16 (21%) were diagnosed with autoimmune hypothyroidism either before onset or after remission of GD. At the end of follow-up, 33% had normal thyroid hormone levels without antithyroid-drugs or levothyroxine treatment. The remaining had either active disease (5%), had undergone ablative treatment (41%), or had developed autoimmune hypothyroidism (21%). Conclusion: The true prevalence of hypothyroidism in AAD is lower than reported in the current literature. Careful consideration of the indication to start thyroxin therapy is warranted. Long-term remission rates in GD patients with AAD are comparable to recent reports on long-term follow-up of patients without AAD. Key Words: autoimmune Addison disease, autoimmune hypothyroidism, Graves disease, autoimmune polyendocrine syndromes Abbreviations: AAD, autoimmune Addison disease; APS-2, autoimmune polyendocrine syndrome type-2; ATD, antithyroid drug; FT4, free thyroxine; GD, Graves disease; ROAS, Norwegian Registry for Organ-specific Autoimmune Diseases; TPOAb, thyroid peroxidase antibody; TRAb, thyrotropin receptor antibody; TSH, thyrotropin.
Context: Autoimmune thyroid disease is the most common endocrine comorbidity in autoimmune Addison disease (AAD), but detailed investigations of prevalence and clinical course are lacking. Objective: This work aimed to provide comprehensive epidemiological and clinical data on autoimmune thyroid disorders in AAD. Methods: A nationwide registry-based study including 442 patients with AAD and autoimmune thyroid disease were identified through the Norwegian National Registry of Autoimmune Diseases. Results: Of 912 registered AAD patients, 442 (48%) were diagnosed with autoimmune thyroid disease. A total of 380 (42%) had autoimmune hypothyroidism. Of the 203 with available thyroid function tests at time of diagnosis, 20% had overt hypothyroidism, 73% had subclinical hypothyroidism, and 7% had thyroid levels in the normal range. Negative thyroid peroxidase antibodies was found in 32%. Ninety-eight percent were treated with levothyroxine, 5% with combination therapy with liothyronine or thyroid extracts, and 1% were observed without treatment. Seventy-eight patients (9%) were diagnosed with Graves disease (GD), of whom 16 (21%) were diagnosed with autoimmune hypothyroidism either before onset or after remission of GD. At the end of follow-up, 33% had normal thyroid hormone levels without antithyroid-drugs or levothyroxine treatment. The remaining had either active disease (5%), had undergone ablative treatment (41%), or had developed autoimmune hypothyroidism (21%). Conclusion: The true prevalence of hypothyroidism in AAD is lower than reported in the current literature. Careful consideration of the indication to start thyroxin therapy is warranted. Long-term remission rates in GD patients with AAD are comparable to recent reports on long-term follow-up of patients without AAD. Key Words: autoimmune Addison disease, autoimmune hypothyroidism, Graves disease, autoimmune polyendocrine syndromes Abbreviations: AAD, autoimmune Addison disease; APS-2, autoimmune polyendocrine syndrome type-2; ATD, antithyroid drug; FT4, free thyroxine; GD, Graves disease; ROAS, Norwegian Registry for Organ-specific Autoimmune Diseases; TPOAb, thyroid peroxidase antibody; TRAb, thyrotropin receptor antibody; TSH, thyrotropin.