A reason for thyroid problems

Greer JM, Broadley S, Pender MP. Reactivity to Novel Autoantigens in Patients with Coexisting Central Nervous System Demyelinating Disease and Autoimmune Thyroid Disease. Front Immunol. 2017 May 8;8:514.

Several lines of evidence suggest a definite and unique link between CNS demyelinating diseases and autoimmune thyroid disease (AITD). The aim of the current study was to systematically compare the clinical and laboratory features of patients with co-existent AITD and CNS demyelinating disease with those of patients with just CNS demyelinating disease. Forty-four patients with co-existing CNS demyelinating disease and AITD were identified and their clinical and radiological features were recorded. Blood and DNA were collected and tested for HLA type and for the response of T cells and antibodies to a variety of antigens. Patients with multiple sclerosis (MS) without AITD and healthy individuals were included as controls. Patients with co-existing AITD and CNS demyelinating disease were almost exclusively female (43/44) and had prominent spinal cord involvement as the main neurological finding. The HLA molecules carried by individuals with CNS demyelinating disease and AITD differed from both other MS patients and healthy individuals. Furthermore, patients with both CNS disease and AITD showed less T cell reactivity than patients with MS alone to myelin proteolipid protein, but, compared to other groups, showed elevated levels of T cell reactivity to the calcitonin gene-related peptide, which is present in both the CNS and the thyroid, and elevated levels of T cell and antibody to the leucine-rich repeat-containing G-protein coupled receptor 4 (LGR4), a molecule that is expressed in the brainstem and spinal cord, and which is a homolog of the thyroid-stimulating hormone receptor. We suggest that reactivity of autoreactive immune cells in these patients against antigens present in both the thyroid and the spinal cord is a potential mechanism underlying the pattern of lesion development in the CNS in patients with coexisting AITD and MS and might indicate a novel mechanism of disease pathogenesis in these patients.

Thyroid disease occurs in people with MS. Notably it is a common occurrence in people with MS, notably in those treated with alemtuzumab. In this study they suggest there is a common target in both tissues to explain the finding that MS and thyroid disease can co-exist and maybe this is why the thyroid problems occur. Reactivity to  Calcitonin gene-related peptide occurred ,which is a nerve transmitter found in nerves all over the body. Leucine-rich repeat-containing G-protein coupled receptor 4 is found in a number of organs. So it can be a cross-reactivity, but why the common occurence of MS and thyroid verses MS other things.
There are other explanations

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  • The other explanations may be more important. ..If we consider the neuro endocrine-immune axis, would make sense to see more links between MS, hormone dysfunctions and /or other autoimmune diseases.
    Oligodendrocytes not only produce brain steroids , but also myelin- under the influence of the thyroid hormones. Since almost all patients were females, would have been interesting to test progesterone, dhea and pregnenolone.

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