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Meneghini V, Tebar WR, Santos IS, Janovsky CCPS, de Almeida-Pititto B, Birck MG, Lotufo PA, Goulart AC, Sgarbi JA, Teixeira PDFDS, Silva GTD, Benseñor IM. Potential Determinants of Thyroid Peroxidase Antibodies and Mortality Risk: Results From the ELSA-Brasil Study. J Clin Endocrinol Metab 2024; 109:e698-e710. [PMID: 37698138 DOI: 10.1210/clinem/dgad539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/16/2023] [Accepted: 09/09/2023] [Indexed: 09/13/2023]
Abstract
CONTEXT The presence of thyroid peroxidase antibodies (TPOAbs) may be considered as an indicator of adverse health outcomes. OBJECTIVE We aimed to investigate the potential determinants of TPOAb levels and to analyze the association between TPOAb titers and the risk of all- and specific-cause mortality. METHODS Baseline and longitudinal data of 13 187 participants from the ELSA-Brasil Study were analyzed. We investigated the association of TPOAb, detectability, positivity, and persistent positivity with sociodemographic and lifestyle factors using logistic regressions. Cox proportional hazards and Fine-Gray subdistribution hazard regression analyses were used to verify the association of TPOAbs with mortality. RESULTS The determinants of TPOAb detectability and positivity were younger age, higher body mass index, female sex, and former and current smoking status. Black, mixed, and other self-reported races, intermediate and higher education, and heavy drinking were determinants of detectable and positive TPOAb levels. Female sex, White race, and former smoking were determinants of persistent TPOAb positivity at 2 visits, although only the female sex maintained its association at 3 visits. Moreover, after multivariate adjustment, there were associations between higher levels of TPOAbs and higher risk of cancer-related mortality among men, and TPOAb detectability and mortality by other causes among women. CONCLUSION Sociodemographic and lifestyle-related factors were determinants of multiple TPOAb categories. TPOAb levels were associated with mortality risk; however, the low mortality rate in this sample might have compromised this finding. We suggest further studies to explore the clinical importance of detectable TPOAb levels, not only its positivity, as a potential marker of inflammation.
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Affiliation(s)
- Vandrize Meneghini
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | - William Rodrigues Tebar
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | - Itamar Souza Santos
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
- Department Internal Medicine, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | | | - Bianca de Almeida-Pititto
- Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, SP 04023-062, Brazil
| | - Marina Gabriela Birck
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
- Department Internal Medicine, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | - Alessandra Carvalho Goulart
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | - José Augusto Sgarbi
- Division of Endocrinology and Metabolism, Department of Medicine, Faculdade de Medicina de Marilia, Marilia, SP 17519-030, Brazil
| | | | - Gisela Tunes da Silva
- Institute of Mathematics and Statistics, Universidade de São Paulo, São Paulo, SP 05508-090, Brazil
| | - Isabela Martins Benseñor
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
- Department Internal Medicine, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
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Bagherzadeh-Fard M, Yazdanifar MA, Aghaali M, Masoumi M. The prevalence of thyroid dysfunction and autoimmune thyroid disease in patients with rheumatoid arthritis. BMC Rheumatol 2022; 6:63. [PMID: 36274180 PMCID: PMC9590164 DOI: 10.1186/s41927-022-00293-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is one of the most common chronic non-organ-specific autoimmune diseases; meanwhile, autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disease that can lead to hypo or hyperthyroidism. Although the etiology of both diseases is complex with a combination of genetic and environmental factors, there are overlaps in genes contributing to the pathogenesis of both diseases. Numerous studies found a correlation between thyroid abnormality and RA in different populations, yet some didn’t. This study is aimed to evaluate the prevalence of thyroid dysfunction, AITD, and anti-thyroid peroxidase (anti-TPO) positively in Iranian patients with RA. Methods A total of 250 RA patients and 248 patients with non-inflammatory rheumatologic disease were included in this case–control study. All participants underwent complete clinical and laboratory assessments. Participants were also assessed for thyroid function testing, including anti-TPO antibodies. Results Thyroid dysfunction was twice as common in RA patients as in controls (OR = 2.16; P-value > 0.001). Overt hypothyroidism was the most common thyroid dysfunction among RA patients (58 out of 84). Anti-TPO positivity was also significantly more common in RA compared with controls (OR = 2.65; P-value > 0.001). The proportion of controls and RA patients with AITD were 9 and 21.5%, respectively. AITD was found 2.8 times more common in RA group than controls (OR = 2.77; P-value > 0.001). Conclusion It was demonstrated that RA was an independent factor associated with thyroid dysfunction and AITD. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00293-9.
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Liu YJ, Miao HB, Lin S, Chen Z. Association between rheumatoid arthritis and thyroid dysfunction: A meta-analysis and systematic review. Front Endocrinol (Lausanne) 2022; 13:1015516. [PMID: 36313752 PMCID: PMC9608862 DOI: 10.3389/fendo.2022.1015516] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is an autoimmune disorder. Multiple studies have investigated the risk of thyroid dysfunction in patients with RA but have reached conflicting conclusions. This systematic review aimed to determine whether patients with RA are at higher risk of thyroid dysfunction. METHODS We comprehensively reviewed online literature databases, including PubMed, Scopus, Embase, and the Cochrane Library, from their respective inception dates to March 25, 2022. Studies that provided data on at least one case of thyroid dysfunction in RA patients and their controls were included. Based on these data, we calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) for thyroid dysfunction in RA and non-RA patients. RESULTS Twenty-nine studies met the inclusion criteria, involving a total of 35,708 patients with RA. The meta-analysis showed that, compared with non-RA patients, RA patients had an increased risk of developing thyroid dysfunction, particularly hypothyroidism (OR 2.25, 95% CI 1.78-2.84). Subgroup analysis suggested that study type and sample source of control group were the source of heterogeneity. CONCLUSIONS Patients with RA are at increased risk of developing thyroid dysfunction, especially hypothyroidism. Routine biochemical examination of thyroid function in RA patients should be strengthened. Larger prospective studies are needed to explore the causal relationship between RA and thyroid dysfunction, and to investigate the impact of thyroid dysfunction on RA disease activity, drug efficacy, and medication safety. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier CRD42022331142.
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Affiliation(s)
- Yi-jing Liu
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Hai-bing Miao
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Group of Neuroendocrinology, Garvan Institute of Medical Research, Sydney, NSW, Australia
- *Correspondence: Shu Lin, ; Zhen Chen,
| | - Zhen Chen
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- *Correspondence: Shu Lin, ; Zhen Chen,
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Wang Q, Shangguan J, Zhang Y, Pan Y, Yuan Y, Que W. The prevalence of thyroid autoantibodies in autoimmune connective tissue diseases: a systematic review and meta-analysis. Expert Rev Clin Immunol 2020; 16:923-930. [PMID: 32811198 DOI: 10.1080/1744666x.2020.1811089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM Patients with autoimmune connective tissue disease (ACTD) may have anti-thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb). This study aimed to compare the prevalence of thyroid autoantibodies in ACTD patients and controls. METHODS All case-control studies published between 1980 and 2019 in English were searched from Medline, Embase, Web of Science, PubMed databases for meta-analysis and subgroup analyses. RESULTS Total 10,321 ACTD cases and 12,949 healthy controls were included, and the prevalence of thyroid autoantibody positivity was higher in ACTD patients than in controls. Subgroup analysis revealed positive association between TgAb and ACTD in populations from all continents including European, Asian, African, and American. In addition, we found positive association between TgAb positivity and most ACTD cases including RA, SLE, pSS, and UCTD, positive association between TPOAb positivity and all ACTD cases including RA, SLE, pSS, SSc, and UCTD, and positive association between TPOAb positivity and ACTD in European, Asian, and African but not in American populations. CONCLUSION Thyroid autoantibodies are more prevalent in ACTD patients than in healthy controls. It is important to screen patients with ACTD for the presence of thyroid autoimmunity, and perform thyroid function tests in clinical evaluation of ACTD patients.
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Affiliation(s)
- Qinqin Wang
- Department of Rheumatology, The Affiliated Nanping First Hospital of Fujian Medical University , Nanping, Fujian Province, China
| | - Jie Shangguan
- Department of Anesthesiology, The Affiliated Nanping First Hospital of Fujian Medical University , Nanping, Fujian Province, China
| | - Yanping Zhang
- Department of Scientific Research, the Affiliated Nanping First Hospital of Fujian Medical University , Nanping, Fujian Province, China
| | - YiDan Pan
- Department of Internal Medicine, Puyang County People's Hospital , Puyang, Henan Province, China
| | - Yue Yuan
- Department of Medical Imaging, The 989 Hospital of the Joint Service Support Force of the Chinese People's Liberation Army , Pingdingshan, Henan Province, China
| | - Wenzhong Que
- Department of Rheumatology, The Affiliated Nanping First Hospital of Fujian Medical University , Nanping, Fujian Province, China
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