title: Risk factors for and prevalence of thyroid disorders in a cross-sectional study among healthy female relatives of patients with autoimmune thyroid disease.
abstract: OBJECTIVE
  Autoimmune thyroid disease (AITD) is a common disorder especially in women, and both genetic and environmental factors are involved in its pathogenesis. We wanted to gain more insight into the contribution of various environmental factors. Therefore, we started a large prospective cohort study in subjects at risk of developing AITD, for example healthy female relatives of AITD patients. Here we report on their baseline characteristics.
  
  
  METHODS
  Only first- or second-degree female relatives of patients with documented AITD were included.
  
  
  METHODS
  Smoking habits, oestrogen use, pregnancy history and iodine exposure were assessed by questionnaires, and correlated to the thyroid function and antibody status.
  
  
  RESULTS
  Of 803 subjects, 440 came from families with more than one patient with documented AITD. Of these families, 33% had documented cases of both Graves' disease and Hashimoto's thyroiditis. Although the subjects were in self-proclaimed good health, 3.6% were found to have hypothyroidism (overt disease in 1.3%) and 1.9% had hyperthyroidism (overt disease in 0.4%). These patients were older than the euthyroid subjects and were mostly positive for thyroid peroxidase (TPO) antibodies. Oestrogen use was associated with a lower rate of hyperthyroidism [relative risk (RR) 0.169; 95% confidence interval (CI) 0.06-0.52], whereas having been pregnant was associated with a higher relative risk for hyperthyroidism (RR 6.88; 95% CI 1.50-30.96). Of the 759 euthyroid subjects, 24% had TPO antibodies. Smoking and oestrogen use were negatively correlated with the presence of TPO antibodies. In the euthyroid subjects, TPO antibody titre correlated positively with TSH levels (r = 0.386; P < 0.001).
  
  
  CONCLUSIONS
  The high prevalence of evidence for autoimmune thyroiditis at baseline supports the importance of genetic factors in its pathogenesis. The co-occurrence of Hashimoto's thyroiditis and Graves' disease within one family suggests a common genetic basis for these diseases. Oestrogen use is associated with a lower risk, and pregnancy with a higher risk for developing hyperthyroidism. The positive correlation between TPO antibody titres and TSH levels in euthyroid subjects suggests that TPO antibodies are indeed a marker of future thyroid failure.
authors.affiliation: Departments of Endocrinology and Metabolism and Cardiology, Academical Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Thea G A
authors.initials: TG
authors.lastname: Strieder
authors.forename: Mark F
authors.initials: MF
authors.lastname: Prummel
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Eric
authors.initials: E
authors.lastname: Endert
authors.forename: Wilmar M
authors.initials: WM
authors.lastname: Wiersinga
mesh_terms: D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D004967:Estrogens / Q000008:administration & dosage; D005260:Female; D006111:Graves Disease / Q000097:blood / Q000235:genetics*; D006801:Humans; D007453:Iodide Peroxidase / Q000276:immunology; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking; D013967:Thyroiditis, Autoimmune / Q000097:blood / Q000235:genetics*; D013972:Thyrotropin / Q000097:blood
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D003278:Contraceptives, Oral, Hormonal; D004967:Estrogens; D013972:Thyrotropin; D007453:Iodide Peroxidase