BACKGROUND:

Systemic autoimmune diseases including rheumatoid arthritis can coexist with organ-specific autoimmune diseases.

OBJECTIVE:

To report a case series of rheumatoid arthritis patients who developed autoimmune thyroid disease (Hashimoto’s thyroiditis, Graves’ disease).

MATERIAL AND METHOD:

A retrospective study was done from January to December 2017 including patients with rheumatoid arthritis and autoimmune thyroid disease. Rheumatoid arthritis was assessed according to the diagnostic criteria of 2010 (ACR/ EULAR).

RESULTS:

There were identified 26 cases with rheumatoid arthritis and an autoimmune thyroid disease. In 14 cases rheumatoid arthritis was the initial manifestation and in 12 the initial manifestation was hypothyroidism or Graves’ disease (GD). All the patients (females, median age: 46) had symmetrical polyarthritis of hands, wrists and knees. In total, serology was positive for rheumatoid factor (21), anti-cyclic citrullinated peptide antibody (11), anti-thyroid peroxidase antibody (21) and elevated levels of TSH in 15 cases. In 5 cases, hyperthyroidism was the initial feature. Palpable abnormality of the thyroid gland was present in 5 cases. The treatment consisted on synthetic thyroid hormones, radioactive iodine therapy, thyroid surgery and disease modifying drugs.

CONCLUSION:

In this case series, the most common cause of hypothyroidism was Hashimoto’s thyroiditis preceding or following rheumatoid arthritis.

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