Thyroid abnormality can be associated with rheumatoid arthritis severity

Rheumatoid Arthritis (RA) and autoimmune thyroid disease (AITD) are the two most prevalent coexisting autoimmune diseases due to their similar pathogenesis. A recent study published in the journal BMC Endocrine Disorder reported that among RA patients with more severe disease activity, thyroid dysfunction, anti-thyroid peroxidase (anti-TPO) antibody positivity, and AITD were considerably more prevalent.  

The cross-sectional observational study was conducted by Yazdanifar and colleagues comprising 350 RA patients registered between April 2021 and March 2022, at the Shahid Beheshti Tertiary Care Centre in Qom, Iran. Patients were assigned to remission (111 patients), mild-to-moderate (96 patients), and severe disease activity (138 patients) groups. The rate of anti-TPO antibody positivity was found to be 2.93 times higher in patients with severe disease compared to those in the remission subgroup (OR: 2.93; P <0.001). Patients with severe disease were almost 2.7 times more likely to have AITD (OR: 2.71; P < 0.001) and they had an 82% higher likelihood of having thyroid dysfunction compared to patients in remission (OR = 1.82; P = 0.006). 

A study by Joshi et al., involving 52 RA patients, demonstrated a significantly elevated level of erythrocyte sedimentation rates (ESR) in patients with hypothyroidism compared to those without hypothyroidism. They also found significantly higher Disease Activity Score-28 for RA with ESR (DAS28-ESR) scores, tender joint counts, and visual analogue scale scores in RA patients with hypothyroidism. Additionally, serum thyroid-stimulating hormone (TSH) levels were significantly correlated with ESR and DAS28-ESR. 

Thyroid abnormalities, such as thyroid dysfunction and comorbidity with autoimmune thyroid disease (AITD), can significantly impact the severity of RA. This interaction can have substantial consequences on the quality of life and prognosis of individuals with RA. Therefore, it is crucial to incorporate thyroid function tests into the clinical assessment of RA patients. By assessing the thyroid function of RA patients, healthcare providers can expand their approach to managing RA and addressing its numerous complications, leading to more comprehensive and effective care. 


  1. Yazdanifar MA, Bagherzadeh-Fard M, Habibi MA, Vahedian M, Bagherzadeh M, Masoumi M. The association between thyroid dysfunction, autoimmune thyroid disease, and rheumatoid arthritis disease severity. BMC Endocr Disord. 2023 Oct 5;23(1):212.  
  1. Joshi P, Agarwal A, Vyas S, Kumar R. Prevalence of hypothyroidism in rheumatoid arthritis and its correlation with disease activity. Trop Doct. 2017 Jan;47(1):6–10.