Common phenotype and different non-HLA genes in Graves’ disease and alopecia areata

An Update on Alopecia and its Association With Thyroid Autoimmune Diseases

Alopecia is comorbid with several illnesses, including various autoimmune conditions such as thyroid disease. Leukocyte-mediated inflammation of hair follicles in alopecia was first described over a century ago. However, the high prevalence of the role of thyroid autoimmune disease in the pathogenesis of alopecia has only recently come to light, together with a strong association between the two. Therefore, this review focuses on articles published between 2011 and 2022 on alopecia's association with thyroid autoimmune disease, and the mechanism behind it. In addition, it highlights the link between alopecia and thyroid cancer, as patients with alopecia have increased risk of thyroid cancer. In conclusion, this comprehensive, focused, scoping review will serve as a reference highlighting recent information on alopecia, exploring its association with thyroid autoimmune diseases.

Association of CTLA-4 Gene Polymorphisms and Alopecia Areata: A Systematic Review and Meta-analysis

Objective: To provide evidence of the association between CLTA-4 gene polymorphisms and Alopecia Areata (AA). Methods: PubMed, EMBASE, Web of Science, Cochrane, Wanfang and CNKI databases were searched until April 30, 2021.The selection was completed according to the inclusion and exclusion criteria. The study quality assessment was based on Newcastle-Ottawa Scale. The assessment of the association was measured by ORs and 95%CIs. Results: Nine studies, containing 2858 AA cases and 5444 disease-free control subjects were included. For rs231775 polymorphism, no significant association with AA was found, which was A vs a, OR =1.02[0.81,1.30], P = 0.85; AA vs aa, OR =1.26[0.81,1.97], P = 0.31; Aa vs aa, OR =1.04[0.54,2.01], P = 0.91; AA + Aa vs aa, OR =1.04[0.71,1.53], P = 0.82; AA vs Aa + aa, OR =1.31[0.97,1.78], P = 0.08. For rs3087243 polymorphism, also no significant association was found, which was A vs a, OR =0.93[0.78,1.11]; P = 0.40, AA vs aa, OR =0.68[0.44,1.06]; P = 0.09; Aa vs aa, OR =0.87[0.45,1.68], P = 0.68; AA + Aa vs aa, OR =0.93[0.68,1.28], P = 0.66; AA vs Aa + aa, OR =0.78[0.34,1.81], P = 0.57. For rs231726 polymorphism, a significant correlation was found, which was A vs a, OR =0.76[0.70,0.82], P < 0.05. Conclusions: A significant correlation between CTLA-4 rs231726 polymorphism and AA susceptibility was found, but no significant association of CTLA-4 gene rs231775 and rs3087243 polymorphisms and AA susceptibility was found.

General hyperpigmentation induced by Grave's disease: A case report

RATIONALE

Hyperpigmentation is a common skin disease. However, there are few reported cases of Grave's disease with diffuse hyperpigmentation. We hereby described a rare case with diffuse hyperpigmentation induced by Grave's disease.

PATIENT CONCERNS

A 42-year-old Chinese woman with accumulated general pigmentation of skin was admitted to our hospital in October 2017. On examination, hyperpigmentation was observed throughout the whole body, especially on the extremities and the face.

DIAGNOSES

The patient has elevated levels of serum free thyroxine (FT4), free triiodothyronine (FT3), reduced levels of thyroid-stimulating hormone (TSH) and positive anti-TSH receptor antibody (TRAb). She presented with grade I goiter and a diffusely increased thyroid uptake to 18.5% in thyroid scan. Histopathological examination demonstrated melanin pigmentation in the pigmented skin area. The patient was diagnosed with hyperpigmentation induced by Grave's disease.

INTERVENTIONS

The patient was treated with oral methimazole (15 mg/day) for thyroid dysfunction and beta blocker for symptom control.

OUTCOMES

After a period of treatment with methimazole and beta blocker, symptoms of hyperthyroidism ameliorated and hyperpigmentation abated.

LESSONS

Our studies proposed that in this case the diffuse hyperpigmentation in Grave's disease was caused by elevated adrenocorticotropic hormone (ACTH) as well as anti- TSH receptor stimulating antibody instead of enhanced capillary fragility. Other potential mechanisms for skin pigmentation in hyperthyroidism still need further exploration.

Alopecia areata and overt thyroid diseases: A nationwide population-based study

An association between alopecia areata (AA) and other autoimmune diseases has been reported. We investigated the associations between AA and overt autoimmune thyroid diseases. A nationwide, population-based, cross-sectional study was performed using the Korea National Health Insurance claims database. We defined patients with AA as those whose records showed at least four physician contacts in which AA, alopecia totalis (AT) or alopecia universalis (AU) was the principal diagnosis. We also established an age- and sex-matched control group without AA. In a subgroup analysis, patients with AT or AU were classified into the severe AA group, and the remainder were classified into the mild to moderate AA group. Patients with AA were at an increased risk of Graves' disease (odds ratio [OR], 1.415; 95% confidence interval [CI], 1.317-1.520) and Hashimoto thyroiditis (OR, 1.157; 95% CI, 1.081-1.237), and the associations were stronger in the severe AA group (Graves' disease: OR, 1.714; 95% CI, 1.387-2.118; Hashimoto thyroiditis: OR, 1.398; 95% CI, 1.137-1.719). In conclusion, AA was significantly associated with overt autoimmune thyroid diseases. Furthermore, the risk was much higher in the severe AA group.

Rheumatic Disease Autoantibodies in Patients with Autoimmune Thyroid Diseases

BACKGROUND

Patients with autoimmune thyroid diseases (ATD) such as Graves' disease (GD) and Hashimoto thyroiditis (HT) may have non-organ specific autoantibodies such as antinuclear antibodies (ANA) and rheumatoid factor (RF).

AIM

To study the prevalence of rheumatic autoantibodies in a group of ATD patients without known rheumatic diseases and to evaluate its association with the patients' epidemiological and treatment profiles. To follow positive non-organ specific autoantibody-positive ATD individuals to investigate whether they will develop a rheumatic disorder.

METHODS

A sample of 154 ATD patients (70 HT and 84 GD; mean age 45.3 ± 14.2) had determination of ANA by immunofluorescence, using hep-2 cells as substrate, extractable nuclear antigen profile by ELISA kits and RF by latex agglutination. Epidemiological and treatment profiles were obtained through chart review. These patients were followed for the mean period of 5 years, between 2010 and 2015.

RESULTS

Positive ANA was found in 17.5% (27/154) of the patients: anti-Ro/SS-A in 4/154 (2.5%); anti-RNP in 4/154 (2.5%), and anti-La/SS-B in 3/154 (1.9%). None had anti-Sm antibodies. RF was detected in 12/154 (7.7%) of ATD patients and was more common in older individuals (p = 0.007). There was a positive association between the presence of RF and ANA (p = 0.03; OR 3.89; 95% CI 1.1-13.3). None of the patients with positive autoantibodies developed clinical rheumatic diseases during the period of observation.

CONCLUSION

We found rheumatic autoantibodies in 17.5% of ATD patients without rheumatic diseases. None of them were associated with the appearance of clinical rheumatic disorder during the period of 5 years.