Thyroid autoimmunity linked to persistent symptoms for patients with Hashimoto’s disease
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Thyroid autoimmunity is associated with persistent symptoms for patients with Hashimoto’s disease and normal thyroid hormone levels, according to a systematic review published in the Journal of Translational Autoimmunity.
“Approximately 5% to 10% of patients with Hashimoto’s disease experience persisting symptoms despite normalized free thyroxine and thyroid-stimulating hormone levels by levothyroxine treatment,” Paul van Trotsenburg, MD, PhD, and Christiaan Mooij, MD, PhD, pediatric endocrinologists at Emma Children’s Hospital, Amsterdam University Medical Centers in The Netherlands, told Healio. “Previously, several hypotheses have been postulated to explain these persisting symptoms. The results of our systematic review show that there is an association between thyroid autoimmunity and persisting symptoms, or lowered quality of life, in patients with Hashimoto’s disease, independent of thyroid function or thyroid hormone levels. Therefore, the presence of autoimmunity should be considered as an additional explanation for persisting symptoms in treated Hashimoto’s disease patients.”
Van Trotsenburg, Mooij and colleagues searched the PubMed database for original studies investigating the relationship between thyroid autoimmunity and persistent symptoms in euthyroid people with Hashimoto’s disease. Articles were classified as either disease-based studies in which euthyroid adults with hypothyroidism due to Hashimoto’s disease were compared with non-autoimmune hypothyroidism patients or euthyroid adults with a benign goiter, or as population-based studies. A meta-analysis was not performed due to different outcome measures and presentation of results in the studies.
Of 30 articles included in the systematic review, seven were disease-based studies and 23 were population-based studies. Of the seven disease-based studies, five found a significant association between persisting symptoms and the presence of thyroid autoimmunity. Five studies evaluated the well-being of levothyroxine-treated adults with Hashimoto’s disease compared with people with non-autoimmune hypothyroidism. A significant relationship between persisting symptoms and thyroid autoimmunity was reported in three of the studies. In six of the seven disease-based studies, thyroid function was specified, with four studies reporting similar TSH, free T4 and free triiodothyronine levels in adults with and without Hashimoto’s disease. In two studies, TSH values were lower in control groups of adults who underwent thyroidectomy due to differentiated thyroid cancer and received levothyroxine to suppress TSH.
Of the 23 population-based studies, 12 included large and representative samples of the general population. Seven of the 12 general population studies showed an association between persistent symptoms and thyroid autoimmunity. The other 11 studies were performed in a population from a primary care facility (n = 3), postpartum women (n = 3), pregnant women (n = 2), patients with another autoimmune disease (n = 2) and perimenopausal women (n = 1). Nine of the 11 studies found a significant relationship between symptoms and thyroid autoimmunity.
“The results of our systematic review stress that further research is needed to find out if there is a causal relation between thyroid autoimmunity and persisting symptoms in treated Hashimoto’s disease patients,” van Trotsenburg and Mooij said.
For more information:
Christiaan Mooij, MD, PhD, can be reached at c.mooij@amsterdamumc.nl.
Paul van Trotsenburg, MD, PhD, can be reached at a.s.vantrotsenburg@amsterdamumc.nl.
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