Autoimmune thyroid disease and urticarial vasculitis: is there a significant association?

Pearson’s correlation coefficient was used to describe the linear correlation between normally distributed data, and Spearman’s correlation coefficient was used to describe the linear correlation between non-normally distributed data. Kaplan–Meier analysis was used to analyze survival rates of the normal thyroid function group and thyroid dysfunction group and to create graphs of the observed survival curves, while the log-rank test was used to compare curves from different groups. Logistic regression was used to analyze the risk factors related to thyroid dysfunction.

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• As relevant limitations to our study we must mention the small sample size and retrospective nature.
• However, she rapidly developed multiple organ failure due to the exacerbation of severe hypothyroidism, i.e., myxedema.
• And W.Y.; writing—review and editing, S.G.; visualization, Y.W.; supervision, S.G.; project administration, S.G.; funding acquisition, P.F.
• However, the thyroid function status in AAV patients with renal injury remains unclear.
• Their major concern is that our study does not support our statement that the use of anti-thyroid agents does not account for many cases of ANCA-Small Vessel Vasculitis (ANCA-SVV) in the general population, a contention we continue to support.

However, whether IgA vasculitis causes synthroid label deterioration of hypothyroidism into myxedema coma requires further clarification. In addition, it remains unclear whether liothyronine (LT3) should be administered in addition to levothyroxine (LT4) to treat myxedema coma, although the efficacy of combination therapy with LT3 and LT4 has been demonstrated previously (14–16). Drug-induced vasculitis is an inflammation of blood vessels caused by the use of various pharmaceutical agents. Vasculitis causes changes in the walls of blood vessels, including thickening, weakening, narrowing and scarring. Inflammation can be short-term (acute) or long-term (chronic) and can be so severe that the tissues and organs supplied by the affected vessels do not get enough blood.

Allergy, Asthma & Clinical Immunology

This study aimed to investigate thyroid function in AAV patients with renal injury and to explore the clinical relevance of renal dysfunction in the patients. T3 administration should be considered an alternative treatment for patients with myxedema coma who require concomitant glucocorticoid administration. Myxedema coma is often treated with LT4 alone, as recommended by the guidelines in the United States (25) and Latin America (26).

• Kidney survival curve of AAV patients with renal injury in different groups.
• As for IgA vasculitis with nephritis, glucocorticoid administration had successfully reduced proteinuria, with peak elevation observed at 0.66 g/gCr on day 3, which reduced to 0.26 g/gCr on day 5, and was finally absent by day 10.
• Infectious diseases, stroke, myocardial infarction, sedative drugs, and cold exposure are considered the main triggers for myxedema coma.
• In addition, the thyroid hormone also regulates neutrophil respiratory burst by regulating gp91phox, the catalytic core of NADPH oxidase, which is an important part of the pathogenesis of AAV 8,9.

Analysis of Thyroid Function in ANCA-Associated Vasculitis Patients with Renal Injury

This report describes a patient with UV triggered by thyroid replacement, necessitated by Hashimoto’s thyroiditis, whichcan itself cause UV. There were no significant differences in thyroid hormone levels among groups of patients with different ANCA positivity status. Clinicians should be aware of this critical condition that would be masked by the trigger disorders.

In clinical practice, a subset of AAV patients with renal involvement exhibiting thyroid dysfunction were observed. However, the clinical and prognostic relevance of thyroid dysfunction in AAV patients with renal injury remained unclear. The present study analyzed the thyroid function in the cohort of AAV patients with renal injury. Woywodt et al. also question our method of collecting medical and treatment history via telephone interviews. We concur that recall bias is a concern in any case-control study and can lead to spurious associations. The best defense against recall bias is the confirmation of information through a separate source.

Although combination therapy with LT3 and LT4 is not common (14–16), it has reportedly been effective in improving the prognosis in certain cases of myxedema coma (27). Additionally, rapid thyroid hormone replacement is generally avoided because it carries the risk of inducing myocardial infarction and arrhythmias (28). In this context, administration of LT3 was hesitated; however, recovery of serum free T3 levels were delayed in comparison with normal to high levels of serum free T4 levels (Figure 3) (16). The potential for exacerbation of hypothyroidism in response to a pharmacological dose of glucocorticoid should also be noted. Combination therapy with both LT4 and LT3 may prove effective, especially for myxedema coma patients with diseases requiring glucocorticoid administration.

As for IgA vasculitis with nephritis, glucocorticoid administration had successfully reduced proteinuria, with peak elevation observed at 0.66 g/gCr on day 3, which reduced to 0.26 g/gCr on day 5, and was finally absent by day 10. After prednisolone was tapered to 60 mg/day, she was transferred to another hospital to undergo cholecystectomy for cholecystitis. After 1 year, she regularly visits our hospital for follow-up and medical treatment. Initially, 636 AAV patients with renal injury were screened from November 2011 to December 2020.

Associated Data

A two-tailed p-value of less than 0.05 was considered statistically significant. Statistical analyses were performed using SPSS Statistics for Windows Version 25.0 (SPSS Inc., Chicago, IL, USA). Although the pathogenic mechanism of immunoglobulin A (IgA) vasculitis has yet to be elucidated, it has been suggested that immune complexes deposit mainly on arterial walls and activate the complement system (9). Blood vessel wall destruction by neutrophils causes IgA vasculitis with nephritis (10), the symptoms of which include tactile purpura on the lower legs, arthritis, abdominal pain, and nephropathy. Systemic inflammation caused by autoimmune mechanisms may cause severe hypothyroidism resulting in the development of myxedema coma by disrupting the compensatory mechanism for downregulated T3 expression. In addition, proteinuria related to IgA vasculitis with nephritis may contribute to thyroid hormone deficiency (11–13).

We expect to conduct a large-scale, multi-center collaborative study to investigate overall characteristics. Further investigation into the underlying mechanisms and potential treatment strategies may be a direction of future research. There were twenty-four patients (13.79%) in the group of AAV patients with normal thyroid function. The thyroid dysfunction group consisted of one hundred and fifty (86.21%) individuals.

Hence, clinicians should be aware of the risks of dynamic exacerbations in patients with hypothyroidism. Furthermore, our study suggested that combination therapy with thyroxine and liothyronine might prove effective for patients with myxedema coma, especially for those who require high-dose glucocorticoid administration. In addition, the thyroid hormone also regulates neutrophil respiratory burst by regulating gp91phox, the catalytic core of NADPH oxidase, which is an important part of the pathogenesis of AAV 8,9. Thyroid dysfunction can disrupt the delicate balance of the immune system, leading to an unbalanced inflammatory response 10.