title: Mitral valve prolapse in autoimmune thyroid disease: an index of systemic autoimmunity?
abstract: A coexistence of mitral valve prolapse (MVP) with autoimmune thyroid disease (AITD) has been described, but there are not sufficient data to explain this association. The aim of the present study was to investigate the prevalence of MVP in patients with AITD and to evaluate whether any correlation between MVP and certain immunological parameters exists. M-mode, two-dimensional Doppler echocardiography was performed in 29 patients with Graves' disease (GD), 35 with Hashimoto's thyroiditis (HT), 20 with nonautoimmune goiter, and 30 normal controls. Serum samples were examined for antinuclear antibodies (ANA), antibodies against extractable nuclear antigen (ENA), antiphospholipid antibodies (aCL), rheumatoid factor (RF), thyroid autoantibodies (TAAb), immunoglobulins and C3, C4. Eight of 29 GD patients and 8 of 35 HT patients had MVP, while none of the control group and 2 of 20 of the simple goiter group had MVP (p < 0.05). ANA were detected at low titers in 5 of 8 in MVP(+) GD versus 3 of 21 in MVP(-) GD (p < 0.05). In the HT group the MVP(+) patients had a significantly higher incidence of ANA and ENA, 5 of 8 and 2 of 8 versus 5 of 27 and 0 of 27 of MVP(-) patients, respectively, p < 0.05. A statistically significant higher incidence of aCL was found in HT MVP(+) patients. (3/8) versus HT MVP(-) 1/27, p < 0.05. RF levels (immunoglobulin A [IgA]) were significantly higher in MVP(+) patients. The association of MVP with nonorgan-specific autoantibodies indicates that MVP may also be an autoimmune disease. It is possible that patients with AITD who also have MVP may be at an increased risk to develop systemic autoimmunity.
authors.affiliation: Department of Medical Therapeutics, Alexandra Hospital, Athens University School of Medicine, Greece.
authors.forename: M E
authors.initials: ME
authors.lastname: Evangelopoulou
authors.forename: M
authors.initials: M
authors.lastname: Alevizaki
authors.forename: S
authors.initials: S
authors.lastname: Toumanidis
authors.forename: G
authors.initials: G
authors.lastname: Piperingos
authors.forename: M
authors.initials: M
authors.lastname: Mavrikakis
authors.forename: D
authors.initials: D
authors.lastname: Sotou
authors.forename: K
authors.initials: K
authors.lastname: Evangelopoulou
authors.forename: D A
authors.initials: DA
authors.lastname: Koutras
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D017152:Antibodies, Antiphospholipid / Q000097:blood; D034961:Antigens, Nuclear; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000150:complications* / Q000276:immunology; D015150:Echocardiography, Doppler; D005260:Female; D006042:Goiter / Q000150:complications; D006111:Graves Disease / Q000150:complications / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000209:etiology*; D009687:Nuclear Proteins / Q000276:immunology; D012217:Rheumatoid Factor / Q000097:blood; D013959:Thyroid Diseases / Q000150:complications* / Q000276:immunology; D013961:Thyroid Gland / Q000276:immunology; D013967:Thyroiditis, Autoimmune / Q000150:complications / Q000276:immunology
chemical_list: D000974:Antibodies, Antinuclear; D017152:Antibodies, Antiphospholipid; D034961:Antigens, Nuclear; D001323:Autoantibodies; D009687:Nuclear Proteins; D012217:Rheumatoid Factor