According to estimates, about 6% of patients with lupus also have hypothyroidism and 1% hyperthyroidism. Hashimoto’s disease is the most common form of hypothyroidism in patients with lupus. This finding doesn’t come as a surprise because both conditions are autoimmune diseases with a common etiology.
Lupus is a systemic autoimmune disease that can target almost any part of the body, especially the joints, lungs, heart, skin, blood, kidneys and brain.
In Hashimoto’s the immune system attacks only the thyroid, however a lack of thyroid hormones can affect all bodily functions and any organs. As a result when lupus and a thyroid disease coexist it can have a much bigger negative impact on your body. Many symptoms of both disorders can overlap and drive each other making the diagnosis and treatment even more difficult.
It can take years for Hashimoto’s disease and lupus to develop and progress to the stage when a person can be diagnosed with a standard testing. This can lead to a missed or delayed diagnosis and treatment or being labled as “borderline”.
A timely diagnosis is very important because the longer a person remains undiagnosed and not treated, the greater the damage to the affected organs become and the more difficult to deal with it in time.
5 Explanations Of Lupus And Hashimoto’s Co-existence
Presence of more than two autoimmune diseases in one patient is known as multiple autoimmune syndrome (MAS). In fact, it is not uncommon for both SLE and Hashimoto’s patients to have other autoimmune diseases and develop polyautoimmunity. For example, people with Hashimoto’s are at 50% risk to develop one or more autoimmune condition during their lives.
Antibodies are used as one of the diagnostic criteria for many autoimmune conditions. In the case of Hashimoto’s disease TPO and/or Tg thyroid antibodies often become elevated, while in lupus ANA antibodies are present in up to 96% of patients.
Several research studies showed that up to 35% of patients with Hashimoto’s also have a presence of ANA-antibodies which means that SLE and Hashimoto’s are very likely to share a common underlying immunogenetic mechanism.
2. Some lupus drugs can induce Hashimoto’s in susceptible individuals
Many lupus drugs target the immune system and as a result the majority of people with lupus are treated with immune modulating or immunosuppressive medications. While this type of treatment can provide many benefits, immune modulations can trigger another autoimmune conditions.
Furthermore, a restoration of balance may be difficult to achieve because insufficient or excessive cell activation achieved with immune modulating drugs can predispose to autoimmunity.
Hashimoto’s thyroiditis has been considered to be a Th1 dominant autoimmune condition when Th2 part of the immune system is suppressed (read more about it here). While SLE is a disease in which Th2 cells predominate, lupus patients with class IV lupus nephritis show a strong predominance of Th1.
This means if the immune system is pushed too hard and too far from Th2 into the Th1 zone it can trigger the development of another autoimmune disease like Hashimoto’s thyroiditis which is Th1 predominant.
3. A direct connection between lupus and thyrotoxicity
The coexistence of lupus and thyrotoxicosis can have different expressions. In some patients thyrotoxicosis preceded the onset of SLE, in others the signs of SLE appear first and in some people both diseases begin simultaneously.
Further evidence of the close association between SLE and Hashimoto’s is that the discontinuation of lupus therapy has been reported to be associated with a relapse of thyrotoxicity or hashitoxicosis.
Other studies reported that there is the possibility of drug-induced SLE in some patients, treated with antithyroid drugs.
Many symptoms of lupus and Hashimoto’s can be very similar, however some doctors might not think to check for thyroid conditions in a person with lupus. There is often a presumption of a lupus flare or potentially a reaction to a lupus drug when it actually may be another issue such as thyrotoxicity or hashitoxicosis.
4. Estrogen dominance as a trigger
Estrogens has a direct influence on the susceptibility to both Hashimoto’s and SLE. As evidenced by predominance of both conditions in women and onset during the major hormonal shifts during puberty, pregnancy and around menopause.
In addition high estrogen and low DHEA tend to increase the symptoms. The inability to detoxify estrogen properly by the liver which is typical in people who have a combination of Hashimoto’s and hypothyroidism, needs to be considered as a part of the puzzle.
5. Genetic predisposition
A genetic predisposition is a necessary precondition for a person to develop a particular health condition. Lupus and thyroid autoimmune disease are not an exception. The bottom line is that if you don’t have specific genes that are linked to lupus or Hashimoto’s you cannot develop these health conditions.
On the other hand having genetic predisposition doesn’t mean that you get a particular disease because other factors like environmental triggers, infections, bacteria, viruses, increased intestinal permeability are also involved. An interplay between all of them creates a ground for an autoimmune disease to develop while having just one of them present is not enough.
Lupus tends to occur in families. Siblings of SLE patients have a risk of about 2% to develop this disease as well. However, only 25% of even identical twins with SLE are concordant for disease and therefore about 75% of cases are where one twin has SLE and one does not (or discordant).
Recent research studies identified a group of genes that were linked to Hashimoto’s (you can read about it here) and 50 genetic associations with lupus based on the Genome-wide genetic association studies (GWAS). Interestingly enough, some of them overlap.
For example, HLA group of genes seems to be common in both Hashimoto’s disease and lupus patients. However, it also depends on a genotype. In some cases, HLA genes are more highly related to lupus-associated autoantibodies than to lupus itself. While in others having specific HLA genotypes increases the risk of lupus two-folds.
More research is needed. Your DNA could play a critical role in developing lupus treatments.
So What Can You Do?
1. Stop systemic autoimmunity
An important aspect to understand is that if you have multiple autoimmune conditions like a combination of Hashimoto’s disease and lupus it means active systemic autoimmunity is present. The very first step you need to take in order to stop the progression of autoimmune disease and improve your symptoms is to close the door of systemic autoimmunity.
Here is how to stop and prevent autoimmune disease link
2. Get an optimal thyroid treatment
A proper thyroid treatment can not only improve hypothyroid and Hashimoto’s symptoms but also ease lupus symptoms.
As I mentioned before many lupus and Hashimoto’s symptoms like profound fatigue, hair loss, poor blood circulation in fingers and toes, insomnia, joint and muscle pain are overlapping and can be caused by both conditions. When lupus and thyroid problems coexist in one person often it is difficult to say which of them contributes to the same symptoms: whether lupus or hypothyroidism cause, for example fatigue.
If you have thyroid problems they need to be treated. However, having your TSH within normal reference range may not be enough to improve your symptoms. This reference range is too wide and actually TSH test alone doesn’t give any information whether you have Hashimoto’s disease or not.
Your goal is to get an optimal hypothyroidism treatment that allows you to achieve a complete or partial improvement of some symptoms. Then you could focus on the remaining symptoms that can be solely due to lupus.
Lupus affects everyone differently by targeting kidneys, brain, heart, skin and liver. In fact, a properly functioning thyroid gland can positively affect the function of these organs and improve it to some degree even if they are affected by lupus.
3. Consider taking genetic test
Nowadays genetic testing has become widely available and can provide you with information that can be used for health risk assessment and bring more clarity to treatment of polyautoimmunity. Genetic based therapies have a big future and sound very promising.
However, the major challenge in working on new therapies for SLE is the difficulty in conducting large-scale clinical trials and research studies in this highly complex disease.
Consider taking a genetic test and learn how your genetic can be related to your lupus and Hashimoto’s.
P.S. You can get a genetic testing here: Understand what your DNA says about your health, traits and family history. Explore Your DNA Today at 23andMe.com. Get 10% off each additional kit.
1.Presence of systemic autoimmune disorders in patients with autoimmune thyroid diseases. Ann Rheum Dis 2004;63:1159-1161
2. An imbalance between Th1 and Th2-like cytokines in patients with autoimmune diseases-differential diagnosis between Th1 dominant autoimmune diseases and Th2 dominant autoimmune diseases. Nihon Rinsho. 1997 Jun;55(6):1438-43.
3. The Coexistence of Systemic Lupus Erythematosus and Thyrotoxicosis: The Diagnostic Value of Antihistone Antibodies. Case Reports in Rheumatology
4. Coexistence of systemic lupus erythematosus, Hashimoto’s thyroiditis, and bilateral breast cancer in the same patient: a random association? Acta Dermatovenerol. Apa, 13, 2015