Systemic lupus erythematosus with hypothyroidism as the initial clinical manifestation: A case report

Zhang, Xuejiao; Xu, Bin; Liu, Ziwei; Gao, Yuanyuan; Wang, Qing; Li, Rui

doi:10.3892/etm.2020.8788

Cited by 5 publications

(6 citation statements)

References 53 publications

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“…Clinically, SLE patients coexisting with hyperthyroidism or hypothyroidism are not rare ( 9 , 10 ) and the sequence of diseases onset is different. Therefore, it is not clear whether SLE causes thyroid diseases, or thyroid diseases cause SLE, or the treatment of the former disease causes the latter disease.…”

Section: Introductionmentioning

confidence: 99%

Systemic lupus erythematosus is causally associated with hypothyroidism, but not hyperthyroidism: A Mendelian randomization study

et al. 2023

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BackgroundThe relationship between systemic lupus erythematosus (SLE) and thyroid diseases is still controversial. Due to confounders and reverse causation, previous studies were not convincing. We aimed to investigate the relationship between SLE and hyperthyroidism or hypothyroidism by Mendelian randomization (MR) analysis.MethodsWe performed a two-step analysis using bidirectional two-sample univariable and multivariable MR (MVMR) to explore the causality of SLE and hyperthyroidism or hypothyroidism in three genome-wide association studies (GWAS) datasets, including 402,195 samples and 39,831,813 single-nucleotide polymorphisms (SNPs). In the first step analysis, with SLE as exposure and thyroid diseases as outcomes, 38 and 37 independent SNPs strongly (P < 5*10-8) associated with SLE on hyperthyroidism or SLE on hypothyroidism were extracted as valid instrumental variables (IVs). In the second step analysis, with thyroid diseases as exposures and SLE as outcome, 5 and 37 independent SNPs strongly associated with hyperthyroidism on SLE or hypothyroidism on SLE were extracted as valid IVs. In addition, MVMR analysis was performed in the second step analysis to eliminate the interference of SNPs that were strongly associated with both hyperthyroidism and hypothyroidism. 2 and 35 valid IVs for hyperthyroidism on SLE and hypothyroidism on SLE were obtained in MVMR analysis. MR results of two steps analysis were estimated respectively by multiplicative random effects-inverse variance weighted (MRE-IVW), simple mode (SM), weighted median (WME) and MR-Egger regression methods. Sensitivity analysis and visualization of MR results were performed by heterogeneity test, pleiotropy test, leave-one-out test, scatter plots, forest plots and funnel plots.ResultsThe MRE-IVW method in the first step of MR analysis revealed that SLE was causally associated with hypothyroidism (OR = 1.049, 95% CI = 1.020-1.079, P < 0.001), but not causally associated with hyperthyroidism (OR = 1.045, 95% CI = 0.987-1.107, P = 0.130). In the inverse MR analysis, the MRE-IVW method revealed that both hyperthyroidism (OR = 1.920, 95% CI = 1.310-2.814, P < 0.001) and hypothyroidism (OR = 1.630, 95% CI = 1.125-2.362, P = 0.010) were causally associated with SLE. Results from other MR methods were consistent with MRE-IVW. However, when MVMR analysis was performed, there was no longer a causal relationship of hyperthyroidism on SLE (OR = 1.395, 95% CI = 0.984-1.978, P = 0.061), nor was there a causal relationship of hypothyroidism on SLE (OR = 1.290, 95% CI = 0.823-2.022, P = 0.266). The stability and reliability of the results were confirmed by sensitivity analysis and visualization.ConclusionsOur univariable and multivariable MR analysis revealed that systemic lupus erythematosus was causally associated with hypothyroidism, but did not provided evidence to support a causal relationship of hypothyroidism on SLE or between SLE and hyperthyroidism.

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Section: Introductionmentioning

confidence: 99%

Systemic lupus erythematosus is causally associated with hypothyroidism, but not hyperthyroidism: A Mendelian randomization study

et al. 2023

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“…Then, manual searching was conducted according to the references of relevant acquired articles. Five cases of AH with SLE were reported ( 2 , 8 – 11 ). Unfortunately, we did not obtain the complete publication of the first case reported by Hasegawa et al.…”

Section: Review Of the Literaturementioning

confidence: 99%

Autoimmune Hypophysitis With Systemic Lupus Erythematosus: A Case Report and Literature Review

Xiang

Zhang

et al. 2020

Front. Endocrinol.

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Background: Autoimmune hypophysitis (AH) is a primary autoimmune inflammatory disorder of the pituitary gland, which usually presents as a mass in the sella turcica. Systemic lupus erythematosus (SLE) is another inflammatory disorder in which the immune system attacks healthy cells and tissues throughout the body. Although both diseases are autoimmune disorders, they rarely coexist, and the relationship between them is unclear. Case Report: A 66-year-old man was evaluated at the endocrinology clinic because of worsening fatigue, anorexia, drowsiness, and leg oedema. Examination revealed alertness impairment and lower limb oedema. Laboratory tests showed anterior pituitary hypofunction. The treatment approach, with glucocorticoids and immunosuppressive agents, resulted in long-term remission of symptoms of hypopituitarism and hyponatraemia. Conclusions: Our case demonstrates a potential association between AH and SLE. AH may need to be considered in the evaluation of SLE patients with headache, hyperprolactinemia, a pituitary mass, and hypopituitarism.

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“…Thyroid autoimmune diseases have been associated with various rheumatological diseases, including SLE, caused by an immune response, both humoral and cell-mediated, resulting in tissue damage localized in the thyroid [3]. The two diseases may occur successively or simultaneously [4].…”

Section: Introductionmentioning

confidence: 99%

Association between Systemic Lupus Erythematosus and Autoimmune Thyroid Dysfunction in Pediatric Population Cross Sectional Study, Single Center Experience

Shamma

Soliman

Abdelfattah

et al. 2023

Preprint

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Background Thyroid disease is more frequent in patients with systemic lupus erythematosus (SLE) than in the general population. The main purpose of this study is to evaluate the occurrence of immunological thyroid dysfunctions in Egyptian children with SLE in a single center and its relation to the disease activity and duration. Methods This is a cross-sectional observational study. The study included 50 children and adolescents with SLE. All patients were subjected to complete history taking, thorough physical examination. Thyroid profile, anti-thyroglobulin and anti-thyroid peroxidase antibodies were assayed using an enzyme-linked immunosorbent assay (ELISA) technique. Results Out of 50 patients, six were males (12%), and 44 were females (88%), with female to male ratio (F: M = 7: 1). Their ages ranged from 5–17 years, with a median of 12 years. Thirty-two of patients (64%) had thyroid dysfunctions, 19 (38%) were diagnosed with euthyroid sick syndrome, ten (20%) had overt hypothyroidism, three (6%) had subclinical hypothyroidism, and none of the patients had hyperthyroidism. Antithyroglobulin antibodies (Anti-TG) was normal in all patients of the studied group, and antithyroid peroxidase (anti-TPO) was elevated in one (2%) out of 50 patients. There was a significant negative correlation between free thyroxine (FT4) and disease duration with a p-value of 0.007. Moreover, by comparing the duration of the disease and thyroid antibodies (anti-TG, and anti-TPO), there was a significant negative correlation with p-values of 0.015 and 0.028. Conclusions Intermittent biochemical screening of thyroid function and anti-thyroid antibodies is recommended as part of the clinical profile in SLE patients, to identify clinical/subclinical thyroid disease. To intervene with the most convenient therapy whenever indicated.

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Systemic lupus erythematosus with hypothyroidism as the initial clinical manifestation: A case report

Cited by 5 publications

References 53 publications

Systemic lupus erythematosus is causally associated with hypothyroidism, but not hyperthyroidism: A Mendelian randomization study

Systemic lupus erythematosus is causally associated with hypothyroidism, but not hyperthyroidism: A Mendelian randomization study

Autoimmune Hypophysitis With Systemic Lupus Erythematosus: A Case Report and Literature Review

Association between Systemic Lupus Erythematosus and Autoimmune Thyroid Dysfunction in Pediatric Population Cross Sectional Study, Single Center Experience

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