AUTHOR=Adegunsoye Ayodeji , Oldham Justin M. , Husain Aliya N. , Chen Lena , Hsu Scully , Montner Steven , Chung Jonathan H. , Vij Rekha , Noth Imre , Strek Mary E. 

TITLE=Autoimmune Hypothyroidism As a Predictor of Mortality in Chronic Hypersensitivity Pneumonitis

JOURNAL=Frontiers in Medicine

VOLUME=4

YEAR=2017

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2017.00170

DOI=10.3389/fmed.2017.00170

ISSN=2296-858X

ABSTRACT=<sec id="ST1"><title>Background</title><p>Chronic hypersensitivity pneumonitis (CHP) is a fibrotic parenchymal lung disease that occurs when inhalation of environmental antigens leads to immune dysregulation. Autoimmune features have recently been identified as potentially important among patients with CHP. However, the relationship between hypothyroidism (HT) and CHP is unknown. In this study, we investigate the prevalence and impact of HT among patients with CHP.</p></sec><sec id="ST2"><title>Methods</title><p>We conducted a retrospective, case–control analysis. We identified 121 patients at the University of Chicago Interstitial Lung Disease Center with a multidisciplinary diagnosis of CHP. These patients were matched 3:1 according to age, sex, and race to 363 control subjects with asthma from 2006 to 2015. We analyzed demographics, clinical characteristics, and survival between both groups and assessed the relationship of HT with CHP. Survival analysis was performed using Cox proportional hazards modeling.</p></sec><sec id="ST3"><title>Results</title><p>Patients with CHP had higher prevalence of HT (25.6%, <italic>n</italic> = 31) compared to controls (10.7%, <italic>n</italic> = 39; OR, 2.86; 95% CI, 1.62–4.99; <italic>P</italic> &lt; 0.0001). Compared to CHP alone, patients with CHP/HT were more likely to be female (80.6 vs 51.1%, <italic>P</italic> = 0.004), have increased incidence of autoimmune disease (19.4 vs 3.3%, <italic>P</italic> = 0.009), antinuclear antibody seropositivity (80.6 vs 57.0%, <italic>P</italic> = 0.019), and higher TSH levels (4.0 vs 1.9 mIU/L, <italic>P</italic> &lt; 0.0001). HT was a significant independent predictor of mortality among CHP patients with seropositive ANA (HR, 3.39; 95% CI, 1.31–8.80; <italic>P</italic> = 0.012).</p></sec><sec id="ST4"><title>Conclusion</title><p>HT is common in patients with CHP and may carry prognostic significance in patients with features of autoimmunity. Further research exploring common pathogenic pathways between autoimmune HT and CHP may illuminate the association of HT with survival.</p></sec>