January 21, 2019

An endocrinology consultation should be considered in patients with psoriatic disease who present with thyroid symptoms.

Patients with psoriatic disease have an increased risk for thyroid disease, including hyperthyroidism, hypothyroidism, thyroiditis, and certain autoimmune thyroid conditions such as Grave’s disease and Hashimoto’s thyroiditis, according to study results published in the Journal of the American Academy of Dermatology.

The investigators identified a total of 13,266 patients with psoriatic arthritis (the psoriatic arthritis group), 149,576 patients with psoriasis alone (the psoriasis group), and 162,842 controls who did not have psoriasis (the control group) from data collected between January 1, 2000 and December 31, 2012. Mean patient age in the psoriasis, psoriatic arthritis, and control arms was 45.11±20.09, 43.17±17.72, and 44.95±19.91, respectively (P <.0001); women comprised 46.21%, 37.83%, and 40.65% of the groups, respectively (P <.0001). A significantly higher percentage of the patients in the psoriasis and psoriatic arthritis arms had hypertension, type 2 diabetes, and hyperlipidemia compared with patients in the control group (P <.0001).

Compared with the control group, the psoriatic arthritis and psoriasis groups had an elevated risk for incident hyperthyroidism (adjusted hazard ratio [aHR] 1.32; 95% CI, 1.07-1.65; P <.05 and aHR 1.22; 95% CI, 1.11-1.33; P <.0001, respectively) and Grave’s disease (aHR 1.38; 95% CI, 1.07-1.79; P <.05 and aHR 1.26; 95% CI, 1.131.41; P <.0001, respectively).

Moreover, both the psoriatic arthritis and psoriasis groups also had an increased risk for incident hypothyroidism (aHR 1.74; 95% CI, 1.342.27; P <.0001 and aHR 1.38; 95% CI, 1.231.56; P <.0001 respectively) and Hashimoto’s thyroiditis (aHR 2.09; 95% CI, 1.343.24; P <.01 and aHR 1.47; 95% CI, 1.181.82; P <.01, respectively) compared with the control arm.

A major study limitation was the lack of available data on psoriasis severity. In addition, in order to avoid overestimating the risk for incident thyroid diseases, patients with psoriasis diagnosed prior to 2000 were excluded from this study.

The investigators concluded that the findings demonstrate that an endocrinology consultation should be considered in patients with psoriatic disease who present with thyroid symptoms, particularly patients with psoriatic arthritis.

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Reference

Wang S-H, Wang J, Lin Y-S, Tung T-H, Chi C-C. Increased risk of incident thyroid diseases in people with psoriatic disease: a cohort study [published online December 5, 2018]. J Am Acad Dermatol. doi:10.1016/j.jaad.2018.11.049