Around 50–60% of all patients with autoimmune hyperthyroidism will go on to develop systemic disease, involving their skin, eyes, heart, etc.
In a large, cross-sectional multicentre study, 3286 Caucasian subjects (2791 with
Graves’ disease, 495 with Hashimoto’s thyroiditis) attending UK hospital thyroid clinics were investigated for coexisting autoimmune disorders. The frequency of a further autoimmune disorder in these patients was investigated by questionnaire, and revealed a rate of 9.67% for those with
Graves’ disease and 14.3% for those with Hashimoto’s thyroiditis. The most common coexisting autoimmune condition was rheumatoid arthritis, but other diseases were also present, including pernicious anaemia, systemic lupus erythematosus (SLE), Addison’s disease, celiac disease and vitiligo. Thyroid diseases are frequent in patients with SLE, particularly hypothyroidism and thyroid autoantibodies.
Yes, there is a good chance that the patient will also have symptoms for another autoimmune disorder, which could be caught at an early stage and treated. Further, patients with other autoimmune disorders have an increased probability of autoimmune thyroid disease compared with the general public, and may benefit from testing.
Thyroid antibodies (TPOAb) increase the risk of miscarriage. In a study with 552 women who presented to their obstetrician in the first trimester of pregnancy, miscarriage rate was doubled in women who were euthyroid with TPOAb compared with women who tested negative for TPOAb. Thyroid autoantibody-positive women miscarried at a rate of 17%, compared with 8.4% for the autoantibody-negative women. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease decreased the rate of obstetric complications in a study of 984 pregnant women.
In a meta-analysis of 12,126 women, the cohort studies showed an increased risk of miscarriage in TPOAb+ women (odds ratio [OR] 3.90, 95% confidence interval [CI] 2.48–6.12; P
The risk of malignancy in atypia/follicular lesions of undetermined significance (AUS/FLUS) included under the Bethesda III category is 3–15%. A second fine needle aspiration biopsy (FNAB) is recommended in these patients because in 75–80% of cases, the nodules with cytology Bethesda III will be reclassified as Bethesda I, II, IV, V or VI, modifying the diagnosis towards a category that displays less controversy. However, these figures may vary among studies. Other possible strategies include simple observation, surgery after the first FNAB based on clinical or ultrasound findings, the use of molecular markers that define benign from malignant nodules and core needle aspiration, which provides more material for cytological analysis.