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JAMA Insights
Women's Health
May 3, 2021

Autoimmune Thyroid Disease in Women

Author Affiliations
  • 1Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
  • 2Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • 3Associate Editor, JAMA
JAMA. 2021;325(23):2392-2393. doi:10.1001/jama.2020.22196

Thyroid dysfunction is more common in women than in men. The female predominance is attributed to sex differences in immune function, similar to many autoimmune diseases. More than 80% of patients with acute or chronic thyroiditis and resulting hypothyroidism have antithyroid autoantibodies,1 as well as B-cell and T-cell infiltration of the thyroid gland, consistent with an autoimmune etiology. In a US sample, the prevalence of autoantibodies against the thyroid antigen thyroid peroxidase (TPO) ranged from 3% of teenage males and 7% of teenage females to 12% of men and 30% of women older than 80 years.2 At every age, women were twice as likely to have TPO antibodies as men, and Black women were half as likely to have TPO antibodies as White women. Although they are sensitive for thyroid dysfunction, TPO antibodies are not specific and frequently occur in the absence of thyroid dysfunction and presence of other autoimmune conditions. Antibodies against the thyroid antigen thyroglobulin are less prevalent and less strongly associated with thyroid dysfunction, while those that act as agonists for the thyrotropin receptor are pathogenic in Graves disease, which is more common in Black women. Because many individuals with TPO antibodies have normal thyroid function, other factors play a major role in determining when, if ever, thyroid dysfunction develops. For women, the profound physiologic changes associated with different life stages affect the timing of presentation of thyroid disease.

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