Prevalence of Hypothyroidism in Patients With Erdheim-Chester Disease
Authors: Skand Shekhar, Ninet Sinaii, Jorge A. Irizarry-Caro, William A Gahl, Juvianee I. Estrada-Veras, Rahul Dave, Georgios Z. Papadakis, Amit Tirosh, Brent S. Abel, Joanna Klubo-Gwiezdzinska, Monica C. Skarulis, Bernadette R. Gochuico, Kevin O’Brien, Fady Hannah-Shmouni
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis affecting multiple organs and commonly caused by somatic pathogenic variants in<i>BRAF</i>V600E and mitogen-activated protein kinase genes. Clinical features of ECD result from histiocytic involvement of various tissues; while endocrine involvement in ECD occurs frequently, the prevalence of central or primary hypothyroidism has not been thoroughly investigated. <h3>Objective</h3> To assess hypothalamus-pituitary-thyroid (HPT) dysfunction in patients with ECD. <h3>Design, Setting, and Participants</h3> This cross-sectional study included 61 patients with ECD who were enrolled in a natural history study at a tertiary care center between January 2011 and December 2018. ECD was diagnosed on the basis of clinical, genetic, and histopathological features. Data were analyzed in March 2020. <h3>Exposure</h3> Diagnosis of ECD. <h3>Main Outcomes and Measures</h3> Main outcome was the prevalence of thyroid dysfunction in adults with ECD compared with community estimates. Patients underwent baseline evaluation with a thyroid function test, including thyrotropin, free thyroxine (fT4), and total thyroxine (T4), and sellar imaging with magnetic resonance imaging or computed tomography scan. The association of HPT dysfunction was assessed for differences in age, sex, body mass index,<i>BRAF</i>V600E status, high sensitivity C-reactive protein level, sellar imaging, and pituitary hormonal dysfunction. <h3>Results</h3> A total of 61 patients with ECD (46 [75%] men; mean [SD] age, 54.3 [10.9] years) were evaluated. Seventeen patients (28%) had hypothyroidism requiring levothyroxine therapy. The prevalence of both central and primary hypothyroidism were higher than community estimates (central hypothyroidism: 9.8% vs 0.1%; odds ratio, 109.0; 95% CI, 37.4-260.6;<i>P</i> &lt; .001; primary hypothyroidism: 18.0% vs 4.7%; OR, 4.4; 95% CI, 2.1-8.7;<i>P</i> &lt; .001). Patients with hypothyroidism (both primary and central), compared with patients with euthyroidism, had higher body mass index (median [interquartile range] 31.4 [28.3-38.3] vs 26.7 [24.4-31.9];<i>P</i> = .004) and a higher prevalence of panhypopituitarism (7 [47%] vs 3 [7%];<i>P</i> &lt; .001). Among patients with hypothyroidism, those with central hypothyroidism, compared with patients with primary hypothyroidism, had a lower mean (SD) body mass index (28.3 [2.6] vs 36.3 [5.9];<i>P</i> = .007) and higher frequencies of abnormal sellar imaging (5 [83%] vs 3 [27%];<i>P</i> = .050) and panhypopituitarism (5 [83%] vs 3 [27%];<i>P</i> = .050). <h3>Conclusions and Relevance</h3> In this cohort study, a higher prevalence of central and primary hypothyroidism was identified in patients with ECD compared with the community. There should be a low threshold for testing for hypothyroidism in patients with ECD, and treatment should follow standard guidelines.