Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Higher Prevalence of Coexisting Papillary Thyroid Cancer as Well as Autoimmune Thyroid Diseases in Patients with Rheumatoid Arthritis.

Lee3,  Yeon-Ah, Lee1,  Sang-Hoon, Song2,  Ran, Son Hyung-In Yang and Seung-Jae Hong4,  Kyoung Min

Seoul, Korea, Republic of
Korea, Republic of
Division of Rheumatology, Department of Internal Medicine, School of Medicine, KyungHee University, Seoul, Korea, Republic of
Division of Rheumatology, Department of Internal Medicine, School of Medicine, KyungHee University

Background & Objectives:

Although the exact pathophysiologic mechanisms of autoimmune diseases in various organs remain unclear, an accumulation of autoimmune diseases in individual patients has been observed. It has been well documented that rheumatoid arthritis (RA) is the most common autoimmune disease coexisting with autoimmune thyroid diseases(ATD) such as Graves' disease or Hashimoto's thyroiditis. However, few studies have been performed to investigate the incidence of thyroid cancers and nodules in RA patients. The goal of our study was to investigate the prevalence of concurrent thyroid diseases (ATD, thyroid nodules and thyroid cancers) in patients with RA compared to the control group involving age and sex matched subjects.

Methods:

A case-control study was done in 110 RA patients and 101 osteoarthritis (OA) patients. We screened consecutive patients by thyroid ultrasonography (USG), regardless of the presence of palpable nodules. Patients with nodule(s) of 7 mm or greater were evaluated by fine-needle aspiration (FNA). Serum T3, free T4, thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies (anti-TG), and anti-peroxidase antibodies (anti-TPO) were measured.

Results:

The mean age was 55.2 ± 8.9 years in the RA patient group and 56.6 ± 8.5 years in the OA group. Thyroid nodule(s) were detected in 47.3% (52/110) among 110 RA patients, and in 56.4% (57/101) among 101 OA patients by USG. Among patients with thyroid nodule(s), 59 patients had nodule(s) of 7 mm or greater in size and 54 cases of them (92.0%) underwent FNA. Seven cases of thyroid cancer were histologically confirmed and all of them were papillary type. Six cases of 7 papillary thyroid cancers were RA patients. So, the cancer prevalence of sonographically detected thyroid nodules was at least 11.5 % (6/52) in RA patients and this was higher than in OA patients (11.5% vs 1.8%, P=0.052). Most of thyroid cancers(5/7) had a solid and hypoechoic pattern in USG. The positivity of anti-TG was significantly higher in RA (6% vs 0%, P=0.039) and the prevalence of ATD tended to be higher in RA patients than in controls (14.7% vs. 7.8%), although the difference was not statistically significant. Concurrent ATD comprised Hashimoto's thyroiditis (7 in RA, 4 in OA), and Grave's diseases (4 in RA). The most common thyroid dysfunction observed in both groups was subclinical hypothyroidism (9 in RA, 5 in OA). Other types of thyroid dysfunctions included overt hypothyroidism (3 in RA, 4 in OA), hyperthyroidism (4 in RA), and sick euthyroid disease (2 in RA).

Conclusions:

In this study, concurrent thyroid diseases were relatively common in patients with RA and more interestingly, papillary thyroid cancers were detected dominantly in RA patients. Therefore, an extended diagnostic screening for accumulating thyroid diseases, especially Graves's disease and thyroid cancer, seems reasonable in patients with RA.

To cite this abstract, please use the following information:
Lee, Yeon-Ah, Lee, Sang-Hoon, Song, Ran, Son Hyung-In Yang and Seung-Jae Hong, Kyoung Min; Higher Prevalence of Coexisting Papillary Thyroid Cancer as Well as Autoimmune Thyroid Diseases in Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1038
DOI: 10.1002/art.28805

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