Is There A Connection Between Autoimmune Thyroid Diseases And Vitiligo?

Vitiligo is a rare disorder that affects the skin. Several studies have been performed on the subject, but no accurate figure has been presented regarding the prevalence of the condition. One study explains that the estimated prevalence range from 0.1% to 2%1, depending on factors such as the population being studied.

Even though this skin condition is not considered a fatal disease, it has been linked to an increased risk of cancer. Patients who suffer from the condition also tend to experience depressive symptoms. Other complications have also been linked to the condition.

What we want to focus on in this post is the possible link that may exist between vitiligo and autoimmune Thyroid diseases.

Various studies have proven a connection between autoimmune diseases and this skin-related condition, often stating that the primary connections most often observed lies within two particular autoimmune diseases that affect the Thyroid gland.

What Is Vitiligo?

Vitiligo is a skin-related chronic disease that has no cure. The disease is not yet fully understood by scientists, but it is known that it developed when melanocytes die or when the function of these cells is inhibited. Melanocytes are cells that produce melanin, a pigment that is responsible for the color of the eyes, hair, and the skin.

Thus, when melanin production is halted, the color in the affected areas of the body will be lost. Even though most commonly associated with the skin, vitiligo does affect the hair and the eyes in some patients.

Even though this disease is rare, it is still important for patients to notice the symptoms early on to receive treatment. While no cure has been established, a number of treatments have been developed that helps to reduce the speed at which the discoloration of the skin progresses. In some cases, treatment has been able to restore some color to affected patches of skin in patients as well, but this is a rare upside of treatment.

There are different types of vitiligo that may develop. In some cases, it is found that the disease progresses on both sides of the body symmetrically. There are also cases where only a single side of the body is affected by the disease. In other cases, however, the disease may show up in a single localized area of the body.

This type of the disease is called focal vitiligo. There are cases where focal vitiligo can cause additional areas to develop symptoms of the condition as well, but generally, the number of areas affected tend to be very few.

Since the disease is unpredictable, doctors cannot provide patients with details as to how severe the condition will become. There is currently no completely accurate way of predicting how fast pigmentation will be lost, or how large the patches affected by vitiligo will become.

What Are The Symptoms Of Vitiligo?

Symptoms of this condition are usually easy to identify. The most common symptom that is associated with vitiligo involves a loss of color in a particular area of the skin. The color loss will usually start by affected a small patch of the skin, and then gradually progress into a larger patch.

Some patients may also find that their hair starts to lose its color and turn white at a relatively young age – considered premature graying. This symptom does not only affect the patient’s hair on their scalp but may also cause their eyelashes and eyebrows to lose color. Men may also find that their beard starts to turn white.

A large number of patients with this condition tend to experience a loss of pigmentation inside their mouth as well. The mucous membranes tend to become white instead of the usual pink. Since mucous membranes are also present in the nose, a loss of color may also be experienced inside of the patient’s nose.

While relatively rare, it should be noted that vitiligo is also known to affect the eyes. The retina of the eyes obtains their color from melanin as well, similar to the skin and the hair. Thus, when melanocytes in the retina are destroyed or stop producing the pigment melanin, the color may be lost as well.

What Causes Vitiligo?

At the moment, scientists are still trying to provide more accurate data on a specific cause for vitiligo. Some advancements have recently been made in regards to this particular topic. A paper published in the F1000 Research Journal2 opens by explaining how stress to melanocytes is currently considered a primary trigger for the development of the disease.

The research paper explains that various stressors to the skin can cause damage to these cells. This may include excessive exposure to the sun, resulting in sunburn, as well as exposure to chemicals. Mechanical trauma is also listed as a possible trigger. When such damage is suffered, an autoimmune response may be triggered – in such a case, the immune system will start to develop antibodies that target melanocytes in the area of the skin that was affected by the damage.

A family history of vitiligo may also increase a patient’s risk of developing this disease3. Additionally, it has been found that patients with existing autoimmune disorders are also more likely to develop a type of vitiligo where the immune system attacks and destroys the cells that are responsible for producing melanin pigments.

An Overview Of Thyroid Function And Autoimmune Thyroid Diseases

The Thyroid is an essential gland to the human body. It produces hormones that work together with other glands in the endocrine system, as well as with all cells in the body, to regulate metabolism, as well as other important functions. Two of the most commonly discussed hormones produced by this gland include:

  • Thyroxine, or T4 – this is considered the Thyroid gland’s prohormone.
  • Triiodothyronine, or T3 – this is considered the active form of Thyroid hormones.

These hormones are necessary for the normal growth of the human body. They are also involved in the neurological development and is essential for the regulation of human metabolism4. Scientific studies have found that every single cell in the human body has a receptor that can respond to Thyroid hormones.

Several conditions in the body may affect the function of the Thyroid gland. This may cause too high or too little concentration of Thyroid hormones to be available in the bloodstream.

When the levels of Thyroid hormones increase too much, it causes Hyperthyroidism. This causes metabolism to speed up and affects many other functions and organs in the body as well. Symptoms may include5 weight loss, an increase in appetite, heat intolerance, tremors, fatigue, insomnia, poor concentration, heart palpitations, shortness of breath, nausea, and an increase in perspiration.

On the other end, if the Thyroid does not produce enough of these hormones, or the level of Thyroid hormones in the bloodstream becomes low, Hypothyroidism may develop. This is the opposite condition of Hyperthyroidism. This may cause symptoms such as weight gain, fatigue, dry skin, constipation, hair loss, and cold intolerance6. The condition has also been associated with complications such as heart failure, as well as problems with the patient’s fertility.

Is There A Connection Between Autoimmune Thyroid Diseases And Vitiligo?

Numerous autoimmune diseases have been identified by scientists, in which healthy cells are attacked by the immune system mistakenly. Thyroid diseases, including both Hyperthyroidism and Hypothyroidism, are commonly caused by autoimmune reactions that occur in the patient’s body.

The two autoimmune diseases that have been associated with Thyroid diseases include Graves’ disease and Hashimoto’s disease. When a patient develops Graves’ disease, their immune system causes the Thyroid gland to produce an excessive number of Thyroid hormones. In Hashimoto’s disease, however, the immune system’s healthy cells are attacked, and their function becomes impaired. The result is a lower production of essential Thyroid hormones.

Several studies have proven that connections between vitiligo and autoimmune disorders exist. This is especially the case when a patient experiences symptoms of vitiligo brought on by an autoimmune reaction. A variety of autoimmune disease has been connected to vitiligo, including rheumatoid arthritis, psoriasis, pernicious anemia, systemic lupus erythematous, type 1 diabetes, and inflammatory bowel disease.

A multi-author review paper in the frontiers in Endocrinology Journal7 explains that the most common autoimmune disease found among patients with vitiligo, however, is autoimmune thyroid diseases. This includes both Hashimoto’s disease and Graves’ disease.

After analyzing 48 different study papers, published from the year 1968 to 2012, the scientists found that approximately 14.3% of patients with vitiligo have also been diagnosed with autoimmune Thyroid disease. They also found that up to 7% of patients with an autoimmune Thyroid disease also falls under the criteria for diagnosis with vitiligo.

When a further investigation was conducted, blood samples were collected from 79 patients with diagnosed vitiligo. Antibodies that acts against Thyroid hormones were found to be present in 77 of the blood samples that were collected. Even though not all of these patients had fallen under the criteria for a diagnosis of Hypothyroidism or Hashimoto’s disease, the study did conclude that they were at a significantly higher risk of developing the disease.

The conclusion that was made is that there is a connection between these diseases, but not every patient with vitiligo will go on to develop problems with their Thyroid gland. Still, an emphasis is being placed on patient and physician awareness regarding this link that was discovered between the autoimmune diseases.

Patients who are diagnosed with vitiligo are advised to obtain appropriate blood sample tests to help detect the possible presence of Thyroid and Thyroid hormone-related antibodies in their bloodstream. These patients should also be made aware of the symptoms associated with both Hyperthyroidism and Hypothyroidism. When such symptoms develop, further tests should be requested to determine if the patient has developed any of these conditions.

Since the presence of one autoimmune disease increases the likeliness of developing another, prompt treatment of autoimmune Thyroid diseases are advised. While this will not cure the Thyroid disease or vitiligo, it may help to reduce the symptoms associated with the Thyroid-related condition, and potentially prevent that condition from causing symptoms of vitiligo to become aggravated.

Conclusion

Autoimmune disorders can cause the immune system to attack many different parts of the human body. Scientists have discovered that patients with vitiligo caused by an autoimmune reaction are more likely to suffer from an autoimmune disease that attacks the cells of the Thyroid gland as well. This may lead to conditions like Hypothyroidism and Hyperthyroidism, causing the patient to experience symptoms like fatigue, weight gain, depression, and more.

Patients with existing signs of vitiligo are now advised to be tested for both of these Thyroid diseases. Tests should also be conducted to identify the presence of antibodies that may target the Thyroid gland or Thyroid hormones in a patient’s body.  This will help to identify a patient’s risk of developing such a condition and will ensure early treatment can be initiated in the presence of an autoimmune disease that attacks the patient’s Thyroid.

References

1 R. Yaghoobi, M. Omidian, N. Bagherani. Vitiligo: a review of the published work. The Journal of Dermatology. May 2011. https://www.ncbi.nlm.nih.gov/pubmed/21667529

2 P. Manga, N. Elbuluk, S.J. Orlow. Recent advancements in understanding vitiligo. F1000 Research Journal. 6 September 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017284/

3 Vitiligo. Mayo Clinic. 8 March 2018. https://www.mayoclinic.org/diseases-conditions/vitiligo/symptoms-causes/syc-20355912

4 G.A. Brent. Mechanisms of thyroid hormone action. The Journal of Clinical Investigations. 4 September 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433956/

5 S.D. Leo, S.Y. Lee, L.E. Braverman. Hyperthyroidism. HHS Public Access. 30 March 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014602/

6 I. Kostoglou-Athanassiou, K. Ntalles. Hypothyroidism – new aspects of an old disease. Hippokratia Quarterly Medical Journal. 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895281/

7 Multiple Authors. Vitiligo and Autoimmune Thyroid Disorders. Frontiers in Endocrinology. 27 October 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663726/

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