Department of Internal Medicine, IPGMER, Room no. 302, Junior Doctors Hostel, 242 AJC Bose Road, Kolkata, West Bengal 700020, India.
Rheumatol Int. 2012 Jan;32(1):73-8. doi: 10.1007/s00296-010-1556-5. Epub 2010 Jul 25.
To study the spectrum of thyroid disorders in systemic lupus erythematosus (SLE). Hundred SLE patients as per American Rheumatology Association(ARA) classification criteria underwent clinical examination, including assessment of disease activity (SLEDAI) and laboratory evaluation for serum triiodothyronine (T3),free thyroxine (FT4), thyroid stimulating hormone (TSH), antithyroperoxidase (TPO) antibody and antithyroglobulin (TG) antibody. Hundred age- and sex-matched apparently healthy individuals served as control. Thirty-six (36%) lupus patients had thyroid dysfunction when compared to 8 (8%) of controls and all of them were women. Primary hypothyroidism was the commonest dysfunction in 14 (14%), while subclinical hypothyroidism and subclinical hyperthyroidism was seen in 12 (12%) and 2 (2%), respectively. Eight (8%) had isolated low T3 consistent with sick euthyroid syndrome. Eighteen (50%) of thyroid dysfunction were autoimmune in nature (autoantibody positive) and rest 18 (50%) were non-autoimmune. Euthyroid state with the elevation of antibodies alone was seen in 12 (12%) of the lupus patients. In contrast, only 5 (5%) of controls had primary hypothyroidism and 3 (3%) had subclinical hypothyroidism, while none had hyperthyroidism. SLEDAI score and disease duration were compared between lupus patients with thyroid dysfunction to those with normal thyroid function. A statistically significant association was found between SLEDAI and thyroid dysfunction of sick euthyroid type.SLE disease duration had no statistically significant association with thyroid dysfunction. Prevalence of thyroid autoantibodies in lupus patients was 30% when compared to 10% of controls. Ninety-six (96%) of the SLE patients were ANA positive, while 4 (4%) of them were ANA negative but were anti-Sm antibody positive. There were no suggestions of any other autoimmune endocrine diseases like diabetes or Addison's disease (clinically and on baseline investigations) in our lupus cohort and hence no further work up was done for these diseases. Thyroid disorders are frequent in SLE and are multifactorial with a definite higher prevalence of hypothyroidism as well as thyroid autoantibodies.
研究系统性红斑狼疮（SLE）患者甲状腺功能紊乱的谱。 按照美国风湿病学会（ARA）分类标准，100 例 SLE 患者接受了临床检查，包括疾病活动度（SLEDAI）评估和血清三碘甲状腺原氨酸（T3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、抗甲状腺过氧化物酶（TPO）抗体和抗甲状腺球蛋白（TG）抗体的实验室评估。 100 名年龄和性别匹配的明显健康个体作为对照。 与对照组的 8 例（8%）相比，36 例（36%）狼疮患者存在甲状腺功能障碍，且均为女性。 原发性甲状腺功能减退症最常见，为 14 例（14%），亚临床甲状腺功能减退症和亚临床甲状腺功能亢进症分别为 12 例（12%）和 2 例（2%）。 8 例（8%）患者出现孤立性低 T3，符合病态甲状腺功能正常综合征。 18 例（50%）甲状腺功能障碍为自身免疫性（自身抗体阳性），其余 18 例（50%）为非自身免疫性。 12 例（12%）狼疮患者甲状腺功能正常，但抗体升高。 相比之下，对照组只有 5 例（5%）发生原发性甲状腺功能减退症，3 例（3%）发生亚临床甲状腺功能减退症，无甲状腺功能亢进症。 将甲状腺功能障碍的狼疮患者与甲状腺功能正常的狼疮患者的 SLEDAI 评分和疾病持续时间进行比较。 病态甲状腺功能正常型甲状腺功能减退症与 SLEDAI 之间存在统计学显著关联。 甲状腺功能障碍与 SLE 病程无统计学显著关联。 与对照组的 10%相比，狼疮患者的甲状腺自身抗体阳性率为 30%。 96%的 SLE 患者抗核抗体阳性，而 4%的患者抗核抗体阴性但抗 Sm 抗体阳性。 在我们的狼疮队列中，没有提示任何其他自身免疫性内分泌疾病，如糖尿病或艾迪生病（临床和基线研究），因此没有对这些疾病进行进一步检查。 甲状腺疾病在 SLE 中很常见，且具有多种病因，甲状腺功能减退症以及甲状腺自身抗体的患病率均明显升高。
