The Risk of Recurrence of Subacute Thyroiditis Is HLA-Dependent

Abstract

The frequency of recurrence of subacute thyroiditis (SAT) is rather high, reaching 20–30%. The reason for SAT relapse is still unknown. Recently, we have demonstrated the association between SAT and the presence of HLA-B*18:01, DRB1*01, and C*04:01, apart from the previously known HLA-B*35. The aim of the present study was to evaluate the correlation between SAT-associated HLA haplotypes and the risk of SAT recurrence. HLA-A, -B, -C, -DQB1 and -DRB1 were genotyped using a next-generation sequencing method in 49 SAT patients. The patients were divided into the following HLA groups: 1. HLA-B*35 and/or HLA-C*04, but without any other of the analyzed antigens; 2. HLA-DRB1*01, regardless of the co-presence of HLA-B*35 or -C*04:01, but without HLA-B*18:01; 3. HLA-B18 only, without any other antigen; 4. HLA-B*18:01 plus -B*35, regardless of the presence of any other analyzed antigens. The recurrence rate was compared between the groups. The recurrence rate was significantly increased in patients with HLA-B*18:01 plus HLA-B*35. In conclusion, the risk of SAT recurrence was HLA-dependent and the determining factor was the co-presence of HLA-B*18:01 and -B*35. In such high-risk patients, the steroid treatment regimen should be intensified with a slower dose reduction.

Subacute Thyroiditis is Associated with HLA-B*18:01, -DRB1*01 and -C*04:01—The Significance of the New Molecular Background

“…The independent association of HLA-B*18:01 and SAT is supported by our recent study demonstrating differences in the sonographic patterns of SAT associated with either -B*35 or -B*18:01 [27]. Additionally, the simultaneous presence of HLA-B*18:01 and -B*35 was demonstrated to increase the risk of SAT recurrence [28]. Thus, HLA-B*18:01 seems to modify the clinical features of SAT depending on whether it occurs alone or with -B35.…”

“…Similarly, we have also observed correlation with onset age, with carriers of HLA-B*18:01 and -B*35 being significantly older at SAT onset (unpublished data). The strong influence of HLA-B*18:01 on the clinical course-i.e., on the US pattern, the recurrence risk and the onset age in SAT-is clearly visible [27,28]. Demonstrating the importance of HLA-B*18:01 and HLA-DRB1*01 complements the existing gap in the knowledge regarding the pathogenesis of, and genetic susceptibility to, SAT.…”

“…Thus, the knowledge of the association between HLA and SAT US images can be useful in clinical practice. Awareness of the correlation between HLA and the risk of SAT recurrence seems even more important for disease management [28]. The details of the clinical courses of other HLA-related thyroid diseases were also demonstrated to depend on HLA antigens.…”

Time-Lag Between Symptom Onset and Diagnosis of Subacute Thyroiditis – How to Avoid the Delay of Diagnosis and Unnecessary Overuse of Antibiotics

“…The disease can be recurrent, and in our cohort the relapse rate was 14 %, which was similar to that reported by other authors. Recently, the correlation between the risk of SAT recurrence and HLA was observed [12]. Proper treatment includes non-steroidal anti-inflammatory drugs (NSAIDs) in mild cases or -in most patients -glucocorticoid therapy.…”

“…Proper treatment includes non-steroidal anti-inflammatory drugs (NSAIDs) in mild cases or -in most patients -glucocorticoid therapy. In patients at high risk of relapse, the reduction of glucocorticoid dose should be slow [12].…”