Grozdinska Alina, Hofmann Elisabeth, Schmid Matthias, Hirschfelder Ursula
Department of Orthodontics and Orofacial Orthopedics, University of Erlangen Medical School, Erlangen, Germany.
Department of Orthodontics and Orofacial Orthopedics, University of Regensburg Medical School, Regensburg, Germany.
J Orofac Orthop. 2018 Jul;79(4):277-288. doi: 10.1007/s00056-018-0140-6. Epub 2018 May 17.
Autoimmune thyroid disease (AITD), also known as Hashimoto thyroiditis (HT), is a degenerative inflammatory disease with high prevalence among women and has been associated with fibromyalgia and widespread chronic pain. The goal was to determine the frequency of temporomandibular disorders (TMD) in patients with HT.
In all, 119 women (age 19-60 years) were divided into a study (52 women diagnosed with HT) and a control (67 healthy individuals, of which 15 were excluded) group. Serum concentrations of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), anti-thyroglobulin (Tg) and anti-thyroid peroxidase (TPO) antibody levels were measured. The temporomandibular jaw and muscles were examined using the German Society of Functional Diagnostics and Therapy guidelines. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used to assess TMD. Standardized questionnaires, incorporating epidemiological criteria, state and treatment of the thyroid disease, Helkimo Index (HI), and Fonseca Anamnestic Index (FAI), were filled out by all patients.
The two groups did not differ in terms of demographic parameters or mandibular jaw mobility. Significantly higher levels of anti-TPO and anti-Tg were attested in all subjects of the HT group. Markedly elevated prevalence of TMD was found in the HT group. Muscle pain and stiffness were found in 45 (86.5%) subjects of the HT group (p < 0.001), of whom 33 (63.4%) also had disc displacement with reposition (p < 0.001). Whereas 50% of the control group showed no TMD symptoms, all subjects in the HT group had symptoms.
A significantly elevated prevalence of TMD was found in patients with HT. Thus, patients with TMD who do not respond to therapy should be referred for thyroid diagnostic workup.
自身免疫性甲状腺疾病（AITD），也称为桥本甲状腺炎（HT），是一种在女性中患病率较高的退行性炎症性疾病，且与纤维肌痛和广泛的慢性疼痛有关。本研究旨在确定HT患者颞下颌关节紊乱症（TMD）的发生率。
总共119名年龄在19至60岁之间的女性被分为研究组（52名被诊断为HT的女性）和对照组（67名健康个体，其中15名被排除）。测量血清促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（fT3）、游离甲状腺素（fT4）、抗甲状腺球蛋白（Tg）和抗甲状腺过氧化物酶（TPO）抗体水平。根据德国功能诊断与治疗协会的指南检查颞下颌关节和肌肉。采用颞下颌关节紊乱症研究诊断标准（RDC/TMD）评估TMD。所有患者填写包含流行病学标准、甲状腺疾病状态和治疗情况、赫尔基莫指数（HI）和丰塞卡问诊指数（FAI）的标准化问卷。
两组在人口统计学参数或下颌关节活动度方面无差异。HT组所有受试者的抗TPO和抗Tg水平显著更高。HT组中TMD的患病率明显升高。HT组45名（86.5%）受试者出现肌肉疼痛和僵硬（p<0.001），其中33名（63.4%）还伴有可复性盘移位（p<0.001）。对照组50%的受试者未出现TMD症状，而HT组所有受试者均有症状。
HT患者中TMD的患病率显著升高。因此，对治疗无反应的TMD患者应转诊进行甲状腺诊断检查。
