Abstract
Autoimmune diseases, including autoimmune thyroid diseases (AITDs), may be associated with Crohn's disease (CD). Taking into consideration the role of tumor necrosis factor alpha (TNF-alpha) in the immune-mediated inflammation that underlies both diseases, we evaluated an ultrasound of thyroid gland in pediatric CD patients, naïve, and treated with infliximab (IFX), an anti-TNF-alpha antibody, to assess the risk for AITD and evaluated the usefulness of ultrasonography to diagnose AITD in patients with CD. Sixty-one patients with CD were enrolled in the study, including 36 patients (mean age 14.5 ± 3.5 years) treated with IFX (IFX group) for a mean of 13.9 ± 16.6 months and 25 patients (mean age 14.7 ± 2.3 years) who never received anti-TNF-alpha therapy (control group). An ultrasound examination of the thyroid gland was performed; thyroid function tests and thyroid antibodies were assessed. We found 10-times higher prevalence of decreased thyroid echogenicity in CD and IFX-naive patients compared to IFX-treated group [a significant reduction in thyroid echogenicity in 1/36 (2.8%) patients receiving IFX compared to 7/25 (28%) patients naive to biologic therapy]. The latter showed significantly lower thyroid-stimulating hormone (TSH) levels (p = 0.034) and higher levels of thyroid antibodies (p = 0.042) in comparison to control. Our data suggest the protective role of IFX therapy in the development of thyroid disorders and indicate the usefulness of thyroid ultrasound to identify the risk of probable AITD in pediatric patients with CD.
Highlights
Crohn’s disease (CD) is one of two main types of inflammatory bowel disease (IBD) that can result in progressive bowel damage and disability
Some studies reported that there were no significant differences in thyroid function tests {serum levels of triiodothyronine [free T3], thyroxine [free T4], and thyroid-stimulating hormone (TSH)} between CD patients and controls, or even the prevalence of thyroid dysfunction was lower in CD patients in comparison to the general population [4,5,6]
In a study by Pooran et al [6], the prevalence of hypothyroidism was lower in CD patients [3.8% (8/210)] than in control individuals [8.2% (17/206)], the prevalence of hyperthyroidism was statistically similar between the groups
Summary
Crohn’s disease (CD) is one of two main types of inflammatory bowel disease (IBD) that can result in progressive bowel damage and disability. In the IFX group, 6/36 patients (5/18 girls, 1/18 boy) had an abnormal echogenicity of thyroid gland parenchyma. Patients in the control group with heterogenic/hypoechoic thyroid parenchymal pattern have significantly higher TRAb levels compared to the patients with normal thyroid ultrasound (0.79 ± 0.23 vs 0.59 ± 0.17 IU/ml, p = 0.042).
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