title: Thyroid-associated orbitopathy is linked to gastrointestinal autoimmunity.
abstract: Common autoimmune disorders tend to co-exist in the same subjects and cluster in families. The objective of this study was to determine the prevalence of autoimmune co-morbidity in patients with autoimmune thyroid disease (AITD) with and without thyroid-associated orbitopathy (TAO). This was a cross-sectional study conducted at an academic tertiary referral centre. Of 1310 patients with AITD [n = 777 or 59% with Graves' disease (GD) and n = 533, 41% with Hashimoto's thyroiditis (HT)] followed at a specialized joint thyroid-eye out-patient clinic, 176 (13·4%) had an adult type of the autoimmune polyglandular syndrome, 129 (9·8%) type 1 diabetes, 111 (8·5%) coeliac disease, 60 (4·6%) type A autoimmune gastritis, 57 (4·4%) vitiligo and 25 (1·9%) Addison's disease. Coeliac disease and autoimmune gastritis were associated positively with GD [odds ratio (OR) = 2·18; P = 0·002 and OR = 6·52; P < 0·001], whereas type 1 diabetes, Addison's disease, autoimmune primary hypogonadism, alopecia areata, rheumatoid arthritis and Sjögren's syndrome were 'protective' for GD and thus linked to HT, OR = 0·49 (P < 0·001), 0·06 (P < 0·001), 0·25 (P < 0·001), 0·50 (P = 0·090) and 0·32 (P = 0·003), respectively. Of 610 (46·6%) AITD patients with TAO, 584 (95·7%) and 26 (4·3%) had GD and HT, respectively (P < 0·001). TAO was most prevalent in GD patients with coeliac disease (94%, OR = 1·87, P < 0·001). Multivariate analysis showed high OR for coeliac disease and autoimmune gastritis (3·4 and 4·03, both P < 0·001) pertaining to the association with TAO while type 1 diabetes, Addison's disease and alopecia areata were protective for TAO. In patients with TAO, coeliac disease is the most prevalent co-morbid autoimmune condition and rates are increased compared to GD patients without TAO.
authors.affiliation: Department of Ophthalmology, Johannes Gutenberg University Medical Center, Mainz, Germany; Center of Thrombosis and Hemostasis (CTH), Johannes Gutenberg University Medical Center, Mainz, Germany.
authors.forename: K A
authors.initials: KA
authors.lastname: Ponto
authors.forename: D
authors.initials: D
authors.lastname: Schuppan
authors.forename: I
authors.initials: I
authors.lastname: Zwiener
authors.forename: H
authors.initials: H
authors.lastname: Binder
authors.forename: A
authors.initials: A
authors.lastname: Mirshahi
authors.forename: T
authors.initials: T
authors.lastname: Diana
authors.forename: S
authors.initials: S
authors.lastname: Pitz
authors.forename: N
authors.initials: N
authors.lastname: Pfeiffer
authors.forename: G J
authors.initials: GJ
authors.lastname: Kahaly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000276:immunology*; D015551:Autoimmunity / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D041981:Gastrointestinal Tract / Q000276:immunology*; D049970:Graves Ophthalmopathy / Q000276:immunology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000276:immunology* / Q000473:pathology; D015995:Prevalence; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000276:immunology / Q000473:pathology; D013961:Thyroid Gland / Q000276:immunology* / Q000473:pathology; D055815:Young Adult
keywords: autoimmune co-morbidity; autoimmune gastritis; autoimmune thyroid diseases; coeliac disease; thyroid-associated orbitopathy