Çağlar KESKİN, Asena GÖKÇAY CANPOLAT, Şule CANLAR, Murat CİNEL, Özgür DEMİR, Mustafa ŞAHİN, Rıfat EMRAL, Onur KESKİN, Demet ÇORAPÇIOĞLU

A detailed analysis of thyroid disorders in autoimmune liver diseases

Aims: Extrahepatic autoimmune diseases are frequently encountered in patients with autoimmune liver diseases (AILD). There is a very limited data in the literature on the incidence of autoimmune thyroid diseases in AILD and the characterization of thyroid diseases in these patients. This study evaluated frequency and clinical features of thyroid disorders in AILD. Methods: We compared clinical and laboratory data and thyroid ultrasonography findings of 100 patients with AILD and 48 healthy controls. Results: The frequency of autoimmune thyroid disease and nodularity was higher in the AILD group compared to the control group (34 % vs 12.1 %; p<0.001 and 62 % vs 41.6%; p: 0.023 respectively). The number of nodules per patient was significantly higher in the AILD group than in the control group (1.37±1.3 vs 0.88±1.3; p=0.039). Hypothyroidism was detected in 17 patients (17%) with AILD (10 newly diagnosed). Only one patient had Graves' disease. Conclusion: In AILD, autoimmune thyroiditis are common. Thyroid pathologies are missed in most patients unless a careful and detailed examination is not performed. Thyroid ultrasonography should be performed in addition to laboratory investigations in the routine follow-up of patients with AILD.

Keywords:

Autoimmune thyroid disease, autoimmune liver disease, ultrasonography, nodularity,

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Wang CR, Tsai HW. Autoimmune liver diseases in systemic rheumatic diseases. World J Gastroenterol. 2022;28(23):2527-2545.
Teufel A, Weinmann A, Kahaly GJ, et al. Concurrent autoimmune diseases in patients with autoimmune hepatitis. J Clin Gastroenterol. 2010;44(3):208-213.
Wong GW, Yeong T, Lawrence D, Yeoman AD, Verma S, Heneghan MA. Concurrent extrahepatic autoimmunity in autoimmune hepatitis: implications for diagnosis, clinical course and long-term outcomes. Liver Int. 2017;37(3):449-457.
Floreani A, Franceschet I, Cazzagon N, et al. Extrahepatic autoimmune conditions associated with primary biliary cirrhosis. Clin Rev Allergy Immunol. 2015;48(2-3):192-197.
Silveira MG, Mendes FD, Diehl NN, Enders FT, Lindor KD. Thyroid dysfunction in primary biliary cirrhosis, primary sclerosing cholangitis and non-alcoholic fatty liver disease. Liver Int. 2009;29(7):1094-1100.
Choudhuri G, Somani SK, Baba CS, Alexander G. Autoimmune hepatitis in India: profile of an uncommon disease. BMC Gastroenterol. 2005;5:27.
Ralli M, Angeletti D, Fiore M, et al. Hashimoto's thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. Autoimmun Rev. 2020;19(10):102649.
Muratori P, Fabbri A, Lalanne C, Lenzi M, Muratori L. Autoimmune liver disease and concomitant extrahepatic autoimmune disease. Eur J Gastroenterol Hepatol. 2015;27(10):1175-1179.
Zeng Q, Zhao L, Wang C, et al. Relationship between autoimmune liver disease and autoimmune thyroid disease: a cross-sectional study. Scand J Gastroenterol. 2020;55(2):216-221.
Khoury T, Kadah A, Mari A, Sbeit W, Drori A, Mahamid M. Thyroid dysfunction is prevalent in autoimmune hepatitis: a case control study. Isr Med Assoc J. 2020;22(2):100-103.
Castagna MG, Belardini V, Memmo S, et al. Nodules in autoimmune thyroiditis are associated with increased risk of thyroid cancer in surgical series but not in cytological series: evidence for selection bias. J Clin Endocrinol Metab. 2014;99(9):3193-3198.
Tansel A, Katz LH, El-Serag HB, et al. Incidence and Determinants of Hepatocellular Carcinoma in Autoimmune Hepatitis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2017;15(8):1207-1217.
Sharma R, Verna EC, Simon TG, et al. Cancer risk in patients with autoimmune hepatitis: a nationwide population-based cohort study with histopathology. Am J Epidemiol. 2022;191(2):298-319
Werner M, Almer S, Prytz H, et al. Hepatic and extrahepatic malignancies in autoimmune hepatitis. A long-term follow-up in 473 Swedish patients. J Hepatol. 2009;50(2):388-393.
Wang KK, Czaja AJ, Beaver SJ, Go VL. Extrahepatic malignancy following long-term immunosuppressive therapy of severe hepatitis B surface antigen-negative chronic active hepatitis. Hepatology. 1989;10(1):39-43.
Ott RA, Calandra DB, McCall A, Shah KH, Lawrence AM, Paloyan E. The incidence of thyroid carcinoma in patients with Hashimoto's thyroiditis and solitary cold nodules. Surgery. 1985;98(6):1202-1206.
Boi F, Lai ML, Marziani B, Minerba L, Faa G, Mariotti S. High prevalence of suspicious cytology in thyroid nodules associated with positive thyroid autoantibodies. Eur J Endocrinol. 2005;153(5):637-642.
Floreani A, Mangini C, Reig A, et al. Thyroid Dysfunction in Primary Biliary Cholangitis: A Comparative Study at Two European Centers. Am J Gastroenterol. 2017;112(1):114-119.
Fisher SB, Perrier ND. The incidental thyroid nodule. CA Cancer J Clin. 2018;68(2):97-105.
McQueen AS, Bhatia KS. Thyroid nodule ultrasound: technical advances and future horizons. Insights Imaging. 2015;6(2):173-188.