Clinic Speak: thyroid disease is not just a problem with alemtuzumab

Thyroid disease; do you know about its link with MS? #ClinicSpeak #MSResearch #MSBlog

“Co-morbidties (other diseases), in particular associated autoimmune diseases, are a common problem in MSers. As part of an holistic approach to MS we need to be aware of this and monitor for them. Thyroid disease is one of he biggies, simply because it is so common. The lifetime prevalence of autoimmune thyroid disease in MSers is about double the background rate with ~10% of MSers developing an under active thyroid or hypothyroidism. One the commonest symptoms of hypothyroidism is fatigue, lack of energy and mood problems. These symptoms are so common that I routinely monitor thyroid function in all the MSers under my care on an annual basis who have these symptoms. I typically pick-up one, or may be 2 cases, a year that need thyroid replacement therapy. Recently the practice of non-evidence based routine blood screening has been queried by NHS managers as waste of NHS resources. We now to need to justify our practice based on medical need and cost-effectiveness. Unfortunately, we don;t have the evidence at hand, which is why we have asked one of our trainees to audit the practice of doing routine annual thyroid function tests to see how much it costs and how many people it picks up with thyroid function problems.”

“The article below highlights the problem in MSers starting interferon-beta of GA treatment and supports routine monitoring. As you should be aware thyroid disease is a major issue post  alemtuzumab treatment with about 40% of woman and 20% of men developing autoimmune thyroid disease within 5 years of receiving the treatment. In this situation it is recommended that thyroid function in monitored every 3 months for up to, and possibly beyond, 4 years. This is not a trivial problem and MSers will need to be highly motivated to go the course.”

“Does your neurologist or MS health care provider monitor your thyroid function on a regular basis?”

Epub: Frisullo et al. Thyroid autoimmunity and dysfunction in multiple sclerosis patients during long-term treatment with interferon beta or glatiramer acetate: an Italian multicenter study. Mult Scler. 2014.

Background: Few long-term follow-up data are available on thyroid dysfunction (TD) in MSers treated with glatiramer acetate (GA) or with interferon-beta (IFNb). 

Methods & Results: In a cohort of 787 relapsing-remitting MSers whom were followed up for 8 years, we observed an increased prevalence of TD and thyroid autoimmunity (TA) within the first year of IFNb treatment, regardless of the dose or frequency of administration, while no change was observed with GA treatment.

Conclusions: The increased prevalence of TD and TA within the first year of IFNb treatment suggested the need for close monitoring of thyroid function and autoimmunity, though only during the first year of IFNb treatment.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

1 comment

  • My doctor does not monitor for thyroid function, though I am on GA (is there anything that GA does[?]). Interestingly my mother and sistser had hoshimotos disease and I ended up with MS. They must be interrelated.

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