Skip to main content

Advertisement

SpringerLink
Log in

Bidirectional association between alopecia areata and thyroid diseases: a nationwide population-based cohort study

  • Original Paper
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Alopecia areata (AA) has long been associated with thyroid diseases; however, the temporality of their association remains unclear. This study aimed to investigate the bidirectional association between AA and thyroid diseases. In analysis 1, we included 5929 AA patients and 59,290 matched controls to assess the risk of thyroid diseases. In analysis 2, we included 35,071 patients with thyrotoxicosis, 19,227 patients with Graves’ disease, 5460 patients with thyroiditis, 3352 patients with Hashimoto’s thyroiditis, and their matched controls (1:10) to assess the risk of AA. Incidence of thyroid diseases and AA were the outcomes in analysis 1 and analysis 2, respectively. After adjusting the potential confounders, AA patients had an increased risk of all thyroid diseases, including toxic nodular goiter, (aHR 10.17; 95% confidence interval [CI] 5.32–19.44), nontoxic nodular goiter (aHR 5.23; 95% CI 3.76–7.28), thyrotoxicosis (aHR 7.96; 95% CI 6.01–10.54), Graves’ disease (aHR 8.36; 95% CI 5.66–12.35), thyroiditis (aHR 4.04; 95% CI 2.12–7.73), and Hashimoto thyroiditis (aHR 4.35; 95% CI 1.88–10.04). On the contrary, a significantly increased risk of developing AA was observed among patients with thyrotoxicosis (aHR 9.29; 95% CI, 7.11–12.14), Graves’ disease (aHR 8.66; 95% CI 6.03–12.42), and thyroiditis (aHR 6.42; 95% CI 3.15–13.11) but not in patients with Hashimoto’s thyroiditis. In conclusion, our study found a bidirectional association between AA and thyroid diseases, suggesting shared biological mechanisms underlying these two diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of data and material

The data that support the findings of this study are available on request from the corresponding author, but they are not publicly available due to privacy restrictions.

References

  1. Dai YX, Chen TJ, Chang YT (2018) Ambulatory practice of dermatologists in Taiwan: a nationwide survey. J Chin Med Assoc 81:729–734

    Article  Google Scholar 

  2. Safavi KH, Muller SA, Suman VJ, Moshell AN, Melton LJ III (1995) Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989. Mayo Clin Proc 70:628–633

    Article  CAS  Google Scholar 

  3. Dai YX, Chen TJ, Chang YT (2018) Skin care services and disease prevalence in Taiwan: A nationwide study. Dermatol Sin 36:124–130

    Article  Google Scholar 

  4. Dai YX, Chen CC (2019) Tofacitinib therapy for children with severe alopecia areata. J Am Acad Dermatol 80:1164–1166

    Article  Google Scholar 

  5. Strazzulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM et al (2018) Alopecia areata: an appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol 78:15–24

    Article  Google Scholar 

  6. Dai YX, Yeh CP, Chen CC (2020) Efficacy and safety of tofacitinib therapy in Asian patients with severe alopecia areata. Dermatol Sin 38:3–8

    Article  Google Scholar 

  7. Rajabi F, Drake LA, Senna MM, Rezaei N (2018) Alopecia areata: a review of disease pathogenesis. Br J Dermatol 179:1033–1048

    Article  CAS  Google Scholar 

  8. Lee S, Lee H, Lee CH, Lee WS (2019) Comorbidities in alopecia areata: a systematic review and meta-analysis. J Am Acad Dermatol 80:466–477 (e416)

    Article  Google Scholar 

  9. Kasumagic-Halilovic E (2008) Thyroid autoimmunity in patients with alopecia areata. Acta Dermatovenerol Croat 16:123–125

    PubMed  Google Scholar 

  10. Bakry OA, Basha MA, El Shafiee MK, Shehata WA (2014) Thyroid disorders associated with alopecia areata in Egyptian patients. Indian J Dermatol 59:49–55

    Article  Google Scholar 

  11. Diaz-Angulo S, Lopez-Hoyos M, Munoz-Cacho P, Lopez-Escobar M, Gonzalez-Lopez MA (2015) High prevalence of thyroid autoimmunity in patients with alopecia areata and vitiligo: a controlled study. Australas J Dermatol 56:142–143

    Article  Google Scholar 

  12. Kinoshita-Ise M, Martinez-Cabriales SA, Alhusayen R (2019) Chronological association between alopecia areata and autoimmune thyroid diseases: a systematic review and meta-analysis. J Dermatol 46:702–709

    Article  Google Scholar 

  13. Tu HP, Yu CL, Lan CC, Yu S (2017) Prevalence of schizophrenia in patients with psoriasis: a nationwide study. Dermatol Sin 35:1–6

    Article  Google Scholar 

  14. Yu S, Tu HP, Yu CL, Lee CH, Hong CH (2017) Is psoriasis an independent risk factor of renal disease? A nationwide retrospective cohort study from 1996 to 2010. Dermatol Sin 35:78–84

    Article  Google Scholar 

  15. Dai YX, Wang SC, Chou YJ, Chang YT, Chen TJ, Li CP et al (2019) Smoking, but not alcohol, is associated with risk of psoriasis in a Taiwanese population-based cohort study. J Am Acad Dermatol 80:727–734

    Article  Google Scholar 

  16. Dai YX, Chen CC, Tai YH, Chang YT, Chen TJ, Chen MH (2020) Increased risk of major depressive disorder among probands with psoriasis and unaffected siblings: a nationwide population-based study. J Eur Acad Dermatol Venereol 34:1510–1515

    Article  Google Scholar 

  17. Dai YX, Tai YH, Chen CC, Chang YT, Chen TJ, Chen MH (2020) Bidirectional association between alopecia areata and major depressive disorder among probands and unaffected siblings: a nationwide population-based study. J Am Acad Dermatol 82:1131–1137

    Article  Google Scholar 

  18. Chang TH, Ho H, Chang YT, Li CP, Wu CY, Wu CY (2020) Is rosacea a risk factor for cancer: a population-based cohort study in Taiwan. Dermatol Sin 38:15–21

    Article  Google Scholar 

  19. Dai YX, Tai YH, Chang YT, Chen TJ, Chen MH (2020) Association between major depressive disorder and subsequent autoimmune skin diseases: a nationwide population-based cohort study. J Affect Disord 274:334–338. https://doi.org/10.1016/j.jad.2020.05.070[Epub ahead of print]

    Article  PubMed  Google Scholar 

  20. Dai YX, Tai YH, Chen CC, Chang YT, Chen TJ, Chen MH (2020) Bidirectional association between alopecia areata and sleep disorders: a population-based cohort study in Taiwan. Sleep Med. https://doi.org/10.1016/j.sleep.2020.06.015[Epub ahead of print]

    Article  PubMed  Google Scholar 

  21. Dai YX, Yeh FY, Chou YJ, Chang YT, Chen TJ, Li CP et al (2020) Cigarette smoking and risk of rosacea: a nationwide population-based cohort study. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.16595[Epub ahead of print]

    Article  PubMed  Google Scholar 

  22. Conic RZ, Miller R, Piliang M, Bergfeld W, Atanaskova Mesinkovska N (2017) Comorbidities in patients with alopecia areata. J Am Acad Dermatol 76:755–757

    Article  Google Scholar 

  23. Petukhova L, Duvic M, Hordinsky M, Norris D, Price V, Shimomura Y et al (2010) Genome-wide association study in alopecia areata implicates both innate and adaptive immunity. Nature 466:113–117

    Article  CAS  Google Scholar 

  24. Noso S, Park C, Babaya N, Hiromine Y, Harada T, Ito H et al (2015) Organ specificity in autoimmune diseases: thyroid and islet autoimmunity in alopecia areata. J Clin Endocrinol Metab 100:1976–1983

    Article  CAS  Google Scholar 

  25. Welsh EA, Clark HH, Epstein SZ, Reveille JD, Duvic M (1994) Human leukocyte antigen-DQB1*03 alleles are associated with alopecia areata. J Investig Dermatol 103:758–763

    Article  CAS  Google Scholar 

  26. Rekha PL, Valluri V, Rakh SS, Pantula V, Ishaq M (2007) Association of HLA DQ B1* and HLA DR B1* alleles with goitrous juvenile autoimmune hypothyroidism—a case control study. J Clin Immunol 27:486–489

    Article  CAS  Google Scholar 

  27. Ji C, Liu S, Zhu K, Luo H, Li Q, Zhang Y et al (2018) HLA-DRB1 polymorphisms and alopecia areata disease risk: A systematic review and meta-analysis. Medicine (Baltim) 97:e11790

    Article  CAS  Google Scholar 

  28. Boehm BO, Kuhnl P, Manfras BJ, Chen M, Lee JC, Holzberger G et al (1992) HLA-DRB3 gene alleles in Caucasian patients with Graves’ disease. Clin Investig 70:956–960

    Article  CAS  Google Scholar 

  29. Chen QY, Huang W, She JX, Baxter F, Volpe R, Maclaren NK (1999) HLA-DRB1*08, DRB1*03/DRB3*0101, and DRB3*0202 are susceptibility genes for Graves’ disease in North American Caucasians, whereas DRB1*07 is protective. J Clin Endocrinol Metab 84:3182–3186

    CAS  PubMed  Google Scholar 

  30. Dejaco C, Duftner C, Grubeck-Loebenstein B, Schirmer M (2006) Imbalance of regulatory T cells in human autoimmune diseases. Immunology 117:289–300

    Article  CAS  Google Scholar 

  31. Marazuela M, Garcia-Lopez MA, Figueroa-Vega N, de la Fuente H, Alvarado-Sanchez B, Monsivais-Urenda A et al (2006) Regulatory T cells in human autoimmune thyroid disease. J Clin Endocrinol Metab 91:3639–3646

    Article  CAS  Google Scholar 

  32. Han YM, Sheng YY, Xu F, Qi SS, Liu XJ, Hu RM et al (2015) Imbalance of T-helper 17 and regulatory T cells in patients with alopecia areata. J Dermatol 42:981–988

    Article  CAS  Google Scholar 

  33. Speiser JJ, Mondo D, Mehta V, Marcial SA, Kini A, Hutchens KA (2019) Regulatory T-cells in alopecia areata. J Cutan Pathol 46:653–658

    Article  Google Scholar 

Download references

Acknowledgements

This study was funded by the Ministry of Science and Technology, R.O.C. under Grant (MOST 107-2314-B-075-032-MY3-2).

Funding

This study was funded by the Ministry of Science and Technology, R.O.C. under Grant (MOST 107-2314-B-075-032-MY3-2).

Author information

Authors and Affiliations

  1. Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan

    Ying-Xiu Dai & Yun-Ting Chang

  2. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Ying-Xiu Dai, Ying-Hsuan Tai, Yun-Ting Chang, Tzeng-Ji Chen & Mu-Hong Chen

  3. Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Ying-Hsuan Tai

  4. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Ying-Hsuan Tai

  5. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Tzeng-Ji Chen

  6. Department of Psychiatry, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd, Beitou District, Taipei, 11217, Taiwan ROC

    Mu-Hong Chen

Authors
  1. Ying-Xiu Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ying-Hsuan Tai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yun-Ting Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tzeng-Ji Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mu-Hong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M-HC had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: all authors. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: Y-XD. critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: Y-HT.

Corresponding author

Correspondence to Mu-Hong Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board of Taipei Veterans General Hospital (2018-07-016AC).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dai, YX., Tai, YH., Chang, YT. et al. Bidirectional association between alopecia areata and thyroid diseases: a nationwide population-based cohort study. Arch Dermatol Res 313, 339–346 (2021). https://doi.org/10.1007/s00403-020-02109-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-020-02109-7

Keywords

Search

Navigation