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A Population-Based Study of Chronic Autoimmune Hypothyroidism in Danish Twins¹

Department of Endocrinology M, Odense University Hospital (T.H.B., L.H.), and the Danish Twin Register, Odense University (T.H.B., K.O.K.), DK-5000 Odense C, Denmark

Address all correspondence and requests for reprints to: Dr. Thomas Heiberg Brix, The Danish Twin Register, Odense University, Winsløwparken 15 st., DK 5000 Odense C, Denmark. E-mail: tBRIX{at}HEALTH SDU.OK.

Hashimoto’s thyroiditis (HT), atrophic thyroiditis (AT), and Graves’ disease are autoimmune thyroid diseases in which genetic factors are suspected to play an important role in disease susceptibility. In a recent population-based twin study we rendered it probable that a substantial part of the susceptibility to Graves’ disease is attributable to genetic factors. At present there are no population-based twin studies supporting such a genetic influence in the etiology of HT/AT.

To elucidate whether there is a genetic influence in the etiology of HT/AT, we studied the distribution of HT/AT in a population-based sample of 2945 Danish female-female twin pairs (5890 individuals) born between 1953 and 1972. Information on hypothyroidism was obtained from a nationwide questionnaire survey in 1994. Information from hospitals, out-patient clinics, general practitioners, and specialists was sought to verify the diagnosis.

The overall prevalence of autoimmune hypothyroidism was 0.41% (24 of 5890). The prevalence did not differ between monozygotic and dizygotic twins (0.42% and 0.40%, respectively). The crude probandwise concordance rates were significantly higher for monozygotic compared to dizygotic twin pairs: 0.55 (95% confidence interval, 0.23–0.83) vs. 0.0 (95% confidence interval, 0.0–0.25; P = 0.01). All of the healthy cotwins (n = 15) of twins with clinically overt autoimmune hypothyroidism were biochemically euthyroid. Overall, regardless of zygosity 53% (8 of 15) of the healthy cotwins were positive for antithyroid antibodies. The prevalence of autoantibodies among the monozygotic cotwins was 80% (4 of 5) and 40% (4 of 10) among dizygotic cotwins (P = 0.36).

In conclusion, the higher concordance rate in monozygotic compared to dizygotic pairs indicates that genetic factors play a role in the etiology of HT/AT among Caucasian women living in areas with borderline iodine deficiency. However, the fact that the concordance rate among MZ twins was below 1 suggests that environmental factors also are of etiological importance.

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