Primer biliyer kolanjit hastalarında tiroid otoimmünitesinin değerlendirilmesi

Year 2018, , 511 - 517, 30.09.2018

Sezgin Vatansever Zehra Betül Paköz , Süleyman Günay , Altay Kandemir , Belkıs Ünsal

https://doi.org/10.31832/smj.416304

Abstract

Amaç: Primer biliyer kolanjit (PBK) sıklıkla diğer
otoimmün hastalıklarla, özellikle de otoimmün tiroit hastalığı ile
ilişkilendirilmektedir. Çalışmalar, otoimmün tiroid hastalığı ve anti-tiroid
antikorlarının prevalansının PBK’de %14-24 olduğunu göstermiştir. Bu çalışmanın
amacı, PBK’li hastalarda eşlik eden tiroid otoimmünitesini
ve diğer tiroid hastalıklarını araştırmaktır.  
                          

Yöntemler:
Bu retrospektif kohort, Haziran 1999 ile Aralık 2017 tarihleri arasında
üçüncü basamak merkezimizin gastroenteroloji bölümünde tedavi edilen 263 PBK
hastasının tıbbi dosyalarından alınan verilere dayanmaktadır. Tiroid otoimmünitesi,
normal aralığın üzerinde anti TPO ve/veya anti TG şeklinde tanımlanmaktadır. Otoimmün
tiroid hastalığı olan ve olmayan PBK hastalarının klinik özellikleri ve
laboratuvar bulgularındaki farklılıklar kaydedilmiştir.

Bulgular:
Tiroid
otoimmünitesi, serimizdeki 80 hastada (%30,4) saptanmıştır. Hashimato tiroiditi 47 hastada tespit edilmiştir. Otoimmun tiroid hastalığı olan grupta hipertiroidi
olan iki hastanın birinde Graves hastalığı, diğerinde ise Hashimato hastalığı
olduğu belirlenmiştir.

Otoimmün dışı tiroid hastalıkları grubunda
19 hasta olup, bunlar arasında 15 hastada multinodüler guatr, 3 hastada toksik
tiroid nodül ve bir hastada tiroid kanseri olduğu belirlenmiştir. Otoimmün dışı
tiroid hastalığı grubunda 9 hipertiroidi hastası  saptanmıştır. Bu hastalar, toksik tiroid nodülü
olan 3 hasta, akut tiroiditi olan 1 hasta ve diğer tiroid hastalıkları olan 5 hasta
şeklindedir. Toksik tiroid nodülü olan bir hastada tiroid papiller mikrokarsinom olduğu belirlenmiştir.

Sonuç:
Tiroid
otoimmünitesi, PBK hastalarında sıklıkla görülmektedir. PBK’li hastaların tiroid
otoimmünitesi açısından taranması gerekir.

Keywords

Primer biliyer kolanjit, tiroid otoimmünitesi

Assessement of thyroid autoimmunity in primary biliary cholangitis patients

Abstract

Purpose: PBC is frequently associated with other autoimmune diseases, especially with auto-immune  thyroid disease. Studies showed 14-24% prevalence of autoimmune thyroid disease and anti-thyroid antibodies vary considerably in primary biliary cholangitis (PBC). The aim of the present study was to investigate thyroid autoimmunity in patients with PBC.                                            

Methods: This study was based on data derived from the medical files of 263 consecutive PBC patients treated in the gastroenterology department of our tertiary care center between June 1999 and Aug 2017. Thyroid autoimmunity was defined as Anti TPO and/or Anti TG above the normal range. The differences in clinical features and laboratory findings of PBC patients with and without autoimmune thyroid disease were documented.                                      

Results: The average age was 55.0±12.4 (28-84) and 244 (92,7%) patients were female. Thyroid autoimmunity was evident in 80 patients (30,2 %) of our series. There were 19 patients in non- autoimmune thyroid diseases group, 15 patients with multinoduler goiter, 3 patients with toxic thyroid nodul and one patient with thyroid cancer. We found 9 hyperthyroid patients in non-thyroid autoimmunity group, 3 patients with toxic thyroid nodul, one patient with acute thyroiditis and 5 patients with other thyroid diseases. One patient who had toxic thyroid nodul was determined as thyroid papillary microcarcinoma.

Conclusion: Thyroid autoimmunity is frequently seen in PBC patients. There were no significant clinical parameters differences in our study. However, patients with PBC should be screened for thyroid disease.

 

Keywords

primary biliary cholangitis;, thyroid auto-immunity

References

• 1. Culp KS, Fleming CR, Duffy J, Baldus WP, Dickson ER. Autoimmune associations in primary biliary cirrhosis. Mayo Clin Proc 1982;57:365.
• 2. Talwalkar JA, Lindor KD. Primary biliary cirrhosis. Lancet 2003; 362: 53–61.
• 3. Floreani A, Franceschet I, Cazzagon N, Spinazzè A, Buja A, Furlan P, Baldo, et al . Extrahepatic autoimmune conditions associated with primary biliary cirrhosis. Clin rev allergy immunol 2015; 48(2-3), 192-197.
• 4. Antonelli A, Ferrari SM, Corrado A, Di Domenicantonio A, Fallahi P. Autoimmune thyroid disorders. Autoimmun Rev 2015; 14(2):174–80.
• 5. Cardenas Roldan J, Amaya-Amaya J, Castellanos-de la Hoz J, Giraldo-Villamil J, Montoya-Ortiz G, Cruz-Tapias P, Rojas-Villarraga A, et al. Autoimmune thyroid disease in rheumatoid arthritis: a global perspective. Arthritis 2012; 2012:864-907.
• 6. Crowe JP, Christensen E, Butler J . Primary biliary cirrhosis: the prevalence of hypothyroidism and its relationship to thyroid autoantibodies and sicca syndrome . Gastroenterology 1980; 78 : 1437 –41.
• 7. Elta GH, Seperrsky RA, Goldberg MJ, Connors CM, Miller KB, Kaplan MM . Increased incidence of hypothyroidism in primary biliary cirrhosis . Dig Dis Sci 1982 ; 28 : 971 – 5.
• 8. Silveira MG, Mendes FD , Diehl NN, Enders FT, Lindor KT, et al. Thyroid dysfunction in primary biliary cirrhosis, primary sclerosing cholangitis and non-alcoholic fatty liver disease . Liver Int 2009 ; 29 : 1094 – 100
• 9. Kurihara Y, Shishido T, Oku K, Takamatsu M, Ishiguro H, Suzuki A, Sekita T, et all. Polymyositis associated with autoimmune hepatitis, primary biliary cirrhosis, and autoimmune thrombocytopenic purpura. Modern Rheumatol 2011; vol. 21, no. 3, pp. 325–329.
• 10. Bach N and Odin JA. Primary biliary cirrhosis: a Mount Sinai perspective. Mt Sinai J Med 2003; vol. 70, no. 4, pp. 242–250
• 11. Bittencourt PL, Farias AQ , Porta G, Cançado EL, Miura I, Pugliese R, Kalil J et al. Frequency of concurrent autoimmune disorders in patients with autoimmune hepatitis: effect of age, gender, and genetic background. Journal of Clinical Gastroenterology 2008; vol. 42, no. 3, pp. 300–305. 12. Kmieciak Le Corguillé M, Rocher P, Eugène C, Lemaire E, Tennenbaum R, Vitte RL, Bergue A. Autoimmune hepatitis, acute pancreatitis, mixed connective tissue disease and Sjogren’s syndrome. A case report. Gastroenterol Clin Biol 2003; vol. 27, no. 8-9, pp. 840–841.
• 13. Kaplan MJ, Ike RW. Theliver is a common non-exocrine target in primary Sjogren’s syndrome: a retrospective review. BMC Gastroenterology 2002; vol. 2, article 21.
• 14. EASL Clinical Practice Guidelines. Management of cholestatic liver diseases. J Hepatol 2009; 51: 237–67.
• 15. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 2012; 18:988–1028.
• 16. Scheuer P. Primary biliary cirrhosis. Proc R Soc Med 1967 60:1257–1260
• 17. Caturegli P , De Remigis A , Rose NR . Hashimoto’s thyroiditis: clinical and diagnostic criteria . Autoimmun Rev 2014 ; 13 : 391–7 .
• 18. Menconi F , Marcocci C , Marino M . Diagnosis and classifi cation of Graves’ disease . Autoimmun Rev 2014 ; 13 : 398–402.
• 19. Punzi L, Betterle C. Chronic autoimmune thyroiditis and rheumatic manifestations. Joint Bone Spine 2004; 71(4):275–83.
• 20. Carlé A, Laurberg P, Knudsen N, Perrild H, Ovesen L, Rasmussen LB, Jorgensen T, et al. Thyroid peroxidase and thyroglobulin auto-antibodies in patients with newly diagnosed overt hypothyroidism. Autoimmunity 2006; vol. 39, no. 6, pp. 497–503
• 21. Tunbridge WM, Brewis M, French JM, Appleton D, Bird T, Clark F, Evered DC, et al. Natural history of autoimmune thyroiditis. Br Med J Clin Res Ed 1981; 282(6260), 258–262.
• 22. Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, Grimley Evans J, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol 1995; 43(1), 55–68
• 23. Prentice LM, Phillips DI, Sarsero D, Beever K, McLachlanSM, Smith BR. Geographical distribution of subclinical autoimmune thyroid disease in Britain: a study using highly sen-sitive direct assays for autoantibodies to thyroglobulin and thyroid peroxidase. Acta Endocrinol 1990; 123(5), 493– 498.
• 24. Floreani A, Mangini C, Reig A, Franceschet I, Cazzagon N, Perini L, Caballería L, et al. Thyroid dysfunction in primary biliary cholangitis: a comparative study at two European centers. Am J Gastroenterol. 2017 Jan;112(1):114-119.
• 25. Watt FE, James OFW, Jones DEJ. Patterns of autoimmunity in primary biliary cirrhosis patients and their families: a population-based cohort study. QJM 2004;vol. 97, no. 7, pp. 397–406.
• 26. Parikh-Patel A, Gold EB, Worman H, Krivy KE, Gershwin ME. Risk factors for primary biliary cirrhosis in a cohort of patients from the United States. Hepatology 2001;33: 16–21
• 27. Plowden TC, Schisterman EF, Sjaarda LA, Zarek SM, Perkins NJ, Silver R, et al. Subclinical hypothyroidism and thyroid autoimmunity are not associated with fecundity, pregnancy loss or live birth. J Clin Endocrinol Metab 2016; 101(6):2358–65. 28. Seror J, Amand G, Guibourdenche J, Ceccaldi PF, Luton D. Anti-TPO anti-bodies diffusion through the placental barrier during pregnancy. PLoS One 2014 Jan 31;9(1):e84647.
• 29. Wang GC, Talor MV, Rose NR, Cappola AR, Chiou RB, Weiss C, et al. Thyroid autoantibodies are associated with a reduced prevalence of frailty in community-dwelling older women. J Clin Endocrinol Metab 2010; 95:1161–8.
• 30. Prinzi N, Sorrenti S, Baldini E, De Vito C, Tuccilli C, Catania A, et al. Association of thyroid diseases with primary extra-thyroidal malignancies in women: results of a cross-sectional study of 6,386 patients. PLoS One 2015 Mar 31;10(3):e0122958
• 31. Lambrinoudaki I, Armeni E, Pliatsika P, Rizos D, Kaparos G, Augoulea A, Alexandrou A, et all. Thyroid function and autoimmunity are associated with the risk of vertebral fractures in postmenopausal women. J Bone Miner Metab J Bone Miner Metab. 2017 Mar;35(2):227-233.
• 32. Polovina SP, Miljic D, Zivojinovic S, Milic, N, Micic, D, Popovic Brkic V. The impact of thyroid autoimmunity (TPOAb) on bone density and fracture risk in postmenopausal women. Hormones (Athens) 2017; 16(1), 54-61.
• 33. Teufel A, Weinmann A, Kahaly GJ, Centner C, Piendl A, Worns M, Lohse AV, et all. Concurrent autoimmune diseases in patients with autoimmune hepatitis. J Clin Gastroenterol 2010; 44:208–213
• 34. Hirschfield GM, Liu X, Xu C, Lu Y, Xie G, Lu Y, Gu X, et all. Primary biliary cirrhosis associated with HLA, IL12A, and IL12RB2 variants. New Engl Journal of Med 2009; 360(24), 2544- 2555.
• 35. Yan N, Meng S, Zhou J, Xu J, Muhali FS, Jiang W, Shi L. Association between STAT4 gene polymorphisms and autoimmune thyroid diseases in a Chinese population. Int j mol sci 2014; 15(7), 12280-12293.
• 36. Chistiakov DA, Turakulov RI. CTLA-4 and its role in autoimmune thyroid disease. J Mol Endocrinol 2003; 31(1):21–36.
• 37. Poupon R. Genetic factors of susceptibility and of severity in primary biliary cirrhosis. J Hepatol 2008; 49(6):1038–1045. 38. Goldblatt J, Taylor PJ, Lipman T, Prince MI, Baragiotta A, Bassendine MF, James OF, et al. The true impact of fatigue in primary biliary cirrhosis: a population study. Gastroenterology 2002; 122(5), 1235-1241.
• 39. Elnady BM, Kamal NM, Shaker RH, Soliman AF, Hasan WA, Alghamdi HA, Algethami MM, et al. Prevalence and clinical significance of nonorgan specific antibodies in patients with autoimmune thyroiditis as predictor markers for rheumatic diseases. Medicine 2016; 95(38).
• 40. Peeva E. Reproductive immunology: a focus on the role of female sex hormones and other genderrelated factors. Clin Rev Allergy Immunol 2011; 40: 1-7
• 41. Wang L, Zhang FC, Chen H, Zhang X, Xu D, Li YZ, Wang Q, et al. Connective tissue diseases in primary biliary cirrhosis: a population-based cohort study. World J Gastroenterol 2013; 19(31), 5131.
• 42. Bryhni B, Aanderud S, Sundsfjord J, Rekvig OP, Jorde R. Thyroid antibodies in northern Norway: prevalence, persistence and relevance. J Intern Med 1996; 239(6), 517–523