Thyroid abnormality in patients with psoriasis: prevalence and association with severity

Fernandes, Luiza de Castro; Arruda, Ana Carolina Belini Bazan; Baeninger, Lisa Gava; Almeida, Debora Pedroso; Villagelin, Danilo

doi:10.1016/j.abd.2022.12.007

Luiza de Castro Fernandes ^⁎⁎ Corresponding author. E-mail: luizacastro.dermatologia@gmail.com (L.C. Fernandes)

Design and planning of the study

data collection, or data analysis and interpretation

statistical analysis

drafting and editing of the manuscript or critical review of important intellectual content

collection, analysis, and interpretation of data

effective participation in research orientation

intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases

critical review of the literature; approval of the final version of the manuscript

Department of Internal Medicine, Universidade Estadual de Campinas, Campinas, SP, Brazil

http://orcid.org/0000-0001-5736-6378

Ana Carolina Belini Bazan Arruda

Design and planning of the study

data analysis and interpretation

drafting and editing of the manuscript or critical review of important intellectual content

collection, analysis, and interpretation of data

effective participation in research orientation

intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases

critical review of the literature

approval of the final version of the manuscript

Department of Dermatology, Hospital da Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil

http://orcid.org/0000-0002-0371-2308

Lisa Gava Baeninger

Design and planning of the study

data collection, drafting and editing of the manuscript

collection

analysis, and interpretation of data

effective participation in research orientation

critical review of the literature

approval of the final version of the manuscript

Department of Dermatology, Hospital da Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil

http://orcid.org/0000-0002-3930-5827

Debora Pedroso Almeida

Design and planning of the study

data collection, drafting and editing of the manuscript

collection, analysis, and interpretation of data

effective participation in research orientation

critical review of the literature

approval of the final version of the manuscript

Department of Dermatology, Hospital da Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil

http://orcid.org/0000-0001-6543-5898

Danilo Villagelin

Design and planning of the study

data collection, or data analysis and interpretation

statistical analysis

drafting and editing of the manuscript or critical review of important intellectual content

collection, analysis, and interpretation of data

effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases

critical review of the literature

approval of the final version of the manuscript

Department of Internal Medicine, Universidade Estadual de Campinas, Campinas, SP, Brazil

Department of Endocrinology and Metabology, Hospital da Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil

http://orcid.org/0000-0002-4173-7258

⁎ Corresponding author. E-mail: luizacastro.dermatologia@gmail.com (L.C. Fernandes)

Conflicts of interest

None declared.

Authors/Year of publication	Study design	Objective	n (sample size)	Country	Thyroid markers	Findings
Arican, Bilgic and Koc, 2004^a a Studies included for literature control.	Case-control	Comparison of serum thyroid hormone levels	103 patients × 96 controls	Turkey	T3T, T3L, T4T, T4L, TSH	Elevated FT4 and FT3 in patients with psoriasis (p<0.05), elevated PASI in these patients (p< 0.001)
Antonelli et al. 2006	Case-control	Prevalence of thyroid disorders in patients with PA vs. controls	Patients: 80 PA/ 112 rheumatoid arthritis / 400 controls	Italy	T3L, T4L, TSH, anti-TPO, anti-TG, thyroid ultrasonography	Autoimmune thyroid dysfunction (patients × controls): 33% × 18% in females and 25% × 5% in males (p = 0.0001)
Gul et al. 2009	Case-control	Association of autoimmune thyroid diseases with psoriasis	105 patients × 96 controls	Turkey	T3L, T4L, TSH, anti-TPO, anti-TG, thyroid ultrasonography	No difference between the groups
James, Hill and Feldman 2016	Cross-sectional	Prevalence of hypothyroidism in patients with rosacea or psoriasis compared to other dermatological diseases	Human Database -1,667,943 patients	USA	CID-10	Prevalence of hypothyroidism of 17.5% in patients with psoriasis. Frequency of hypothyroidism did not differ from other dermatological patients
Lai and Yew 2016	Cross-sectional	Association of psoriasis and thyroid disease		India	Thyroid hormones and autoantibodies	Low levels of TSH in patients with psoriasis (p< 0.019)
Fallahi et al. 2017	Case-control	Incidence of clinical or subclinical thyroid dysfunction in patients with PA	97 patients × 97 controls	Italy	T4L, T3L, TSH, anti-TPO, anti-TG, thyroid ultrasonography	High incidence of anti-TPO positivity (p = 0.017), hypothyroidism (p = 0.017), thyroid dysfunction (p = 0.002), hypoechogenicity (p = 0.009) and thyroid autoimmunity (p = 0.007)
Khan et al. 2017	Cross-sectional analysis of a cohort	Association of positive anti-TPO, TSH and FT4 with psoriatic disease	Population – part of the Rotterdam Study – 8,214 participants	The Netherlands	T4L, TSH, anti-TPO	No association considering incident or prevalent psoriatic disease
Kiguradze et al. 2017	Cross-sectional	Association between psoriasis and HT	Population -Northwestern Medicine Enterprise Data Warehouse -856,615 participants – 9,654 diagnoses of psoriasis – 1,745 diagnoses of HT	USA	T3L, TSH, anti-TPO, anti-TG	Positive association (OR = 2.49 [95% CI 1.79–3.48] p < 0.0001)
Vassilatou et al. 2017^a a Studies included for literature control.	Case-control	Prevalence of autoimmune thyroiditis in patients with psoriasis	114 patients with psoriasis × 286 controls	Greece	T3T, T4T, T4L, TSH, anti-TPO, anti-TG	No difference in prevalence
Valejo, Coelho and Brasileiro 2018	Cross-sectional	Prevalence of thyroid dysfunction	55 patients with psoriasis	Portugal	T3L, T4L, TSH, anti-TPO, anti-TG	Prevalence of 9.1%
Alidrisi et al. 2019^a a Studies included for literature control.	Case-control	Prevalence of HT in patients with psoriasis compared to controls	56 patients × 54 controls	Iraq	T4L, TSH, anti-TPO, anti-TG, thyroid ultrasonography	Higher prevalence of anti-TPO (25% × 9.3% p = 0.02), anti-TG (30.4% × 11.1%; p = 0.01), hypoechogenicity (30.4% × 9.3%; p = 0.02), pseudonodularity (16.1% × 0%; p = 0.002) and elevated vascularity on ultrasonography in patients with psoriasis (35.7% × 5.6%; p = 0.001)
Hansen et al. 2019^a a Studies included for literature control.	Case-control	To assess thyroid function	Population – Danish General Population Study – 1,127 patients × 5,637 controls	Denmark	T3T, T4L, TSH, anti-TPO	Elevated T3T levels in patients with psoriasis (1,72 × 1.69; p = 0.01)
Mallick 2019	Cross-sectional	Frequency of thyroid disorders in patients with psoriasis	112 patients	Pakistan	T3L, T4T, TSH	15.2%
Wang et al. 2019	Cohort	Risk of thyroid disease in patients with psoriasis	Population – Taiwan National Health Insurance Research Database – 13,266 patients with PA/ 149,576 with isolated psoriasis/ 162,842 controls	Taiwan	CID-10	High incidence of hyperthyroidism in patients with psoriasis (aHR = 1.22; 95% IC 1.11–1.33), Graves disease (aHR=1.26; 95% IC 1.13–1.41), incidence of hypothyroidism (aHR = 1.38; 95% IC 1.23–1.56) and HT (aHR = 1.47; 95% CI 1.18–1.82)
Namiki et al. 2020	Cross-sectional	Prevalence of thyroid dysfunction	85 patients: 51 with psoriasis vulgaris/ 23 PA/ 11 GPP	Japan	T3L, T4L, TSH	Prevalence of 8%, 13% and 45%, respectively
Wu et al. 2021	Cross-sectional	Association of psoriasis with increased risk of thyroid disease	National Health and Nutrition Examination Survey – 15,091 patients	USA	Self-reported disease	Positive association (OR = 1.61 [95% CI 1.01–2.55] p = 0.043)
Valduga et al. 2021	Cross-sectional	Prevalence of HT	60 patients × 60 controls	Brazil	TSH, T4L, anti-TPO, anti-TG	Prevalence of HT (OR = 3.8 [95% CI 1.18–12.6] p = 0.03)

Clinical characteristics	Frequency (number of patients)	Percentage (%)
Male	104	64.6
Psoriatic arthritis	54	33.54
Diabetes	45	27.95
Hypertension	70	43.48
Depression/anxiety	10	6.21
Dyslipidemia	52	32.3
Autoimmunity (except hypothyroidism)	4	2.48
Thyroid abnormality	46	28.57
Hypothyroidism	24	14.91
Altered TSH	14	10.29
Positive anti-TPO	13	8.55
Positive anti-TG	7	4.83

Variable	Mean	Minimum–Maximum	Median	Standard deviation
Age	55.17	12–94	56	16.10
Weight	78.78	44–125	77	15.58
Height	1.67	1.48–1.96	1.67	0.09
BMI	28.20	18.80–47.05	27.7	5.12
Disease duration (months)	215.22	12–720	192	152.25
PASI	5.62	0–57	2.2	8.13

PASI	Moderate/severe (> 10) n (%)	Mild (≤ 10) n (%)	p-value
Variables	Moderate/severe (> 10) n (%)	Mild (≤ 10) n (%)	p-value
Hypothyroidism+	4 (2.96)	15 (11.11)	0.49
Hypothyroidism–	17 (12.59)	99 (73.33)	0.49
Altered TSH	0 (0)	10 (8.70)	0.35
Normal TSH	17 (14.78)	88 (76.52)	0.35
Anti-TPO+	3 (2.29)	8 (6.11)	0.38
Anti-TPO–	18 (13.74)	102 (77.86)	0.38
Anti-TG +	1 (0.79)	4 (3.17)	0.58
Anti-TG–	19 (15.08)	102 (80.95)	0.58
Thyroid abnormality+	5 (3.70)	30 (22.22)	0.80
Thyroid abnormality–	16 (11.85)	84 (62.22)	0.80

Psoriatic arthritis	Presence n (%)	Absence n (%)	Valor p
Variable	Presence n (%)	Absence n (%)	Valor p
Hypothyroidism+	9 (5.59)	15 (9.32)	0.65
Hypothyroidism–	45 (27.95)	92 (57.14)	0.65
Altered TSH	3 (2.21)	11 (8.09)	0.38
Normal TSH	42 (30.88)	80 (58.82)	0.38
Anti-TPO+	5 (3.29)	8 (5.26)	0.76
Anti-TPO–	46 (30.26)	93 (61.18)	0.76
Anti-TG+	1 (0.69)	6 (4.14)	0.42
Anti-TG–	48 (33.10)	90 (62.07)	0.42
Thyroid abnormality+	15 (9.32)	31 (19.25)	0.87
Thyroid abnormality–	39 (24.22)	76 (47.20)	0.87

Current treatment	Immunobiological	Non-immunobiological	p-value
Variable	n (%)	n (%)	p-value
Hypothyroidism+	9 (5.59)	15 (9.32)	0.48
Hypothyroidism–	62 (38.51)	75 (46.58)	0.48
Altered TSH	4 (2.94)	10 (7.35)	0.17
Normal TSH	58 (42.65)	64 (47.06)	0.17
Anti-TPO+	5 (3.29)	8 (5.26)	0.56
Anti-TPO–	65 (42.76)	74 (48.68)	0.56
Anti-TG+	3 (2.07)	4 (2.76)	1.0
Anti-TG–	65 (44.83)	73 (50.34)	1.0
Thyroid abnormality+	16 (9.94)	30 (18.63)	0.13
Thyroid abnormality–	55 (34.16)	60 (37.27)	0.13

[1] ⁎ Corresponding author. E-mail: luizacastro.dermatologia@gmail.com (L.C. Fernandes)

Brasil

Brasil

Thyroid abnormality in patients with psoriasis: prevalence and association with severity^☆ ☆ Study conducted at the Hospital da Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil.

Abstract

Background:

Objective:

Methods:

Results:

Brasil

Brasil

Thyroid abnormality in patients with psoriasis: prevalence and association with severity☆ ☆ Study conducted at the Hospital da Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil.

Abstract

Background:

Objective:

Methods:

Results:

Thyroid abnormality in patients with psoriasis: prevalence and association with severity^☆ ☆ Study conducted at the Hospital da Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil.