Low yield of routine screening for thyroid dysfunction in asymptomatic patients with vitiligo

• Published in: British journal of dermatology (1951) Vol. 166; no. 3; pp. 532 - 538
• Main Authors: Kroon, M.W., Joore, I.C.K.W., Wind, B.S., Leloup, M.A.C., Wolkerstorfer, A., Luiten, R.M., Bos, J.D., Geskus, R.B., van der Veen, J.P.W.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-03-2012; Wiley-Blackwell
• Subjects: Adult; Aged; Antibodies - metabolism; Area Under Curve; Biological and medical sciences; Cohort Studies; Dermatology; Early Diagnosis; Female; Humans; Iodide Peroxidase - immunology; Male; Medical sciences; Middle Aged; Pigmentary diseases of the skin; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Thyroid Diseases - complications; Thyroid Diseases - diagnosis; Thyroid Function Tests; Vitiligo - complications; Human; Skin disease; Vitiligo; Pigmentation disorder; Dermatology; Dysfunction; Asymptomatic; Thyroid gland; Medical screening
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/j.1365-2133.2011.10717.x

Summary
Background  Nonsegmental vitiligo is considered to be an autoimmune disease and is known to be associated with other autoimmune diseases, particularly affecting the thyroid. Screening patients with nonsegmental vitiligo for thyroid function and for the presence of thyroid autoantibodies has been recommended.
Objective  To investigate the prevalence of thyroid dysfunction and thyroid peroxidase‐specific (TPO) antibodies in a large cohort of patients with nonsegmental vitiligo in order to help decide whether routine screening is justified.
Methods  A total of 434 adults with nonsegmental vitiligo who were referred to our institute were enrolled. Thyroid function and anti‐TPO antibody titres were assessed in those patients who had no history of thyroid disease or recent thyroid screening.
Results  Forty‐three patients had already been diagnosed with thyroid dysfunction, and in 27 patients the general practitioner had performed a thyroid function test with negative results < 3 months previously. In these patients, thyroid function assessment was not repeated. The remaining 364 patients were screened for thyroid dysfunction. Overt hypothyroidism was newly diagnosed in three (0·8%) patients; subclinical disease was found in 10 (2·7%) patients and increased levels of TPO antibodies, without thyroid disease, were found in 49 (13·5%) patients. An elevated risk for thyroid disease was found among older women and in women with a positive family history of thyroid disease.
Conclusion  The overall prevalence of thyroid dysfunction in adult patients with nonsegmental vitiligo was higher than reported in the general population. However, the number of newly diagnosed cases with overt and subclinical thyroid dysfunction in our population was low. Most patients had already been diagnosed by their general practitioner and had symptoms indicative for thyroid disease. Thyroid disease was found predominantly among older women and in subjects with a positive family history of thyroid disease. Thyroid screening including anti‐TPO antibodies is advisable in these high‐risk subpopulations.