Respiratory symptoms in patients with treated hypothyroidism and inflammatory bowel disease

Abstract

Background: Patients with idiopathic chronic cough and unexplained airflow obstruction in non-smokers have been shown to have an increased prevalence of hypothyroidism and other organ specific autoimmune disorders. Whether patients with hypothyroidism have an increased prevalence of respiratory symptoms is unknown. Methods: The prevalence of respiratory symptoms was assessed in 124 patients with treated hypothyroidism recruited from primary and secondary care, 64 outpatients with inflammatory bowel disease, and 1346 control adults recruited randomly from the electoral register in a case-control study. Respiratory symptoms and smoking history were assessed by a respiratory symptom questionnaire. Results: After adjustment for age, sex and smoking, symptoms of breathlessness and sputum production were more prevalent in both patient populations than in controls (odds ratios for hypothyroidism and inflammatory bowel disease; breathlessness: 3.1 (95% CI 2.1 to 4.6) and 3.4 (95% CI 2.0 to 6.0), respectively; sputum production: 2.7 (95% CI 1.6 to 4.5) and 2.5 (95% CI 1.2 to 5.0), respectively). Cough during the day and night was significantly more prevalent in patients with hypothyroidism (1.8 (95% CI 1.2 to 2.9)) and approached significance in those with inflammatory bowel disease (1.8 (95% CI 1.0 to 3.4)). Wheeze and nocturnal cough were no more prevalent in either disease population than in controls. Conclusion: There is a significantly increased prevalence of respiratory symptoms in patients with hypothyroidism or inflammatory bowel disease compared with controls recruited from the general population. Further work is required to determine whether similar differences are seen in comparison with hospital based controls. These findings support the hypothesis that there is a link between autoimmune hypothyroidism and respiratory disease.

Respiratory System Involvement in Inflammatory Bowel Diseases

“…Association between asthma and IBD was also suggested by Hemminki et al [21]. Another study that showed a significantly increased prevalence of respiratory symptoms in subjects with IBD was one by Birring et al [22]. They compared the frequency of respiratory symptoms in 64 IBD patients and 124 healthy persons.…”

“…In the study by Birring et al [22], there was a trend for those with active inflammatory bowel disease to report more symptoms, compared to those whose IBD was in remission. Yilmaz et al [26] found association of increased respiratory symptom score with high endoscopic activity index in UC patients, but there was no correlation between respiratory symptoms and clinical activity of bowel disease.…”

Patterns of airway involvement in inflammatory bowel diseases

“…The most common findings include bronchial wall thickening and bronchi-CD and 19 UC patients [25,26] . In a case control study of 64 IBD patients compared to 1346 controls, after adjustment for age, sex and smoking status, IBD patients were more likely to report shortness of breath and sputum production and to a lesser degree, cough [odds ratio (OR) respectively 3.4, 2.5, 1.8], highlighting the importance of relative clinical awareness [27] . Moreover, Higenbottam et al [28] described a respiratory exacerbation with cough and shortness of breath several years after coloproctectomy with the primary IBD in remission.…”

New concepts in the management of chronic cough

“…The association between cough and autoimmune disease is also supported by a 2 to 3 fold increase in cough symptoms in patients with treated hypothyroidism compared with controls. 19 Furthermore, studies investigating airway function of patients with hypothyroidism have found evidence of airway inflammation and heightened cough reflex sensitivity. 20 A high prevalence of autoimmune disease has also been reported in patients with unexplained fixed airflow obstruction.…”