Department of Endocrinology, University Medical Centre, Utrecht, The Netherlands.
Eur J Endocrinol. 2011 May;164(5):789-94. doi: 10.1530/EJE-10-1172. Epub 2011 Mar 4.
It is unclear whether Hashimoto's thyroiditis and Graves' disease (often referred to as autoimmune thyroid disease, AITD) cluster to the same extent with other autoimmune disorders.
We assessed adrenal, β-cell, celiac and gastric antibodies in a cohort of 523 adult patients with Graves' disease and 359 patients with Hashimoto's disease and compared their clustering.
Adrenal autoimmunity associated more often with Hashimoto's disease (9.0%) than with Graves' disease (3.3%, P=0.001). β-cell autoimmunity was seen more frequently in Hashimoto's disease (25.4%) than in Graves' disease (15.6%, P=0.001) patients. We found low prevalences of celiac autoimmunity (1.2% for Graves' and 1.2% for Hashimoto's disease). Celiac and gastric autoimmunity were not statistically different in Hashimoto's and Graves' disease patients. Although gastric autoimmunity itself was equally prevalent (around 20%), Hashimoto's disease often showed significantly more clustering of adrenal autoimmunity with gastric autoimmunity (5.3%) than Graves' disease (1.2%, P=0.001). Similarly, clustering of adrenal autoimmunity was seen with β-cell autoimmunity in Hashimoto's patients (3.2%), while such clustering was much less encountered in 359 Graves' patients (0.9%, P=0.029).
In conclusion, Hashimoto's disease shows a markedly higher clustering of additional autoimmunity, especially with adrenal and β-cell autoimmunity. Combined clustering of gastric and adrenal autoimmunity and combined clustering of adrenal and β-cell autoimmunity were both seen more often in Hashimoto's patients. Clustering with celiac disease appears to be low. These findings indicate that Hashimoto's and Graves' disease differ in their clinical expression regarding additional autoimmunity, which argues against the indiscriminate use of AITD as an entity.
桥本甲状腺炎和格雷夫斯病（通常称为自身免疫性甲状腺疾病，AITD）与其他自身免疫性疾病的聚集程度是否相同尚不清楚。
我们评估了 523 例格雷夫斯病和 359 例桥本甲状腺炎成年患者的肾上腺、β 细胞、乳糜泻和胃自身抗体，并比较了它们的聚集情况。
与格雷夫斯病（3.3%，P=0.001）相比，桥本甲状腺炎患者肾上腺自身免疫更为常见（9.0%）。与格雷夫斯病（15.6%）相比，桥本甲状腺炎患者β 细胞自身免疫更为常见（25.4%，P=0.001）。我们发现乳糜泻自身免疫的患病率较低（格雷夫斯病为 1.2%，桥本甲状腺炎为 1.2%）。桥本甲状腺炎和格雷夫斯病患者的乳糜泻和胃自身免疫并无统计学差异。尽管胃自身免疫本身的患病率相当（约 20%），但桥本甲状腺炎患者的肾上腺自身免疫与胃自身免疫的聚集程度（5.3%）明显高于格雷夫斯病（1.2%，P=0.001）。同样，桥本甲状腺炎患者也存在肾上腺自身免疫与β 细胞自身免疫的聚集（3.2%），而在 359 例格雷夫斯病患者中则很少见（0.9%，P=0.029）。
总之，桥本甲状腺炎表现出明显更高的附加自身免疫聚集，特别是与肾上腺和β 细胞自身免疫有关。桥本甲状腺炎患者胃和肾上腺自身免疫的联合聚集以及肾上腺和β 细胞自身免疫的联合聚集更为常见。乳糜泻病的聚集似乎较低。这些发现表明，桥本甲状腺炎和格雷夫斯病在附加自身免疫方面的临床表现存在差异，这表明不应将 AITD 不加区分地作为一个实体使用。
