Summary
The aim of our study was to determine the prevalence of thyroid dysfunction and autoimmune abnormalities in rheumatoid arthritis (RA) and to further investigate the possible association between D-penicillamine and autoimmune thyroiditis. For this purpose, one hundred and one unselected consecutive patients with RA and 70 age and sex matched controls were studied prospectively. Evaluation included a complete history and physical examination with special attention to symptoms suggestive of thyroid pathology, routine laboratory and serologic immune profile, plus determination of serum levels of thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH), antibodies to thyroid peroxidase (AbTPO) and TSH receptor antibodies (TRAB). Serum thyroxine binding globulin (TBG) was measured in all subjects with high thyroid hormone levels, whereas free T3 and T4 concentrations were determined in all individuals with abnormal T3, T4, TSH or TBG.
Six patients with hyperhyroidism, 3 with hypothyroidism and 1 with the euthyroid hyperthyroxinemia (EH) syndrome were found, whereas four of the controls had hyperthyroidism. Thirteen patients and 6 controls had high AbTPO levels whereas no one had high TRAB. No association was detected between thyroid abnormalities and any serologic RA finding. Furthermore, no correlation between thyroid dysfunction and elevated AbTPO's was found.
A relatively high prevalence of thyroid dysfunction (9,9%) and subclinical autoimmune thyroiditis (12,9%), the latter indicated by elevated AbTPO's, was found in our RA patients. These figures were higher than those in the control group (5,7% and 8,6% respectively), but the difference did not reach statistical significance. Of further interest may be our finding that, despite anecdotal reports blaming D-penicillamine for cases of autoimmune thyroiditis, the incidence of the latter was similar among recipients and nonrecipients of the drug. Similarly, TRAB were not detected in any patient treated with D-penicillamine.
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Hijmans, J., Doniach, D., Roitt, I.M., Holborow, E.J. Serological overlap between lupus erythematosus, rheumatoid arthritis, and thyroid auto-immune disease. Br Med J 1961, 2, 909–914.
Buchanan, W.W., Crooks, J., Alexander, W.D., Koutras, D.A., Wayne, E.J., Gray K.G. Association of Hashimoto's thyroiditis and rheumatoid arthritis. Lancet 1961, I, 245–248.
Becker, K.L., Ferguson, R.H., McConahey, W.M. The connective tissue diseases and symptoms associated with Hashimoto's thyroiditis. New Engl J Med 1963, 268, 277–280.
Shiroky, J.B., Cohen, M., Ballachey, M., Neville, C. Thyroid dysfunction in rheumatoid arthritis. Ann Rheum Dis 1993, 52, 454–456.
Betterle, C., Callegari, C., Presotto, F., Zanette, F., Pedini, B., Rampazzo, T., Slack, R.S., Girelli, M.E., Busnardo, B. Thyroid autoantibodies: A good marker for the study of symptomless autoimmune thyroiditis. Acta Endocrinol (Copenh) 1987, 114, 321–327.
Howard-Lock, H.E., Lock, C.J.L., Mewa, A., Kean, D.F. D-penicillamine: Chemistry and clinical use in rheumatic disease. Sem Arthritis Rheum 1986, 15, 261–281.
Andonopoulos, A.P., Terzis, E., Tsibri, E., Papasteriades, C.A., Papapetropoulos, T. D-penicillamine induced myasthenia gravis in rheumatoid arthritis: an unpredictable common occurrence? Clin Rheumatol 1994, 13, 586–588.
Delamere, J.P., Jobson, S., Mackintosh, L.P., Wels, L., Walton, K.W. Penicillamine induced myasthenia gravis in rheumatoid arthritis: its clinical and genetic features. Ann Rheum Dis 1983, 42, 500–504.
Arnett, F.C., Edworthy, S.M., Bloch, D.A. et al. The American Rheumatism Association criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988, 31, 315–324.
Vitali, C., Bombardieri, S., Moutsopoulos, H.M. et al. Preliminary criteria for the classification of Sjögren's syndrome: Results of a prospective concerted study supported by the European Community. Arthritis Rheum 1993, 36, 340–347.
Borst, G.C., Eil, C., Burman, K.D. Euthyroid hyperthyroxinemia. Ann Intern Med 1983, 98, 366–378.
Whaley, K., Webb, J., McAvoy, B.A., Hughes, G.R.V., Lee, P., MacSween, R.N.M., Buchanan, W.W. Sjögren's syndrome: Clinical associations and immunological phenomena. Q J Med 1973, XLII, 513–548.
Goh, K.L., Wang, F. Thyroid disorders in systemic lupus erythematosus. Ann Rheum Dis 1986, 45, 579–583.
Miller, F.W., Moore, G.F., Weintraub, B.D., Steinberg, A.D. Prevalence of thyroid disease and abnormal thyroid function tests in patients with systemic lupus erythematosus. Arthritis Rheum 1987, 30, 1124–1131.
Kohno, Y., Yamaguchi, F., Saito, K., Niimi, H., Nishikawa, T., Hosoya, T. Antithyroid peroxidase antibodies in sera from healthy subjects and from patients with chronic thyroiditis: Differences in the ability to inhibit thyroid peroxidase activities. Clin Exp Immunol 1991, 85, 459–463.
Saller, B., Hormann, R., Mann, K. Heterogeneity of autoantibodies against thyroid peroxidase in autoimmune thyroid disease: evidence against antibodies directly inhibiting peroxidase activity as regulatory factors in thyroid hormone metabolism. J Clin Endocrinol Metab 1991, 72, 188–195.
McKenzie, J.M., Zakarija, M. Antibodies in autoimmune thyroid disease. In: The Thyroid. A Fundamental and Clinical Text, 6th ed., Eds.: Braverman, L.E., Utiger, R.D., Philadelphia, J.B. Lippincott Company, 1991, 506–524.
Volpe, R. Autoimmune thyroiditis. In: The Thyroid. A Fundamental and Clinical Text, 6th ed., Eds.: Braverman, L.E., Utiger, R.D., Philadelphia, J.B. Lippincott Company, 1991, 921–933.
Konno, N., Yuri, K., Taguchi, H., Miura, K., Taguchi, S., Hagiwara, K., Murakami, S. Screening for thyroid diseases in an iodine sufficient area with sensitive thyrotropin assays, and serum thyroid autoantibody and urinary iodine determinations. Clin Endocrinol 1993, 38, 273–281.
Morgan, G.J., McGuire, J.L., Ochoa, J. Penicillamine induced myositis in rheumatoid arthritis. Muscle Nerve 1981, 4, 137–140.
Benvenista, M. Crouzet, J., Hombert, J.C., Lessana, M., Camus, J.P., Hewitt, J. Pemphigus induit par la D-penicillamine dans la polyarthrite rhumatoide. Nouv Presse Med 1975, 4, 3125–3128.
Chalmers, A., Thompson, D., Stein, H.E., Reid, G., Patterson, A.C. Systemic lupus erythematosus during penicillamine therapy for rheumatoid arthritis. Ann Intern Med 1982, 97, 659–663.
Stenlieb, I., Bennet, B., Scheinberg, I.H. D-penicillamine induced Goodpasture's syndrome in Wilson's disease. Ann Intern Med 1975, 82, 673–676.
Wilkin, T.J. Receptor autoimmunity in endocrine disorders. N Engl J Med 1990, 323, 1318–1324.
Bever, C.T., Chang, H.W., Penn, A.S., Jaffe, I.A., Bock, E. Penicillamine induced myasthenia gravis. Effects of penicillamine on acetylcholine receptor. Neurology 1980, 32, 1077–1082.
Delrieu, F., Menkes, C.J., Sainte-Croix, A., Delbarre, F., Babinet, P., Chesneau, A.M. Myasthenie et thyroidite auto-immune au cours d'une polyarthrite rhumatoide traitee par la D-penicillamine. Nouv Presse Med 1975, 4, 2890.
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Andonopoulos, A.P., Siambi, V., Makri, M. et al. Thyroid function and immune profile in rheumatoid arthritis. A controlled study. Clin Rheumatol 15, 599–603 (1996). https://doi.org/10.1007/BF02238551
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DOI: https://doi.org/10.1007/BF02238551