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Cui B, Xiao X, Wang J, Wang H, Wu C, Yan Y, Zheng J, Wang J, Zong Y, Zhang Y, Hui R, Gerdes AM, Wang Y. Low THRB (thyroid hormone receptor beta) Promoter Methylation Levels in Peripheral Blood Leukocytes Induced By Systematic Inflammation Are Involved in Low Thyroid Hormone Function in Metabolic Syndrome. Hypertension 2021; 78:1005-1015. [PMID: 34397273 DOI: 10.1161/hypertensionaha.121.17847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Bing Cui
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.C., X.X., Jin'e Wang, H.W., C.W., Y.Y., Y. Zong, Y. Zhang, R.H., A.M.G., Y.W.)
| | - Xiao Xiao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.C., X.X., Jin'e Wang, H.W., C.W., Y.Y., Y. Zong, Y. Zhang, R.H., A.M.G., Y.W.)
| | - Jin'e Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.C., X.X., Jin'e Wang, H.W., C.W., Y.Y., Y. Zong, Y. Zhang, R.H., A.M.G., Y.W.)
| | - Hongrui Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.C., X.X., Jin'e Wang, H.W., C.W., Y.Y., Y. Zong, Y. Zhang, R.H., A.M.G., Y.W.)
| | - Cunjin Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.C., X.X., Jin'e Wang, H.W., C.W., Y.Y., Y. Zong, Y. Zhang, R.H., A.M.G., Y.W.)
| | - Yupeng Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.C., X.X., Jin'e Wang, H.W., C.W., Y.Y., Y. Zong, Y. Zhang, R.H., A.M.G., Y.W.)
| | - Jun Zheng
- Rizhao Port Hospital, Rizhao, Shandong, China (J.Z., JingJun Wang)
| | - JingJun Wang
- Rizhao Port Hospital, Rizhao, Shandong, China (J.Z., JingJun Wang)
| | - Yuru Zong
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.C., X.X., Jin'e Wang, H.W., C.W., Y.Y., Y. Zong, Y. Zhang, R.H., A.M.G., Y.W.)
| | - Yu Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.C., X.X., Jin'e Wang, H.W., C.W., Y.Y., Y. Zong, Y. Zhang, R.H., A.M.G., Y.W.)
| | - Rutai Hui
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.C., X.X., Jin'e Wang, H.W., C.W., Y.Y., Y. Zong, Y. Zhang, R.H., A.M.G., Y.W.)
| | - A Martin Gerdes
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.C., X.X., Jin'e Wang, H.W., C.W., Y.Y., Y. Zong, Y. Zhang, R.H., A.M.G., Y.W.).,Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic Medicine, New York (A.M.G.)
| | - Yibo Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.C., X.X., Jin'e Wang, H.W., C.W., Y.Y., Y. Zong, Y. Zhang, R.H., A.M.G., Y.W.)
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Thyroid, Adrenal, PRL Impairments and Ovarian Function. ENDOCRINES 2021. [DOI: 10.3390/endocrines2030021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Endocrine axes (prolactin, thyroid and adrenal axes) directly and indirectly modulate and drive human female central functions, mainly behavior and reproduction. Though having distinct abilities, they greatly act both at peripheral as well as at neuroendocrine levels, so as to participate in the control of reproduction. Any event that changes these balanced activities produces specific peripheral signals that induce abnormal functions centrally, thus triggering menstrual disorders such as oligomenorrhea or amenorrhea. It is clear that the knowledge of the relationships that exist between the different endocrine axes becomes essential for the choice of therapeutical approach. This review aims to focus on the main aspects of the physiopathology of the endocrine diseases that might be at the basis of that interference with female reproductive capacity.
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Kjaergaard AD, Marouli E, Papadopoulou A, Deloukas P, Kuś A, Sterenborg R, Teumer A, Burgess S, Åsvold BO, Chasman DI, Medici M, Ellervik C. Thyroid function, sex hormones and sexual function: a Mendelian randomization study. Eur J Epidemiol 2021; 36:335-344. [PMID: 33548002 DOI: 10.1007/s10654-021-00721-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/20/2021] [Indexed: 12/12/2022]
Abstract
Hypothyroidism and hyperthyroidism are observationally associated with sex hormone concentrations and sexual dysfunction, but causality is unclear. We investigated whether TSH, fT4, hypo- and hyperthyroidism are causally associated with sex hormones and sexual function. We used publicly available summary statistics from genome-wide association studies on TSH and fT4 and hypo- and hyperthyroidism from the ThyroidOmics Consortium (N ≤ 54,288). Outcomes from UK Biobank (women ≤ 194,174/men ≤ 167,020) and ReproGen (women ≤ 252,514) were sex hormones (sex hormone binding globulin [SHBG], testosterone, estradiol, free androgen index [FAI]) and sexual function (ovulatory function in women: duration of menstrual period, age at menarche and menopause, reproductive lifespan, and erectile dysfunction in men). We performed two-sample Mendelian randomization (MR) analyses on summary level, and unweighted genetic risk score (GRS) analysis on individual level data. One SD increase in TSH was associated with a 1.332 nmol/L lower (95% CI: - 0.717,- 1.946; p = 2 × 10-5) SHBG and a 0.103 nmol/l lower (- 0.051,V0.154; p = 9 × 10-5) testosterone in two-sample MR, supported by the GRS approach. Genetic predisposition to hypothyroidism was associated with decreased and genetic predisposition to hyperthyroidism with increased SHBG and testosterone in both approaches. The GRS for fT4 was associated with increased testosterone and estradiol in women only. The GRS for TSH and hypothyroidism were associated with increased and the GRS for hyperthyroidism with decreased FAI in men only. While genetically predicted thyroid function was associated with sex hormones, we found no association with sexual function.
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Affiliation(s)
- Alisa D Kjaergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, Aarhus, Denmark.
| | - Eirini Marouli
- Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Areti Papadopoulou
- Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK
- National Institute of Health Research Barts Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Panos Deloukas
- Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aleksander Kuś
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Rosalie Sterenborg
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- Partner site Greifswald, DZHK (German Center for Cardiovascular Research), Greifswald, Germany
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Bjørn O Åsvold
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and Nursing, HUNT Research Center, , NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Daniel I Chasman
- Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marco Medici
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Internal Medicine, Academic Center for Thyroid Diseases, , Rotterdam, The Netherlands
| | - Christina Ellervik
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark
- Department of Pathology, Harvard Medical School, Boston, MA, 02215, USA
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Carlé A, Knudsen N, Jørgensen T, Thuesen B, Karmisholt J, Linding Andersen S, Bülow Pedersen I. Previous Live Births and Induced Abortions May Precede Later Development of Graves' Hyperthyroidism. Eur Thyroid J 2019; 8:70-78. [PMID: 31192145 PMCID: PMC6514508 DOI: 10.1159/000494836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/23/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the association between reproductive history and later development of various nosological subtypes of overt hyperthyroidism. STUDY DESIGN From the Danish population, we included incident hyperthyroid women, and for each case we recruited 4 euthyroid age-sex-region-matched controls from the same sub-population. Hyperthyroid cases/controls were: Graves' disease (GD, n = 232/928), multinodular toxic goitre (MNTG, n = 91/364), solitary toxic adenoma (STA, n = 21/84). Patients diagnosed with hyperthyroidism within 1 year after delivery including post-partum GD were excluded. In multivariate conditional regression models (reference: no reproductive events), we analysed the association between development of GD/MNTG/STA and reproductive factors such as age at menarche/menopause, reproductive span, number of pregnancies/childbirths/abortions, investigations for infertility, and years on oral contraceptives. We adjusted for possible confounders such as alcohol intake, smoking, co-morbidity, and education. Age was studied as a potential effect measure modifier. RESULTS GD patients diagnosed before the age of 40 years had given births more often than control subjects (OR [95% CI] for 1/2/3+ births [ref.: nulliparous] were 1.57 [0.80-3.11]/2.06 [1.001-4.22]/3.07 [1.50-6.26]), and they had induced abortions performed more often (OR for 1/2+ induced abortions [ref.: no: events] were 0.99 [0.54-1.84]/2.24 [1.12-4.45]). No associations were observed between any reproductive factor and the development of MNTG or STA. CONCLUSIONS Childbirths and induced abortions may be followed by development of Graves' hyperthyroidism after the post-partum period. This was not the case for the non-autoimmune subtypes of hyperthyroidism.
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Affiliation(s)
- Allan Carlé
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Institute, Aalborg University, Aalborg, Denmark
- *Allan Carlé, MD, PhD, Department of Endocrinology, Aalborg University Hospital, DK–9000 Aalborg (Denmark), E-Mail
| | - Nils Knudsen
- Department of Endocrinology I, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Centre for Clinical Research and Prevention, Capital Region of Denmark, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bettina Thuesen
- Centre for Clinical Research and Prevention, Capital Region of Denmark, Copenhagen, Denmark
| | - Jesper Karmisholt
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Stine Linding Andersen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Inge Bülow Pedersen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Institute, Aalborg University, Aalborg, Denmark
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Aminorroaya A, Meamar R, Amini M, Feizi A, Tabatabae A, Faghih Imani E. Incidence of thyroid dysfunction in an Iranian adult population: the predictor role of thyroid autoantibodies: results from a prospective population-based cohort study. Eur J Med Res 2017. [PMID: 28637498 PMCID: PMC5480126 DOI: 10.1186/s40001-017-0260-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background The prevalence of thyroid dysfunction is high in Isfahan, an area of iodine sufficient in Iran. The aim of this study is to investigate the incidence of thyroid dysfunctions in adults of metropolitan Isfahan and to determine the role of thyroid autoantibodies. Methods In a population-based cohort study in 2006–2011, we measured TSH, T4, T3, thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) in 618 out of 2254 people who were euthyroid in 2006. The incidence rates per 1000 person-year (pr) were calculated. The odds ratio (OR), relative risk (RR), and 95% confidence interval (95% CI) were calculated based on logistic regression to quantify the potential predictors of thyroid dysfunction. The receiver-operator characteristic (ROC) analysis along with area under the curve (AUC) was used to determine the optimal cutoff values for baseline TPOAb and TgAb as predictors of thyroid dysfunction. Results Within a 6-year follow-up, the incidence rate of hypothyroidism was 3.3 in women and 2.1 in men while the incidence rate of hyperthyroidism was 3.8 in women and none in men per 1000 (person-year). A cutoff value of TPOAb at 38 IU/mL was obtained to differentiate the patients with hypothyroidism and hyperthyroidism, with specificity of 0.75 and sensitivity of 0.76, and AUC (CI 95%) of 0.882 (0.743–1.02), P = 0.01 and 0.817 (0.600–1.035) P = 0.033, respectively. There is a statistically significant association of hypothyroidism and hyperthyroidism with positive TPOAb [RR (CI 95%): 1.99 (1.27–3.13) and 2.20 (1.23–3.95), respectively]. Conclusions The incidence rate of thyroid dysfunction is high in Isfahan, and higher TPOAb concentration is its strong predictor.
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Affiliation(s)
- Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Sedigheh Tahereh Research Complex, Khorram Street, Isfahan, 8187698191, Iran.
| | | | - Massoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Sedigheh Tahereh Research Complex, Khorram Street, Isfahan, 8187698191, Iran
| | - Awat Feizi
- Isfahan Endocrine and Metabolism Research Center, Isfahan, Iran.,Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Elham Faghih Imani
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Sedigheh Tahereh Research Complex, Khorram Street, Isfahan, 8187698191, Iran
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Andersen SL, Carlé A, Olsen J, Laurberg P. Hypothyroidism incidence in and around pregnancy: a Danish nationwide study. Eur J Endocrinol 2016; 175:387-93. [PMID: 27511824 DOI: 10.1530/eje-16-0446] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/10/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Immunological changes in and after a pregnancy may influence the onset of autoimmune diseases. An increased incidence of hyperthyroidism has been observed both in early pregnancy and postpartum, but it remains to be studied if the incidence of hypothyroidism varies in a similar way. DESIGN Population-based cohort study using Danish nationwide registers. METHOD All women who gave birth to a singleton live-born child in Denmark from 1999 to 2008 (n = 403 958) were identified, and data on hospital diagnosis of hypothyroidism and redeemed prescriptions of thyroid hormone were extracted. The overall incidence rate (IR) of hypothyroidism during 1997-2010 and the IR in three-month intervals before, during and after the woman's first pregnancy in the study period were calculated and compared with the IR of hyperthyroidism. RESULTS Altogether 5220 women were identified with onset of hypothyroidism from 1997 to 2010 (overall IR 92.3/100 000/year) and 1572 women developed hypothyroidism in the period from 2 years before to 2 years after birth of the first child in the study period. The incidence of hypothyroidism decreased during the pregnancy (incidence rate ratio (IRR) vs overall IR in the rest of the study period: first trimester: 0.89 (95% CI: 0.66-1.19), second trimester: 0.71 (0.52-0.97), third trimester: 0.29 (0.19-0.45)) and increased after birth with the highest level at 4-6 months postpartum (IRR 3.62 (2.85-4.60)). CONCLUSION These are the first population-based data on the incidence of hypothyroidism in and around pregnancy. The incidence declined during pregnancy followed by a sharp increase postpartum. Notably, hypothyroidism as opposed to hyperthyroidism showed no early pregnancy increase.
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Affiliation(s)
- S L Andersen
- Departments of Endocrinology Clinical BiochemistryAalborg University Hospital, Aalborg, Denmark
| | - A Carlé
- Departments of Endocrinology
| | - J Olsen
- Department of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark
| | - P Laurberg
- Departments of Endocrinology Department of Clinical MedicineAalborg University, Aalborg, Denmark
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Bjergved L, Carlé A, Jørgensen T, Perrild H, Laurberg P, Krejbjerg A, Ovesen L, Bülow Pedersen I, Rasmussen LB, Knudsen N. Parity and 11-Year Serum Thyrotropin and Thyroid Autoantibody Change: A Longitudinal Population-Based Study. Thyroid 2016; 26:203-11. [PMID: 26711373 DOI: 10.1089/thy.2014.0279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A role for female reproductive factors in the pathogenesis of thyroid autoimmunity has been suggested. This study investigated the prospective association between parity, abortion, use of oral contraceptive pill (OCP), and use of hormone replacement therapy (HRT), and 11-year change in serum thyrotropin (TSH), as well as change in thyroid peroxidase autoantibody (TPOAb) status. METHODS A random sample of 4649 people aged 18-65 years participated in a population-based study in the period 1997-1998. In the study presented here, 1749 non-pregnant women with no history of thyroid disease were included who participated in the 11-year follow-up examination in the period 2008-2010. Gynecological exposures were reported in a self-administered questionnaire at baseline and follow-up. TSH and TPOAb were measured at baseline and follow-up. Increased TPOAb status during follow-up was defined as a TPOAb below the assay cutoff (<30 kIU/L) at baseline and a TPOAb ≥30 kIU/L at follow-up. Multiple linear regression models were used, adjusted for age, smoking status, and urinary iodine excretion. RESULTS An inverse association was found between the number of years on HRT and the risk (odds ratio) of increased TPOAb status during follow-up (0.735 [confidence interval 0.558-0.968], p = 0.03). However, this association was not statistically significant when applying the Bonferroni adjusted significance level. The remaining reproductive factors showed no statistically significant association with risk of increased TPOAb during follow-up. Furthermore, parity, abortions, use of OCP, HRT use, age at menarche, and being pre- or postmenopausal were not significantly associated with 11-year TSH change. CONCLUSIONS No statistically significant association was found between the studied female reproductive measures and 11-year risk of TSH or TPO change. A possible protective role for HRT in the etiology of thyroid autoimmunity, however, deserves further research.
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Affiliation(s)
- Lena Bjergved
- 1 Research Centre for Prevention and Health , The Capital Region of Denmark, Glostrup, Denmark
- 2 Department of Endocrinology, Bispebjerg University Hospital , Copenhagen, Denmark
| | - Allan Carlé
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
| | - Torben Jørgensen
- 1 Research Centre for Prevention and Health , The Capital Region of Denmark, Glostrup, Denmark
- 4 Faculty of Health Sciences, University of Copenhagen , Copenhagen, Denmark
- 5 Faculty of Medicine, Aalborg University , Aalborg, Denmark
| | - Hans Perrild
- 2 Department of Endocrinology, Bispebjerg University Hospital , Copenhagen, Denmark
| | - Peter Laurberg
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
- 5 Faculty of Medicine, Aalborg University , Aalborg, Denmark
| | - Anne Krejbjerg
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
| | - Lars Ovesen
- 6 Department of Gastroenterology, Slagelse Hospital , Slagelse, Denmark
| | - Inge Bülow Pedersen
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
| | - Lone Banke Rasmussen
- 7 Department of Nutrition, National Food Institute, Technical University of Denmark , Søborg, Denmark
| | - Nils Knudsen
- 2 Department of Endocrinology, Bispebjerg University Hospital , Copenhagen, Denmark
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Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Rasmussen LB, Laurberg P. Development of autoimmune overt hypothyroidism is highly associated with live births and induced abortions but only in premenopausal women. J Clin Endocrinol Metab 2014; 99:2241-9. [PMID: 24694338 DOI: 10.1210/jc.2013-4474] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT The 1-year postpartum period is often accompanied by increased risk for thyroid disease. OBJECTIVE The objective of the study was to investigate the role of reproductive risk factors in the development of autoimmune overt hypothyroidism in the years after the 1-year postpartum period. DESIGN, SETTING, AND SUBJECTS In a population study, we included Danish women with new autoimmune overt hypothyroidism not diagnosed within the first year after a pregnancy (n = 117; median age 53.0 y) and age- and region-matched euthyroid controls from the same population (n = 468). MAIN OUTCOME MEASURES In conditional multivariate logistic regression models, we analyzed the associations between the development of autoimmune hypothyroidism and age at menarche/menopause, years of menstruations, pregnancies, spontaneous and induced abortions, live births, and years on oral contraceptives and postmenopausal hormone replacement therapy, also taking various possible confounders into account. RESULTS In multivariate regression models with no event as reference, the odds ratios (ORs) for hypothyroidism [95% confidence interval (CI)] after one/two/three or more live births were 1.72 (0.56-5.32)/3.12 (1.14-8.48)/4.51 (1.65-12.3) and 1.02 (0.57-1.81)/2.70 (1.27-5.75) after one/two or more induced abortions. Findings were valid only for women having hypothyroidism diagnosed before the age of 55 years. We found no association between disease development and other reproductive risk factors investigated. CONCLUSIONS Previous live births and induced abortions were major risk factors for the development of autoimmune overt hypothyroidism in women aged up to 55 years. The increased risk for hypothyroidism after giving birth extends longer than just to the 1-year postpartum period, and numbers of previous pregnancies should be taken into account when evaluating the risk of hypothyroidism in a young women.
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Affiliation(s)
- Allan Carlé
- Department of Endocrinology (A.C., I.B.P., P.L.), Aalborg University Hospital, DK-9000 Aalborg, Denmark; Endocrine Unit (N.K., H.P.), Medical Clinic I, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark; Department of Internal Medicine (L.O.), Slagelse Hospital, DK-4200 Slagelse, Denmark; and National Food Institute (L.B.R.), Technical University of Denmark, DK-2800 Copenhagen, Denmark
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Płoski R, Szymański K, Bednarczuk T. The genetic basis of graves' disease. Curr Genomics 2012; 12:542-63. [PMID: 22654555 PMCID: PMC3271308 DOI: 10.2174/138920211798120772] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 08/05/2011] [Accepted: 08/15/2011] [Indexed: 01/09/2023] Open
Abstract
The presented comprehensive review of current knowledge about genetic factors predisposing to Graves’ disease (GD) put emphasis on functional significance of observed associations. In particular, we discuss recent efforts aimed at refining diseases associations found within the HLA complex and implicating HLA class I as well as HLA-DPB1 loci. We summarize data regarding non-HLA genes such as PTPN22, CTLA4, CD40, TSHR and TG which have been extensively studied in respect to their role in GD. We review recent findings implicating variants of FCRL3 (gene for FC receptor-like-3 protein), SCGB3A2 (gene for secretory uteroglobin-related protein 1- UGRP1) as well as other unverified possible candidate genes for GD selected through their documented association with type 1 diabetes mellitus: Tenr–IL2–IL21, CAPSL (encoding calcyphosine-like protein), IFIH1(gene for interferon-induced helicase C domain 1), AFF3, CD226 and PTPN2. We also review reports on association of skewed X chromosome inactivation and fetal microchimerism with GD. Finally we discuss issues of genotype-phenotype correlations in GD.
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Affiliation(s)
- Rafał Płoski
- Department of Medical Genetics, Centre for Biostructure, Medical University of Warsaw, Poland
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Pokoradi AJ, Iversen L, Hannaford PC. Factors associated with age of onset and type of menopause in a cohort of UK women. Am J Obstet Gynecol 2011; 205:34.e1-13. [PMID: 21514918 DOI: 10.1016/j.ajog.2011.02.059] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 01/06/2011] [Accepted: 02/17/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We sought to describe the pattern of age at menopause and factors associated with type of menopause. STUDY DESIGN This was a prospective cohort study of 5113 postmenopausal health survey respondents in the Royal College of General Practitioners' Oral Contraception Study. Logistic regression was used to evaluate associations between sociodemographics, lifestyle, and medical history and menopause type. RESULTS Median age at natural menopause (n = 3650) was 49.0 years (interquartile range, 45.0-51.0), and at surgical menopause (n = 1463) was 42.4 years (38.0-46.4). Early natural menopause was associated with smoking, ever-use of oral contraception, sterilization, and history of endometriosis (all increased odds ratios) and ever-use of hormone replacement therapy (decreased). Surgical menopause was associated with manual social class, sterilization, and having a history of endometriosis, menorrhagia, or painful menstruation (all increased), and ever-use of hormone replacement therapy (decreased). CONCLUSION Age at natural menopause was younger in this cohort than in other studies. More associations were found for surgical menopause than early natural menopause.
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Affiliation(s)
- Alida J Pokoradi
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Sgarbi JA, Kasamatsu TS, Matsumura LK, Maciel RMB. Parity is not related to autoimmune thyroid disease in a population-based study of Japanese-Brazilians. Thyroid 2010; 20:1151-6. [PMID: 20883173 DOI: 10.1089/thy.2009.0424] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND It has been suggested that the female preponderance for autoimmune thyroid disease might be associated with hormonal differences, abortion, and fetal microchimerism. Findings emerging from the few epidemiological studies on this matter, however, are controversial. In this study, we investigated the hypothesis whether parity, abortion, and the use of estrogens are associated with a higher risk for thyroid autoimmunity. METHODS This cross-sectional population-based study examined 675 women from a Japanese-Brazilian population aged above 30 years. Thyroid peroxidase antibodies (TPOAbs), thyroglobulin antibodies (TgAbs), thyrotropin, and free T₄ were measured by immunofluorimetric assays. Urinary iodine concentration was measured using a colorimetric method. Data were analyzed in logistical regression models to obtain the odds ratio (OR) and 95% confidence intervals. RESULTS TPOAbs and TgAbs were present in 11.6% and 13.6% of women, respectively. After adjustment for age, smoking, and urinary iodine concentration, the OR for positive TPOAb (OR, 1.22 [95% confidence interval, 0.73–2.02]) and for positive TgAb (OR, 1.01 [0.63–1.62]) among women who had one or more parities did not differ from those who had never given birth. In addition, we found no association between the presence of thyroid antibodies and previous abortions or the use of estrogens. CONCLUSIONS Parity, abortion, and the use of estrogens are not associated with thyroid autoimmunity in this population. These findings reinforce previous reports that advocated against a key role of fetal microchimerism in the pathogenesis of autoimmune thyroid disease.
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Affiliation(s)
- José A Sgarbi
- Laboratory of Molecular Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Federal University of São Paulo, Rua Pedro de Toledo 669, São Paulo, Brazil
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Friedrich N, Schwarz S, Thonack J, John U, Wallaschofski H, Völzke H. Association between parity and autoimmune thyroiditis in a general female population. Autoimmunity 2009; 41:174-80. [DOI: 10.1080/08916930701777629] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kajantie E, Phillips DIW, Osmond C, Barker DJP, Forsén T, Eriksson JG. Spontaneous hypothyroidism in adult women is predicted by small body size at birth and during childhood. J Clin Endocrinol Metab 2006; 91:4953-6. [PMID: 16984989 DOI: 10.1210/jc.2006-1093] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The relationships of early growth with coronary heart disease and type 2 diabetes have received considerable attention. It is not known whether fetal or childhood growth is linked with autoimmune disorders. OBJECTIVE Our objective was to assess whether the risk of adult-onset spontaneous hypothyroidism is predicted by body size at birth and during childhood. DESIGN AND SETTING We conducted a birth cohort study in Helsinki, Finland. PARTICIPANTS A total of 293 women who were born between 1934 and 1944 and had their heights and weights recorded at birth and during childhood participated in the study. MEASUREMENTS We measured spontaneous hypothyroidism, defined as: 1) a disease history confirmed from medical records, or 2) previously undiagnosed hypothyroidism (TSH > 10 mU/liter). RESULTS Twenty women (6.8%) had spontaneous hypothyroidism; 18 had been diagnosed previously, between 43 and 65 yr of age, and two had undiagnosed subclinical hypothyroidism. In addition, 59 women were thyroid peroxidase antibody positive. Compared with the 214 thyroid peroxidase antibody-negative women with no thyroid disorder, those with spontaneous hypothyroidism had on average 252 g [95% confidence interval (CI), 61 to 443 g; P = 0.01] lower birth weight and 1.2 cm (95% CI, 0.5 to 2.0 cm; P = 0.002) shorter length at birth. The odds of developing hypothyroidism increased 4.4-fold per kilogram decrease in birth weight (95% CI, 1.4 to 14.1). Hypothyroid subjects had been shorter in early childhood and had lower body mass index during later childhood. CONCLUSIONS Small body size at birth and during childhood increases the risk of spontaneous hypothyroidism in adult women.
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Affiliation(s)
- Eero Kajantie
- National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheimintie 166, 00300 Helsinki, Finland.
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Bülow Pedersen I, Laurberg P, Knudsen N, Jørgensen T, Perrild H, Ovesen L, Rasmussen LB. Lack of association between thyroid autoantibodies and parity in a population study argues against microchimerism as a trigger of thyroid autoimmunity. Eur J Endocrinol 2006; 154:39-45. [PMID: 16381989 DOI: 10.1530/eje.1.02070] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Thyroid autoimmunity is more common in females than in males. One possible explanation for this female preponderance may be the effect of oestrogens on the immune system. It has also been suggested that foetal microchimerism involving transfer of foetal cells into maternal tissue during pregnancy may play an important role. OBJECTIVE We investigated the association between the presence of circulating thyroid autoantibodies and previous pregnancy, parity and the use of oral contraceptives (OCs) and hormone replacement therapy (HRT) in a population cohort. METHODS We examined 3712 women randomly selected from the general population. Serum was analysed for thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (Tg-Ab) using assays based on an RIA technique (DYNO test). Data were analysed in logistic regression models to adjust for possible confounders. Women previously treated for thyroid disease or with pregnancy within 1 year prior to the study were excluded from the analyses. RESULTS In both univariate and multivariate models and whether the presence of TPO-Ab and Tg-Ab was investigated alone or in combination, findings were negative with respect to an association between circulating thyroid antibodies and previous pregnancy, number of pregnancies, parity and previous abortion. There was no association between thyroid autoantibodies and use of OCs. Women aged 60-65 years receiving HRT now or previously had a lower prevalence of Tg-Ab (univariate, P = 0.01; multivariate, P = 0.02). No such association was observed between HRT and TPO-Ab. CONCLUSION In this population study there was no association between previous pregnancy, parity and thyroid antibodies, which argues against the role of microchimerism as a trigger of thyroid autoimmunity. Exogenous oestrogens may reduce aspects of autoimmunity.
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Affiliation(s)
- Inge Bülow Pedersen
- Department of Endocrinology and Medicine, Aalborg Hospital, Aarhus University Hospital, DK-9000 Aalborg, Denmark.
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Strieder TGA, Prummel MF, Tijssen JGP, Endert E, Wiersinga WM. Risk factors for and prevalence of thyroid disorders in a cross-sectional study among healthy female relatives of patients with autoimmune thyroid disease. Clin Endocrinol (Oxf) 2003; 59:396-401. [PMID: 12919165 DOI: 10.1046/j.1365-2265.2003.01862.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Autoimmune thyroid disease (AITD) is a common disorder especially in women, and both genetic and environmental factors are involved in its pathogenesis. We wanted to gain more insight into the contribution of various environmental factors. Therefore, we started a large prospective cohort study in subjects at risk of developing AITD, for example healthy female relatives of AITD patients. Here we report on their baseline characteristics. SUBJECTS Only first- or second-degree female relatives of patients with documented AITD were included. MEASUREMENTS Smoking habits, oestrogen use, pregnancy history and iodine exposure were assessed by questionnaires, and correlated to the thyroid function and antibody status. RESULTS Of 803 subjects, 440 came from families with more than one patient with documented AITD. Of these families, 33% had documented cases of both Graves' disease and Hashimoto's thyroiditis. Although the subjects were in self-proclaimed good health, 3.6% were found to have hypothyroidism (overt disease in 1.3%) and 1.9% had hyperthyroidism (overt disease in 0.4%). These patients were older than the euthyroid subjects and were mostly positive for thyroid peroxidase (TPO) antibodies. Oestrogen use was associated with a lower rate of hyperthyroidism [relative risk (RR) 0.169; 95% confidence interval (CI) 0.06-0.52], whereas having been pregnant was associated with a higher relative risk for hyperthyroidism (RR 6.88; 95% CI 1.50-30.96). Of the 759 euthyroid subjects, 24% had TPO antibodies. Smoking and oestrogen use were negatively correlated with the presence of TPO antibodies. In the euthyroid subjects, TPO antibody titre correlated positively with TSH levels (r = 0.386; P < 0.001). CONCLUSIONS The high prevalence of evidence for autoimmune thyroiditis at baseline supports the importance of genetic factors in its pathogenesis. The co-occurrence of Hashimoto's thyroiditis and Graves' disease within one family suggests a common genetic basis for these diseases. Oestrogen use is associated with a lower risk, and pregnancy with a higher risk for developing hyperthyroidism. The positive correlation between TPO antibody titres and TSH levels in euthyroid subjects suggests that TPO antibodies are indeed a marker of future thyroid failure.
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Affiliation(s)
- Thea G A Strieder
- Departments of Endocrinology and Metabolism and Cardiology, Academical Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Luoto R, Grenman S, Salonen S, Pukkala E. Increased risk of thyroid cancer among women with hysterectomies. Am J Obstet Gynecol 2003; 188:45-8. [PMID: 12548194 DOI: 10.1067/mob.2003.121] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Hysterectomy with bilateral oophorectomy has been suggested to increase the risk of thyroid cancer. We studied the relationship between hysterectomy and thyroid cancer in a population-based setting in Finland. STUDY DESIGN Women undergoing hysterectomy between 1986 and 1995 (n = 17,900) were identified from the National Hospital Discharge Registry. The cohort was followed up through the Finnish Cancer Registry until 1997. RESULTS There were 118 cases of thyroid cancer diagnosed, 103 papillary and 15 follicular or medullar type. The incidence for thyroid cancer was significantly elevated (standardized incidence ratio [SIR] 1.38, 95% CI 1.15-1.64). The increase in the incidence of thyroid cancer was not dependent on the extent of operation but on the length of follow-up. Thyroid cancer incidence was increased 0.5 to 1.4 years after hysterectomy (SIR 2.00, 95% CI 1.31-2.93), but decreased thereafter (SIR 1.30, 95% CI 0.99-1.67). Hysterectomy with and without oophorectomy was associated with a similar increase in the incidence of thyroid cancer. CONCLUSION Women who have undergone hysterectomy have an increased risk of thyroid cancer during the first 2 years after the operation. Thyroid cancer and bleeding disorders may share a common background.
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Affiliation(s)
- Riitta Luoto
- Tampere School of Public Health, University of Tampere, Tampere, Finland
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Rotondi M, Sorvillo F, Mazziotti G, Balzano S, Iorio S, Savoia A, Piscopo M, Biondi B, Amato G, Carella C. The influence of parity on multinodular goiter prevalence in areas with moderate iodine deficiency. J Endocrinol Invest 2002; 25:442-6. [PMID: 12035941 DOI: 10.1007/bf03344035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite the observation that parity may increase the risk of thyroid carcinoma, very few studies have investigated the possible repercussion of parity on thyroid benign pathology. Recently, parity has been identified as one of the factors contributing to a larger thyroid size in healthy females. The aim of this work was to investigate a possible role for parity on the prevalence of multinodular goiter in iodine deficient areas. For this purpose, the reproductive histories of 2 cohorts of women, normal (Group I, 235 cases) and non-toxic multinodular goiter (NTMNG) affected (Group II, 274 cases) were compared. All subjects were euthyroid and had no previous history of thyroid function abnormalities. The number of full-term previous pregnancies (2.55+/-0.11 vs 1.77+/-0.10) and age (47.7+/-0.76 vs 42.3+/-0.83 yr) were found significantly higher (p<0.001) in multinodular goiter (MNG) patients than controls. Parity and age were found to be directly correlated (p<0.001), nevertheless the partial correlation coefficients demonstrated an independent and statistically significant difference for both variables between normal and NTMNG. Therefore, the independent effects of parity and age were further investigated. The effect of age on NTMNG prevalence seems to be weaker, in fact significant differences (p<0.001) for age between patients and controls were detected only when the effect of parity was absent (nulliparous), while with increasing gestations the effect of age disappeared. Our results indicate that age plays a minor role compared to parity which can therefore be considered as a stronger risk factor. In conclusion, the present study shows that, at least in iodine deficient regions, non-toxic multinodular goiter women show a statistically significant higher parity rate than healthy controls. Age may play a certain role but only when additional stronger risk factors are absent.
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Affiliation(s)
- M Rotondi
- Institute of Endocrinology, Second University of Naples, Italy
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Koo MM, Rohan TE, Jain M, McLaughlin JR, Corey PN. A cohort study of dietary fibre intake and menarche. Public Health Nutr 2002; 5:353-60. [PMID: 12020388 DOI: 10.1079/phn2002261] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the influence of dietary fibre on menarche in a cohort of pre-menarcheal girls. DESIGN Prospective cohort study. SETTING Ontario, Canada. SUBJECTS Free-living pre-menarcheal girls (n = 637), 6 to 14 years of age. METHODOLOGY Information on dietary intake, physical activity and date of menarche was collected at baseline and was updated annually by self-administered questionnaires for three years. Cox proportional hazards models were used to evaluate the association between dietary fibre and menarche, adjusting for age at entry to the study and potential confounders. RESULTS A higher intake of energy-adjusted dietary fibre was associated with a lower risk of (i.e. a later age at) menarche (relative hazard 0.54, 95% confidence interval (CI) 0.31-0.94 for highest vs. lowest quartile, P for trend = 0.027). At the fibre component level, a higher intake of energy-adjusted cellulose was associated with a lower risk of menarche (relative hazard 0.45, 95% CI 0.26-0.76, P for trend = 0.009). CONCLUSIONS The findings are consistent with the hypothesis that pre-menarcheal dietary intake can influence menarche.
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Affiliation(s)
- Malcolm M Koo
- Department of Public Health Sciences, University of Toronto, Ontario, Canada.
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Abstract
This study was conducted as part of the third annual follow-up of a cohort of 657 girls to test the accuracy of short-term recall of age at menarche. During the first and second annual follow-ups of the cohort, 101 girls had reported menarche. We sent questionnaires to these subjects at the third annual follow-up and asked them to recall the month and year of their menarche. Eighty-eight respondents returned their questionnaires with the relevant information. Overall, 59.1% of the respondents were able to recall their menarche with the exact month and year. The mean recall interval was 430 days. When the data were grouped by the interval of recall, higher accuracy was observed with a shorter interval of recall. With a mean interval of recall of 323 days, 66.1% of the subjects were able to recall their menarche correctly, whereas with a mean interval of 649 days, only 44.8% of the subjects were able to recall correctly.
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Affiliation(s)
- M M Koo
- University of Toronto, Ontario, Canada
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Abstract
OBJECTIVE To determine whether women with rheumatoid arthritis (RA) had differences in obstetric and gynaecological histories when compared with sisters without RA (controls) METHODS Ninety eight RA discordant sister pairs, 36 of whom were identical for histocompatibility locus antigen (HLA-A, HLA-B, and HLA-Cw) types, were asked to recall their age of menarche, duration of use of contraceptive pill, pregnancy history, and age of menopause. RESULTS The 98 siblings with RA had an older mean age of menarche (13.90 (95% confidence interval (95% CI) 13.56 to 14.24) years) than their sisters (13.49 (95% CI 13.22 to 13.76) years; mean difference within pairs 0.41, 95% CI 0.09 to 0.73 years, paired t test t = 2.54, p = 0.013). When the pairs were divided into identical HLA and non-identical HLA groups, the first showed no significant difference (mean difference 0.17 (95% CI -0.40 to 0.73) years), whereas the second did (mean difference 0.55 (95% CI 0.16 to 0.94) years, t = 2.80, p = 0.007). A multiple regression analysis to predict differences in menarche in the non-identical HLA sibling pairs failed to show any demographic or reproductive confounding variables. In 19 RA concordant sibling pairs, the seven HLA identical pairs had similar ages of menarche, whereas the 12 non-identical HLA pairs had interpair differences that narrowly missed significance (p = 0.054). All other obstetric and gynaecological variables were not significantly different within the pairs. CONCLUSIONS The interpretations of these results are that either delayed menarche may predispose to or act as a marker of RA, or HLA linked genes are important in determining the age of menarche irrespective of disease state. This study fails to support a significant role for other obstetric and gynaecological variables in RA.
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Affiliation(s)
- C M Deighton
- Department of Rheumatology, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
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