Clinical Endocrinology (1978) 9,215-219.
AUTOIMMUNE THYROID D I S E A S E A N D THE POLYMYALGIA RHEUMATICA-GIANT CELL ARTERITIS S Y N D R O M E
R. G . D E N T A N D 0. M . E D W A R D S
Addenbrooke’s Hospital, Cambridge (Received 13 January 1978; revised 23 February 1978; accepted 4March 1978) SUM M A R Y
In a study of 250 patients with autoimmune thyroid disease, seven (2.8%) were found t o have polymyalgia rheumatica or giant cell arteritis. All cases occurred in female patients over the age of 60 years, a prevalence in this group of 9.3%. No cases of either disorder were seen in a control population of 150 female patients over the age of 50 years attending a cardiac clinic at the same hospital. Awareness of this association may allow earlier diagnosis and treatment of this syndrome in elderly patients with thyroid disease. Thomas & Croft (1974) studied a group of 59 women with giant cell arteritis (GCA) and found five patients (8.5%) with a history of thyrotoxicosis. Recently a patient presented t o us with partial blindness due t o GCA whose Graves’ disease had previously been treated with an ablative dose of radioactive iodine. This finding prompted us t o determine the prevalence of the polymygalia rheumatica-giant cell arteritis syndrome (PR-GCA) in a thyroid clinic. PATIENTS, MATERIALS AND METHODS The patients studied were attending the thyroid clinic of Addenbrooke’s Hospital, Cambridge, between May 1976 and June 1977. They consisted of patients with treated Graves’ disease, primary hypothyroidism and Hashimoto’s thyroiditis. The patients had presented to the thyroid clinic a t varying times before the period of the study and confirmation of the diagnosis had depended on tests of thyroid function available at that time. Not all of the patients had accurate measurements of thyroid antibody titres. The group of 250 studied consisted of 199 females of whom 75 were over 60 years and 5 1 males of whom 17 were over 60 years. The diagnosis of PR-GCA was based on a typical clinical history and examination (Hamilton et al., 197 1 ; Hazleman, 1976), a raised erythrocyte sedimentation rate (ESR) (Westergren), and a dramatic response to systemic corticosteroid therapy. Temporal artery biopsy was performed whenever possible. The control population was taken from patients attending the cardiac clinic at Addenbrooke’s Hospital. Since n o cases of PRGCA were seen in male patients we used only female Correspondence: Dr R. G. Dent, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2 m .
0300-0644/78/0900-O21S$02.00 01978 Blackwell Scientific Publications
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R. G. Dent and 0.M . Edwards
controls. It is generally accepted that PR-GCA is a disease of the elderly, rarely occurring under the age of 50, so we confined the control group to patients over this age. One hundred and fifty female patients over the age of 50 were seen over a four month period in the cardiac clinic. The age distribution of these patients was similar to that of patients over 50 attending the thyroid clinic. All patients were asked specifically about the presence of headaches and proximal muscle aching or stiffness, and in the case of suggestive symptoms an ESR was performed. Lymphocytes for analysis of HLA patterns were prepared and stored in liquid nitrogen before being tissue typed. HLA typing was carried out using a microlymphocytotoxicity test (Joysey, 1973). Results are expressed as mean k S.E.M. Fishers exact test was used t o assess the significance of the difference in prevalence of PR-GCA between thyroid patients and controls (Snedecor & Cochran, 1969). RESULTS Seven cases of PR-GCA were seen amongst 250 patients with thyroid disease (2.8%). The prevalence in those over 50, the susceptible age group of PR-GCA, was 5.8% (7/120). We found n o cases in the control population of 150 females, the difference between the two groups being highly significant (P
AUTOIMMUNE THYROID D I S E A S E A N D THE POLYMYALGIA RHEUMATICA-GIANT CELL ARTERITIS S Y N D R O M E
R. G . D E N T A N D 0. M . E D W A R D S
Addenbrooke’s Hospital, Cambridge (Received 13 January 1978; revised 23 February 1978; accepted 4March 1978) SUM M A R Y
In a study of 250 patients with autoimmune thyroid disease, seven (2.8%) were found t o have polymyalgia rheumatica or giant cell arteritis. All cases occurred in female patients over the age of 60 years, a prevalence in this group of 9.3%. No cases of either disorder were seen in a control population of 150 female patients over the age of 50 years attending a cardiac clinic at the same hospital. Awareness of this association may allow earlier diagnosis and treatment of this syndrome in elderly patients with thyroid disease. Thomas & Croft (1974) studied a group of 59 women with giant cell arteritis (GCA) and found five patients (8.5%) with a history of thyrotoxicosis. Recently a patient presented t o us with partial blindness due t o GCA whose Graves’ disease had previously been treated with an ablative dose of radioactive iodine. This finding prompted us t o determine the prevalence of the polymygalia rheumatica-giant cell arteritis syndrome (PR-GCA) in a thyroid clinic. PATIENTS, MATERIALS AND METHODS The patients studied were attending the thyroid clinic of Addenbrooke’s Hospital, Cambridge, between May 1976 and June 1977. They consisted of patients with treated Graves’ disease, primary hypothyroidism and Hashimoto’s thyroiditis. The patients had presented to the thyroid clinic a t varying times before the period of the study and confirmation of the diagnosis had depended on tests of thyroid function available at that time. Not all of the patients had accurate measurements of thyroid antibody titres. The group of 250 studied consisted of 199 females of whom 75 were over 60 years and 5 1 males of whom 17 were over 60 years. The diagnosis of PR-GCA was based on a typical clinical history and examination (Hamilton et al., 197 1 ; Hazleman, 1976), a raised erythrocyte sedimentation rate (ESR) (Westergren), and a dramatic response to systemic corticosteroid therapy. Temporal artery biopsy was performed whenever possible. The control population was taken from patients attending the cardiac clinic at Addenbrooke’s Hospital. Since n o cases of PRGCA were seen in male patients we used only female Correspondence: Dr R. G. Dent, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2 m .
0300-0644/78/0900-O21S$02.00 01978 Blackwell Scientific Publications
21 5
216
R. G. Dent and 0.M . Edwards
controls. It is generally accepted that PR-GCA is a disease of the elderly, rarely occurring under the age of 50, so we confined the control group to patients over this age. One hundred and fifty female patients over the age of 50 were seen over a four month period in the cardiac clinic. The age distribution of these patients was similar to that of patients over 50 attending the thyroid clinic. All patients were asked specifically about the presence of headaches and proximal muscle aching or stiffness, and in the case of suggestive symptoms an ESR was performed. Lymphocytes for analysis of HLA patterns were prepared and stored in liquid nitrogen before being tissue typed. HLA typing was carried out using a microlymphocytotoxicity test (Joysey, 1973). Results are expressed as mean k S.E.M. Fishers exact test was used t o assess the significance of the difference in prevalence of PR-GCA between thyroid patients and controls (Snedecor & Cochran, 1969). RESULTS Seven cases of PR-GCA were seen amongst 250 patients with thyroid disease (2.8%). The prevalence in those over 50, the susceptible age group of PR-GCA, was 5.8% (7/120). We found n o cases in the control population of 150 females, the difference between the two groups being highly significant (P
