Risk of Incident Autoimmune Diseases in Patients with Thymectomy

Overview

Journal Ann Clin Transl Neurol

Specialty Neurology

Date 2020 Jun 2

PMID 32478484

Citations 6

Authors

Tzu-Min Lin

Yu-Sheng Chang

Tsung-Yun Hou

Hui-Ching Hsu

Sheng-Hung Lin

Wei-Sheng Chen

Pei-I Kuo

Yi-Chun Lin

Jin-Hua Chen

Chi-Ching Chang

Affiliations

Soon will be listed here.

Abstract

Objectives: The data concerning the association between Tx and ADs remain unclear and are scarce. This study was undertaken to investigate whether people with Tx are more likely to develop ADs, compared to those without Tx.

Methods: Individuals who received Tx between 2002 and 2015 were identified and matched on age and sex with individuals without Tx. We performed multivariate and stratified analysis using the Kaplan-Meier method and Cox proportional hazards models in order to estimate the association between Tx and the risk of developing ADs.

Results: A total of 2550 thymectomized (Txd) patients and 24,664.941 non-Txd comparison subjects were selected from NHIRD. Tx-MG (myasthenia gravis) as compared with general population (nonTx-nonMG), adjusted hazard ratio (aHR) were higher for incident Addison disease (aHR = 10.40, 95% CI 1.01-107), autoimmune hemolytic anemia (aHR = 21.54, 95% CI 2.06-14.8), Hashmoto thyroiditis (aHR = 5.52, 95% CI 1.34-34.7), ankylosing spondylitis (aHR = 2.73, 95% CI 1.09-6.84), rheumatoid arthritis (aHR = 5.25, 95% CI 1.79-15.47), primary Sjogren syndrome (pSS) (aHR = 3.77, 95% CI 1.30-11.0), and systemic lupus erythemtoasus (aHR = 10.40). Tx-nonMG as compared with general population, aHR were higher for incident autoimmune hemolytic anemia (aHR = 25.50), Hashmoto thyroiditis (aHR = 6.75) and systemic lupus erythematosus (SLE) (aHR = 13.38). NonTx-MG as compared with general population, aHR were higher for incident Hashmoto thyroiditis (aHR = 6.57), pSS (aHR = 4.50), SLE (aHR = 17.29), and systemic vasculitis (aHR = 25.86).

Interpretation: In conclusion, based on a retrospective cohort study throughout Taiwan, patients with Tx have a higher risk of new onset ADs than patients without Tx.

Citing Articles

Physiological and pathological roles of the thymus and value of thymectomy in myasthenia gravis: a narrative review.

Waheed W, Bacopulos A, Seyam M, Kooperkamp H, Moin M, Malik T Mediastinum. 2024; 8:31.

PMID: 38881805 PMC: 11177005. DOI: 10.21037/med-23-43.

Post-Thymectomy Autoimmune Flare-Up With New-Onset Type 1 Diabetes Mellitus.

Al-Bkoor T, Ata F, Bilal A, Abdulgayoom M, Cherif H, Surchi H JCEM Case Rep. 2024; 2(3):luae039.

PMID: 38524389 PMC: 10958770. DOI: 10.1210/jcemcr/luae039.

Case report: Seropositive myasthenia gravis complicated by limbic encephalitis positive for antibodies to AMPAR and Lgi1.

Nes M, Haugen M, Haugland H, Gilhus N, Vedeler C Front Neurol. 2023; 14:1237140.

PMID: 37900608 PMC: 10602774. DOI: 10.3389/fneur.2023.1237140.

Clinical characteristics of myasthenia gravis (MG) patients developing other autoimmune diseases after thymectomy from one single center cohort.

Tian W, He J, Yu H, Sun Y, Wu Q, Jiao P Thorac Cancer. 2022; 14(2):135-142.

PMID: 36419347 PMC: 9834700. DOI: 10.1111/1759-7714.14723.

Autoimmune Disease in Patients With Advanced Thymic Epithelial Tumors.

Singhal S, Hellyer J, Ouseph M, Wakelee H, Padda S JTO Clin Res Rep. 2022; 3(5):100323.

PMID: 35601925 PMC: 9121321. DOI: 10.1016/j.jtocrr.2022.100323.

References

Galbraith R, Summerskill W, Murray J . SYSTEMIC LUPUS ERYTHEMATOSUS, CIRRHOSIS AND ULCERATIVE COLITIS AFTER THYMECTOMY FOR MYASTHENIA GRAVIS. N Engl J Med. 1964; 270:229-31. DOI: 10.1056/NEJM196401302700504. View

Leavitt R, Fauci A, Bloch D, Michel B, Hunder G, Arend W . The American College of Rheumatology 1990 criteria for the classification of Wegener's granulomatosis. Arthritis Rheum. 1990; 33(8):1101-7. DOI: 10.1002/art.1780330807. View

Scheinecker C, Bonelli M, Smolen J . Pathogenetic aspects of systemic lupus erythematosus with an emphasis on regulatory T cells. J Autoimmun. 2010; 35(3):269-75. DOI: 10.1016/j.jaut.2010.06.018. View

Le Loet X, Pouyol F, Lees O, Ducastelle T, Godin M, Deshayes P . [Acute systemic lupus erythematosus after thymectomy for myasthenia. Sequential study of lymphocyte subpopulations]. Rev Med Interne. 1986; 7(4):425-32. DOI: 10.1016/s0248-8663(86)80134-5. View

Omar H, Alzahrani M, Al Bshabshe A, Assiri A, Shalaby M, Dwedar A . Systemic lupus erythematosus after thymectomy for myasthenia gravis: a case report and review of the literature. Clin Exp Nephrol. 2010; 14(3):272-6. DOI: 10.1007/s10157-009-0256-5. View

Hunder G, Bloch D, Michel B, STEVENS M, Arend W, Calabrese L . The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990; 33(8):1122-8. DOI: 10.1002/art.1780330810. View

Bohan A, Peter J . Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975; 292(7):344-7. DOI: 10.1056/NEJM197502132920706. View

Tung K . Mechanism of self-tolerance and events leading to autoimmune disease and autoantibody response. Clin Immunol Immunopathol. 1994; 73(3):275-82. DOI: 10.1006/clin.1994.1199. View

Bohan A, Peter J . Polymyositis and dermatomyositis (second of two parts). N Engl J Med. 1975; 292(8):403-7. DOI: 10.1056/NEJM197502202920807. View

10.

Simpson J . IMMUNOLOGICAL DISTURBANCES IN MYASTHENIA GRAVIS WITH A REPORT OF HASHIMOTO'S DISEASE DEVELOPING AFTER THYMECTOMY. J Neurol Neurosurg Psychiatry. 1964; 27:485-92. PMC: 495787. DOI: 10.1136/jnnp.27.6.485. View

11.

Chang C, Lin T, Chang Y, Chen W, Sheu J, Chen Y . Thymectomy in patients with myasthenia gravis increases the risk of autoimmune rheumatic diseases: a nationwide cohort study. Rheumatology (Oxford). 2018; 58(1):135-143. DOI: 10.1093/rheumatology/key236. View

12.

Tung K . Elucidation of autoimmune disease mechanism based on testicular and ovarian autoimmune disease models. Horm Metab Res. 1995; 27(12):539-43. DOI: 10.1055/s-2007-980021. View

13.

Miller J, Osoba D . Current concepts of the immunological function of the thymus. Physiol Rev. 1967; 47(3):437-520. DOI: 10.1152/physrev.1967.47.3.437. View

14.

Shoenfeld Y, Lorber M, Yucel T, Yazici H . Primary antiphospholipid syndrome emerging following thymectomy for myasthenia gravis: additional evidence for the kaleidoscope of autoimmunity. Lupus. 1997; 6(5):474-6. DOI: 10.1177/096120339700600511. View

15.

Halnon N, Cooper P, Chen D, Boechat M, Uittenbogaart C . Immune dysregulation after cardiothoracic surgery and incidental thymectomy: maintenance of regulatory T cells despite impaired thymopoiesis. Clin Dev Immunol. 2011; 2011:915864. PMC: 3138054. DOI: 10.1155/2011/915864. View

16.

Itoh M, Takahashi T, Sakaguchi N, KUNIYASU Y, Shimizu J, Otsuka F . Thymus and autoimmunity: production of CD25+CD4+ naturally anergic and suppressive T cells as a key function of the thymus in maintaining immunologic self-tolerance. J Immunol. 1999; 162(9):5317-26. View

17.

MIZON J, Morcamp D, Lefebvre P, Froissart M, Guidicelli C, Goasguen J . [Associated myasthenia and disseminated lupus erythematosus. A report on two cases and complete review of the published literature (author's transl)]. Ann Med Interne (Paris). 1979; 130(11):489-500. View

18.

Kuo C, Grainge M, Valdes A, See L, Luo S, Yu K . Familial Aggregation of Systemic Lupus Erythematosus and Coaggregation of Autoimmune Diseases in Affected Families. JAMA Intern Med. 2015; 175(9):1518-26. DOI: 10.1001/jamainternmed.2015.3528. View

19.

Bagavant H, Thompson C, Ohno K, Setiady Y, Tung K . Differential effect of neonatal thymectomy on systemic and organ-specific autoimmune disease. Int Immunol. 2002; 14(12):1397-406. DOI: 10.1093/intimm/dxf105. View

20.

Chang C, Chang Y, Chen W, Chen Y, Chen J . Effects of annual influenza vaccination on morbidity and mortality in patients with Systemic Lupus Erythematosus: A Nationwide Cohort Study. Sci Rep. 2016; 6:37817. PMC: 5133584. DOI: 10.1038/srep37817. View