Imperial College School of Medicine, Imperial College London, London, United Kingdom.
Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom.
Front Endocrinol (Lausanne). 2021 Mar 5;12:644200. doi: 10.3389/fendo.2021.644200. eCollection 2021.
Thyroid eye disease (TED) is a potentially disfiguring and sight-threatening autoimmune (AI) orbitopathy, affecting up to 400,000 people in the UK. There are no accurate early predictors of TED severity. Although polyautoimmunity has been shown to affect AI disease severity, its influence on TED severity has never been investigated. The prevalence of polyautoimmunity among TED patients is also unclear, with discordant results reported in the literature. This study evaluates the prevalence of non-thyroid/"other" AI (OAI) conditions in an ethnically diverse TED cohort and assesses how polyautoimmunity affects TED severity and activity.
A retrospective study of patients presenting to multidisciplinary TED clinics across three North-West London hospitals between 2011 and 2019. Data collected included: 1) demographics; 2) OAI conditions and management; 3) endocrine management of thyroid dysfunction; 4) details of TED and clinical activity score at presentation.
Two hundred and sixty-seven patients with a median age of 46 (35-54) years were included, 79.4% were female and 55% were Black, Asian and minority ethnic (BAME). Thirty-seven patients (13.9%) had OAI conditions, with rheumatoid arthritis (3.7%), vitiligo (3.0%) and psoriasis (3.0%) among the most prevalent. Of patients with OAI conditions, 43.2% (16/37) required immunosuppression prior to TED onset. Non-immunosuppressed patients with OAI conditions had a significantly higher clinical activity score at presentation than TED-only and previously immunosuppressed patients (p=0.02). No significant differences were observed in thyroid receptor antibody titers between these groups.
This study finds a 13.9% prevalence of OAI conditions among TED patients. Patients with OAI conditions overall have a tendency for more severe and significantly more clinically active TED than those without OAI conditions. Larger, prospective studies are warranted to further evaluate polyautoimmunity as an early predictor of TED severity.
甲状腺眼病（TED）是一种潜在的致盲和威胁视力的自身免疫性（AI）眼眶病，在英国影响多达 40 万人。目前尚无 TED 严重程度的准确早期预测指标。虽然多自身免疫已被证明会影响 AI 疾病的严重程度，但它对 TED 严重程度的影响从未被研究过。TED 患者中多自身免疫的患病率也不清楚，文献中报道的结果不一致。本研究评估了在一个种族多样化的 TED 队列中，非甲状腺/“其他”AI（OAI）疾病的患病率，并评估了多自身免疫如何影响 TED 的严重程度和活动度。
这是一项回顾性研究，纳入了 2011 年至 2019 年期间在三家伦敦西北部医院的多学科 TED 诊所就诊的患者。收集的数据包括：1）人口统计学数据；2）OAI 疾病和管理；3）甲状腺功能障碍的内分泌管理；4）就诊时 TED 和临床活动评分的详细信息。
共纳入 267 例患者，中位年龄为 46（35-54）岁，79.4%为女性，55%为黑人、亚裔和少数族裔（BAME）。37 例（13.9%）患者存在 OAI 疾病，其中最常见的是类风湿关节炎（3.7%）、白癜风（3.0%）和银屑病（3.0%）。在存在 OAI 疾病的患者中，43.2%（16/37）在 TED 发病前需要免疫抑制治疗。与 TED 患者和既往接受免疫抑制治疗的患者相比，未接受免疫抑制治疗的 OAI 疾病患者就诊时的临床活动评分明显更高（p=0.02）。这些组之间的甲状腺受体抗体滴度没有观察到显著差异。
本研究发现 TED 患者中 OAI 疾病的患病率为 13.9%。总体而言，存在 OAI 疾病的患者的 TED 往往更严重，且临床活动度明显更高。需要更大的前瞻性研究来进一步评估多自身免疫作为 TED 严重程度的早期预测指标。
