» autoimmune thyroiditis

Vitiligo must be treated as an autoimmune disorder

Dr. Jonathan — Fri, 08 Jan 2010 00:08:22 +0000

It has come to my attention that many are still not aware that vitiligo, a condition that causes skin to lose its normal pigmentation, is an autoimmune disorder and must be treated as such. A cursory review of the literature turns up an abundance of evidence:

Frontiers and controversies in the pathobiology of vitiligo: separating the wheat from the chaff

“There is a body of interlocking, compelling evidence supporting an autoimmune basis for most or all cases of generalized vitiligo. The development of an autoimmune disease generally involves three components; the immune system, environmental triggers and other exogenous precipitating factors, and the target tissue. In vitiligo, precipitating factors could induce melanocyte damage in genetically susceptible individuals and consequent cell death, loss of tolerance, and induction of melanocyte-directed autoimmunity.”

Immunological pathomechanisms in vitiligo

“Briefly, circulating autoantibodies and autoreactive T cells that recognise pigment cell antigens have been detected in the sera of a significant proportion of vitiligo patients compared with healthy individuals. In addition, vitiligo is often associated with other disorders that have an autoimmune origin, including Hashimoto’s thyroiditis, Graves’ disease, type 1 insulin-dependent diabetes mellitus and Addison’s disease.”

Autoimmune Etiology of Generalized Vitiligo

“Vitiligo is characterized by progressive skin depigmentation resulting from an autoimmune response targeting epidermal melanocytes…Type I cytokine-mediated immunity to melanocytes in vitiligo involves T cells reactive with melanosomal antigens…”

Autoimmune Destruction of Skin Melanocytes by Perilesional T Cells from Vitiligo Patients

“Our data show that perilesional cytotoxic T cells eradicate pigment cells, the characteristic hallmark of vitiligo, thereby providing evidence of T cells being able to mediate targeted autoimmune tissue destruction.”

Prediction and prevention of autoimmune skin disorders

“Autoimmune diseases can be preceded by a symptom-free phase which is defined by the presence of autoantibodies, and may last for many years…Characteristic autoantibodies and susceptible genes have been identified in many autoimmune systemic and mucocutaneous diseases such as systemic lupus erythematosus, pemphigus, vitiligo, dermatitis hepretiformis and even psoriasis…Prevention of overt disease may be achieved once high-risk individuals are identified and triggering factors are avoided. Numerous environmental factors, such as vitamin D deficiency, ultraviolet light, smoking, drugs, etc., that may trigger autoimmunity have been found.”

Moreover, an interesting and important connection with conditions such as autoimmune thyroiditis and type 1 diabetes has been observed:

Autoimmune Aspects of Vitiligo

“In brief, the disease is frequently associated with other disorders which have an autoimmune origin such as autoimmune thyroiditis and insulin-dependent diabetes mellitus. Furthermore, circulating antibodies and T lymphocytes which react against melanocyte antigens are present in the sera of a significant proportion of vitiligo patients compared with healthy individuals.”

High frequency of thyroid dysfunction in patients with vitiligo

“An association between vitiligo and autoimmune thyroid disease has previously been suspected…There appears to be an increased frequency of clinical as well as subclinical thyroid disease in patients with vitiligo. Our findings support the theory of vitiligo being an autoimmune disease and indicate a need for screening vitiligo patients for thyroid disease.”

Of keen interest and significance is the overlap with genes involved in gluten sensitivity:

HLA-DQA1*0301-Associated Susceptibility for Autoimmune Polyglandular Syndrome Type II and III

“We determined the HLA-DR and HLA-DQA1 association in 112 unrelated patients with APS II (n = 29), APS III (n = 83) and 184 unrelated patients with single-component diseases without further manifestations of APS: Graves’ disease, Hashimoto’s thyroiditis, autoimmune Addison’s disease, vitiligo and alopecia…”

Due to its prevalence, treating the causes of autoimmunity is a major part of a functional medicine practice.

Schizophrenia and autoimmune diseases

Dr. Jonathan — Wed, 25 Nov 2009 01:29:03 +0000

This important paper was published in the American Journal of Psychiatry. The authors state, “Thyrotoxicosis, celiac disease, acquired hemolytic anemia, interstitial cystitis, and Sjögren’s syndrome had higher prevalence rates among patients with schizophrenia,” and further conclude, “Schizophrenia is associated with a larger range of autoimmune diseases than heretofore suspected. Future research on comorbidity has the potential to advance understanding of pathogenesis of both psychiatric and autoimmune disorders.” In my experience, the autoimmune component must be recognized and treated. A couple related studies:

Vitamin D deficiency and schizophrenia published in Schizophrenia Bulletin in April, 2009
Gluten sensitivity and schizophrenia also in Schizophrenia Bulletin in June, 2009

Children with type 1 diabetes: autoimmune thyroid & celiac diseases more common

Dr. Jonathan — Fri, 20 Nov 2009 00:34:12 +0000

Most Lapis Light patients understand that when the genes for autoimmune disease are turned on, rarely is there only one tissue target for the inflammatory immune reaction. This paper from the journal Pediatric Endocrinology, Diabetes and Metabolism concludes: “Autoimmune thyroid disease and celiac disease occur more frequently in children with T1DM, therefore screening at an onset and repeated measurements are recommended.”

Celiac Disease and Autoimmune Thyroid Disease

Dr. Jonathan — Tue, 17 Nov 2009 22:42:11 +0000

This paper from the journal Clinical Medicine & Research is an extensive review of the strong association between celiac disease and autoimmune thyroid disease. Two things to bear in mind: (1) most thyroid disease is autoimmune; (2) this paper does not encompass the more widespread non-celiac gluten sensitivity. They conclude: “Treatmentof CD with a gluten-free diet should reduce the recognized complicationsof this [autoimmune thyroid] disease and provide benefits in both general healthand perhaps life expectancy. It also improves glycemic controlin patients with type 1 diabetes mellitus…”

Autoimmune thyroiditis and celiac disease

Dr. Jonathan — Mon, 16 Nov 2009 23:40:25 +0000

Numerous studies have noted the association of autoimmune thyroid disease and celiac disease (not to mention the more widespread non-celiac gluten sensitivity). This recent paper in Nature Reviews Endocrinology asserts that “Clinicians should screen for autoimmune thyroiditis in all patients with celiac disease.”