Is It Possible To Have Lupus And Hashimoto’s Disease?

Hashimoto's disease (also referred to as Hashimoto's thyroiditis) is an immune system disorder where your body produces antibodies that mistakenly attack your thyroid gland. Lupus is a condition where your immune system attacks healthy tissue in your body and affects several organ systems.

But can you have Hashimotos thyroiditis and Lupus together?

What is Hashimoto's disease?

Hashimoto's disease is an autoimmune disorder that can lead to an underactive thyroid or hypothyroidism. It rarely causes overactive thyroid, which is called hyperthyroidism.

Your thyroid is a small gland at the front of your neck, shaped like a butterfly. Individuals with Hashimoto's disease or Hashimoto's thyroiditis experience:

• Large numbers of immune system white blood cells accumulating in the thyroid

• The immune system creating antibodies that attack the thyroid gland

• Thyroid damage, resulting in the inability to produce enough thyroid hormone

Thyroid hormones regulate the way your body uses energy. Therefore, the impact almost every organ in your body, including your heart.

How serious is Hashimoto's disease, and what's the outlook?

The condition can remain stable for years. However, if it does progress gradually to hypothyroidism, doctors can treat it with hormone replacement therapy.

When left untreated, hypothyroidism can cause various health issues, including:

• Goiter

• High cholesterol

• Mental health issues (e.g., depression)

• Myxedema crisis (the life-threatening slow down of body functions)

• Heart failure and heart disease

• Sexual and reproductive dysfunction

Hypothyroidism can also lead to pregnancy issues and infant complications when left untreated.

What is lupus?

Lupus is a long-term (chronic) disease that can lead to pain and inflammation in any body part. It's a type of autoimmune disorder, meaning your immune system, which usually fights infections, starts attacking your healthy tissues instead.

Lupus often affects your:

• Joints

• Skin

• Internal organs (i.e., heart, kidneys)

Since it affects many body parts, it can cause a variety of symptoms.

When individuals speak of lupus, they're typically talking about systemic lupus erythematosus (SLE), which is the most common form of this condition. But, there are other types too, which are:

• Cutaneous lupus: This form is limited to your skin.

• Neonatal lupus: A rare disorder that affects newborns of women with lupus.

• Drug-induced lupus: a lupus-like condition that is caused by specific prescription drugs.

How serious is lupus, and what's the outlook?

According to the Lupus Foundation of America, today, the outlook for lupus is much better than it was in previous decades. With treatment and close follow-up, around 80 to 90% of individuals¹ with this condition can expect to live normal life spans.

But, there still isn't a cure for lupus, and some individuals do die from this condition. However, lupus isn't fatal for most individuals living with the condition today.

The degree and intensity of lupus varies. Some people experience only a mild case, while others experience more moderate-to-severe cases that are often hard to control and treat. For individuals experiencing a severe flare-up, there's a higher risk of their condition being life-threatening.

Is it common to get lupus if you have Hashimoto's disease?

Can you have lupus and Hashimoto's disease at the same time? Autoimmune disorders often coincide, and a link between SLE and thyroid disease has been reported for over 50 years².  However, if you have SLE, it’s more likely that you will experience thyroid dysfunction, particularly if you’re female³.

Hypothyroidism is the most common condition, including both symptomatic and subclinical forms, and seems to be seen slightly more in individuals with SLE than in the general population.  Around 15 to 19% of individuals with lupus² develop primary hypothyroidism.

When testing for thyroid antibodies, it seems individuals with SLE tend to more commonly have antibodies linked with autoimmune thyroid diseases (AITD).  Overall, more research is needed to understand the link fully.  

About polyautoimmunity

When an individual has more than one type of autoimmune disorder, it's known as polyautoimmunity.  In some cases, individuals can have various autoimmune diseases at the same time, and this is referred to as multiple autoimmune syndrome (MAS).

Around 25% of individuals with an autoimmune thyroid disorder⁴ such as Graves' disease or Hashimoto's disease also had a minimum of one other type of autoimmune disorder. Once an individual has one autoimmune disease, it increases their risk of developing another one.

Therefore, those with Hashimoto's disease have a higher risk of developing autoimmune conditions, including SLE.

Are there overlapping symptoms between lupus and Hashimoto's disease?

SLE can be linked with other autoimmune disorders² and have overlapping symptoms. Lupus and thyroid disease symptoms can be confused since they both have nonspecific features, such as:

• Weight change

• Fatigue

• Skin manifestations

• Poor memory

• Cool extremities 

• Dry hair

People with SLE are more susceptible to thyroid issues compared to others, and it is typically more so in people experiencing overlap syndrome.

How are lupus and Hashimotos diseases diagnosed?

Since the symptoms are so alike, it can be difficult to distinguish between lupus and Hashimoto's disease unless you have a characteristic sign, such as a butterfly rash or notable family history.

Individuals with autoimmune disease symptoms, such as joint pain and unexplained fatigue, typically need blood tests to better understand what's occurring at a cellular level. You may have further discussions with a specialist such as an endocrinologist or rheumatologist to ensure the right diagnosis.

Diagnosing Lupus

There's no single diagnostic test that identifies lupus. To test for lupus, your doctor will check for noticeable signs of joint inflammation, such as heat, redness, swelling, and loss of function. Blood testing can also help to identify body inflammation. Your doctor may order one or more of the following blood tests:

• Antinuclear Antibodies (ANA): Your immune system creates antibodies designed to attack foreign cells. While most people with lupus will have ANA antibodies, many people with ANA antibodies will not have lupus and are perfectly healthy.

• Complete blood count (CBC): This involves testing white and red blood cells and platelets. These counts are often low in lupus, with anemia, or a low red blood count, common.

• Liver and kidney function panel: Lupus can decrease the function of both these organs, which will show up in blood tests.

• Erythrocyte sedimentation rate (ESR): ESR is a non-specific marker of inflammation, and if raised, it could indicate lupus.

The doctor may additionally order a urinalysis to check if you have compromised kidney function. In this test, the doctor will look for red blood cells and protein, which shouldn't be present if your kidneys are working correctly.

Diagnosing Hashimoto's disease

Testing for Hashimoto's disease is more straightforward. While you can experience whole-body symptoms with Hashimoto's disease, it primarily attacks your thyroid gland. This means thyroid function tests are the ideal place to start. The doctor will order the following tests:

• A TSH test will measure how much thyroid-stimulating hormone (TSH) you have in your blood.

• A thyroid hormone test will measure the two main thyroid hormones: T3 (triiodothyronine) and T4 (thyroxine).

• A TPO (thyroperoxidase) antibody test to help the doctor detect autoimmune thyroid disease.

Treating lupus when you have Hashimoto's disease

Some studies have shown that if treatment of hypothyroidism is delayed, it can postpone remission of SLE². Along with this, the course of SLE can also impact thyroid disease. The treatment for Hashimoto's disease hypothyroidism is levothyroxine (a synthetic hormone).

When to speak to a doctor

Since individuals with lupus are predisposed to developing autoimmune thyroid disease, people with existing autoimmune thyroid disease should consider screening for lupus.

And, because certain nonspecific complaints of autoimmune thyroid disease, such as hair loss, fatigue, and joint pain, can be linked to lupus, screening for thyroid disease periodically should be considered as well to rule out clinical and subclinical autoimmune thyroid disease.

The American Thyroid Associations (ATA), American Association of Clinical Endocrinology (AACE), and the Endocrine Society, advocate for thyroid disease screening⁵ in individuals with autoimmune diseases, including lupus.

Pregnant women with thyroid disease and lupus may have a higher risk of pregnancy complications. Therefore, women considering pregnancy should also be screened.

The lowdown

Both lupus and Hashimoto's disease are immune system disorders, and people with lupus commonly have thyroid issues. Hashimoto's disease directly affects your thyroid gland, resulting in hypothyroidism, while lupus impacts multiple organ systems in your body.

If you're experiencing symptoms you suspect of either Lupus or Hashimoto's disease, it's important to speak with your doctor and request that they test you for both conditions. This will help in getting an accurate diagnosis and directed treatment.