Restricted accessResearch articleFirst published online 2011-10
Subclinical hypothyroidism and its association with lupus nephritis: a case control study in a large cohort of Chinese systemic lupus erythematosus patients
The aim of this study was to evaluate the prevalence of thyroid diseases in Chinese systemic lupus erythematosus (SLE) patients and the relevance of subclinical hypothyroidism (SCH) with lupus nephritis (LN). A large cohort of 1006 SLE patients was retrospectively analyzed. The prevalence of autoimmune thyroid disease was 2.78%, clinical hypothyroidism 1.69%, subclinical hypothyroidism 10.04%, central hypothyroidism 1.29%, hyperthyroidism 1.19%, euthyroid sick syndrome (ESS) 9.54%, and nodules 1.09%, respectively. Compared with the prevalence of thyroid abnormalities in the general Chinese population (0.91–6.05%), SCH was much higher (10.04%) in this study. In addition, SCH was more frequent in patients with LN (13.4%) than those without LN (7.3%, p = 0.001). Case control study was performed to explore the relative risk factors of SCH. In multiple logistic regression models, 24 h urine protein and estimated glomerular filtration rate (eGFR) were retained as independent correlates of SCH after adjusting for demographic variables, risk factors, and other potential confounders. The results of the present study suggest that SCH is a common complication in SLE patients, and closely related with LN.
Parente CostaLBonfaEMartinagoCDde OliveiraRMCarvalhoJFPereiraRM. Juvenile onset Systemic Lupus Erythematosus thyroid dysfunction: a subgroup with mild disease?J Autoimmun2009; 33: 121–124.
2.
AppenzellerSPalloneATNatalinRACostallatLT. Prevalence of thyroid dysfunction in systemic lupus erythematosus. J Clin Rheumatol2009; 15: 117–119.
3.
Antonelli A, Fallahi P, Mosca M, et al. Prevalence of thyroid dysfunctions in systemic lupus erythematosus. Metabolism 2010; 59: 896–900.
4.
Al SalehJEl SayedMJassimVMohammedNKhanN. Hypothyroidism determines the clinical and immunological manifestations of Arabs with lupus. Lupus2008; 17: 215–220.
5.
MaderRMishailSAdawiMLaviILuboshitzkyR. Thyroid dysfunction in patients with systemic lupus erythematosus (SLE): relation to disease activity. Clin Rheumatol2007; 26: 1891–1894.
6.
ChanATAl-SaffarZBucknallRC. Thyroid disease in systemic lupus erythematosus and rheumatoid arthritis. Rheumatology (Oxford)2001; 40: 353–354.
7.
TunbridgeWMEveredDCHallR. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf)1977; 7: 481–493.
8.
ChongWShanZYSunWTengWP. Multivariate analysis of relationships between iodine biological exposure and subclinical thyroid dysfunctions. Chin Med Sci J2005; 20: 202–205.
EniaGPanuccioVCutrupiS. Subclinical hypothyroidism is linked to micro-inflammation and predicts death in continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant2007; 22: 538–544.
11.
CarreroJJQureshiARAxelssonJ. Clinical and biochemical implications of low thyroid hormone levels (total and free forms) in euthyroid patients with chronic kidney disease. J Intern Med2007; 262: 690–701.
12.
ZoccaliCMallamaciFTripepiGCutrupiSPizziniP. Low triiodothyronine and survival in end-stage renal disease. Kidney Int2006; 70: 523–528.
13.
ZoccaliCTripepiGCutrupiSPizziniPMallamaciF. Low triiodothyronine: a new facet of inflammation in end-stage renal disease. J Am Soc Nephrol2005; 16: 2789–2795.
14.
LoJCChertowGMGoASHsuCY. Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease. Kidney Int2005; 67: 1047–1052.
15.
TargherGChoncholMZoppiniG. Prevalence of thyroid autoimmunity and subclinical hypothyroidism in persons with chronic kidney disease not requiring chronic dialysis. Clin Chem Lab Med2009; 47: 1367–1371.
16.
ChoncholMLippiGSalvagnoGZoppiniGMuggeoMTargherG. Prevalence of subclinical hypothyroidism in patients with chronic kidney disease. Clin J Am Soc Nephrol2008; 3: 1296–1300.
RallisonMLDobynsBMMeikleAWBishopMLyonJLStevensW. Natural history of thyroid abnormalities: prevalence, incidence, and regression of thyroid diseases in adolescents and young adults. Am J Med1991; 91: 363–370.
19.
BjoroTHolmenJKrugerO. Prevalence of thyroid disease, thyroid dysfunction and thyroid peroxidase antibodies in a large, unselected population. The Health Study of Nord-Trondelag (HUNT). Eur J Endocrinol2000; 143: 639–647.
20.
ScofieldRHBrunerGRHarleyJBNamjouB. Autoimmune thyroid disease is associated with a diagnosis of secondary Sjogren's syndrome in familial systemic lupus. Ann Rheum Dis2007; 66: 410–413.
21.
PyneDIsenbergDA. Autoimmune thyroid disease in systemic lupus erythematosus. Ann Rheum Dis2002; 61: 70–72.
22.
MihailovaDGrigorovaRVassilevaB. Autoimmune thyroid disorders in juvenile chronic arthritis and systemic lupus erythematosus. Adv Exp Med Biol1999; 455: 55–60.
23.
TomsicMHojkerSZaletel-KrageljLRozmanB. Prevalence of autoimmune thyroid disease (AITD) in patients with mixed connective tissue disease (MCTD). Clin Rheumatol1995; 14: 379–380.
24.
KollerMDTemplERiedlM. Pituitary function in patients with newly diagnosed untreated systemic lupus erythematosus. Ann Rheum Dis2004; 63: 1677–1680.
25.
KapteinEM. Thyroid hormone metabolism and thyroid diseases in chronic renal failure. Endocr Rev1996; 17: 45–63.
26.
MontenegroJGonzalezOSarachoRAguirreRMartinezI. Changes in renal function in primary hypothyroidism. Am J Kidney Dis1996; 27: 195–198.
27.
BalowJE. Clinical presentation and monitoring of lupus nephritis. Lupus2005; 14: 25–30.
28.
CameronJSLessofMHOggCSWilliamsBDWilliamsDG. Disease activity in the nephritis of systemic lupus erythematosus in relation to serum complement concentrations. DNA-binding capacity and precipitating anti-DNA antibody. Clin Exp Immunol1976; 25: 418–427.
29.
CameronJS. When a patient with known lupus nephritis has persistent proteinuria despite corticosteroids and immunosuppressive treatment can it be assumed that there is continuing disease activity or may it reflect irreparable glomerular damage? How can one be sure?Br J Rheumatol1990; 29: 68–68.
30.
MosleyKTamFWEdwardsRJCrozierJPuseyCDLightstoneL. Urinary proteomic profiles distinguish between active and inactive lupus nephritis. Rheumatology (Oxford)2006; 45: 1497–1504.
31.
ContrerasGPardoVCelyC. Factors associated with poor outcomes in patients with lupus nephritis. Lupus2005; 14: 890–895.
32.
de Leeuw K, Smit AJ, de Groot E, van Roon AM, Kallenberg CG, Bijl M. Longitudinal study on premature atherosclerosis in patients with systemic lupus erythematosus. Atherosclerosis 2009; 206: 546–50.
33.
DaneshJWhincupPWalkerM. Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses. BMJ2000; 321: 199–204.
34.
RidkerPMHennekensCHBuringJERifaiN. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med2000; 342: 836–843.
35.
KoenigWSundMFrohlichM. C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation1999; 99: 237–242.
36.
TuzcuABahceciMGokalpDTuzunYGunesK. Subclinical hypothyroidism may be associated with elevated high-sensitive C-reactive protein (low grade inflammation) and fasting hyperinsulinemia. Endocr J2005; 52: 89–94.
37.
Christ-CrainMMeierCGuglielmettiM. Elevated C-reactive protein and homocysteine values: cardiovascular risk factors in hypothyroidism? A cross-sectional and a double-blind, placebo-controlled trial. Atherosclerosis2003; 166: 379–386.
