{"paper_id":"0c8c2162-25fa-459f-b964-37b24fe586e1","body_text":"Thyroid disorders in idiopathic inflammatory myopathies: prevalence and related clinical scenarios | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Thyroid disorders in idiopathic inflammatory myopathies: prevalence and related clinical scenarios Linda Carli, Michele Diomedi, Chiara Cardelli, Simone Barsotti, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7517793/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Apr, 2026 Read the published version in BMC Endocrine Disorders → Version 1 posted 16 You are reading this latest preprint version Abstract Background Little is known about the relationship between thyroid diseases (TDs) and Idiopathic inflammatory myopathies (IIMs). This study aimed at evaluating the prevalence of TDs in a monocentric cohort of patients with IIMs, exploring possible correlations with clinical phenotype, organ involvement, comorbidities and quality of life (QoL). Methods We retrospectively analysed medical records of patients with IIM according to the EULAR/ACR 2017 criteria, collecting data about demography, IIM subset, disease duration, autoantibody profile, organ involvement and comorbidities. Besides, we registered the occurrence of Hashimoto Thyroiditis (HT), Multinodular goitre (MNG), Grave’s Disease (GD) and Thyroid papillary cancer (TPC). In addition, some different patient reported outcomes were administered, to collect data on QoL. Results A total of 191 patients were enrolled: 125 (65.4%) were female, with a mean age of 66.6±13.5 years and a mean disease duration of 9.8±7.4 years; 111 (58.1%) had dermatomyositis (DM), 50 (26.2%) polymyositis (PM), 11 (5.8%) clinically amyopathic DM or inclusion body myositis, 6 (3.1%) immune-mediated necrotizing myopathy and 2 (1%) juvenile DM. Ninety-nine patients (51.8%) had a TD; 53/191 (27.7%) had MNG, 42/191 (22%) had HT and 3/191 (1.6%) GD. One patient (0.5%) had a TPC. The presence of a TD was associated with oesophagus’ involvement and with a higher risk of osteoporosis and fragility fractures (p≤0.01). Moreover, patients with TDs tended to accumulate a greater number of comorbidities (p<0.001) and showed higher values of cumulative dose of glucocorticoids (p=0.032). Finally, considering patients’ QoL, the presence of a TD was associated with lower values of the SF-36 bodily pain domain (p=0.006). Conclusions More than half of our IIMs patients had a TD, with a higher prevalence of both MNG and HT. Our results partially fill a lack of knowledge about the relationship between TDs and IIMs, stressing the opportunity of regularly screening patients for thyroid function. Figures Figure 1 Figure 2 INTRODUCTION Thyroid diseases (TDs) are a well-known comorbidity of patients with autoimmune systemic diseases, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) ( 1 ) and might compromise the health status of patients, owing to their possible impact on cardiovascular (CV) risk, bone mineral density (BMD) and muscle function. However, the evidence of a link between thyroid disorders and Idiopathic Inflammatory Myopathies (IIMs) is scarce, although both hyper- and hypothyroidism have been reported ( 2 ). IIMs are a heterogeneous group of chronic autoimmune diseases, sharing symptoms of muscle weakness due to muscle tissue inflammation. Other organs, in particular skin, lungs, upper digestive tract and hearth, can be frequently involved by systemic inflammation ( 3 ). As a result of both disease activity, drug toxicity and damage accrual, IIM patients tend to have an impaired quality of life (QoL) ( 4 ). The endocrine system might influence several aspects of muscular functionality, with possible consequences on IIMs’ disease course: in particular, thyroid hormones play a pivotal role in controlling myogenesis, damage repair and also transcription profile of muscle fibres ( 2 ). Moreover, TDs represent an established cause of high bone turnover with an accelerated bone loss, leading to osteoporosis (OP) and increased susceptibility to fragility fractures (FFx) ( 5 ) ( 6 ). Finally, TDs might influence the CV) system via plenty mechanisms, including an increased risk of dyslipidaemia, hypertension, systolic and diastolic myocardial dysfunction, as well as endothelial dysfunction ( 7 ), thus potentially amplifying CV damage accrual in IIM patients ( 8 ). The aim of this study was to evaluate the prevalence of TDs in a monocentric cohort of patients with IIMs, exploring possible correlations with autoantibody profile, organ involvement, comorbidities and patients’ QoL. METHODS We retrospectively analysed medical records of patients diagnosed with IIM followed at our specialistic Myositis Clinic (University medical centre of Pisa) from January 2021 to March 2024. Our monocentric cohort included patients with IIM fulfilling the EULAR/ACR 2017 criteria. The following data were collected from clinical charts: demography, subset, disease duration and autoantibody profile, organ involvement (muscle, oesophagus, skin, lung, heart, joints, microcirculation), comorbidities (hypertension, atrial fibrillation, dyslipidaemia, diabetes, obesity, OP, FFx, cataract, dysthymia, chronic renal failure, fibromyalgia, neoplasms, hyperuricemia, gout, myocardial infarction, stroke), family history of autoimmune disease, other autoimmune disease, smoking, obesity and social-economic status. In addition, we evaluated QoL’s outcome by Short-Form 36 (SF36) ( 9 ), Health Assessment questionnaire (HAQ) ( 10 ), Hospital Anxiety and Depression Subscales (HADS) ( 11 ) and Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) ( 12 ). Patients’ serology was determined by line blot immunoassay (EUROLINE Autoimmune Inflammatory Myopathies 16 Ag, Euroimmun, Lubeck, Germany). The occurrence of Hashimoto Thyroiditis (HT), Multinodular Goitre (MNG), Grave’s Disease (GD) and Thyroid papillary cancer (TPC) and thyroid function were also evaluated systematically in all patients. In particular, thyroid function was assessed by dosing thyroxine (T4), triiodothyronine (T3) and thyroid-stimulating hormone (TSH). Thyroid autoimmunity was assessed on the basis of the presence of anti-thyroperoxidase (TPO), anti-thyreoglobulin (TG) and thyroid-stimulating hormone (TSH) receptor antibodies (TRAb). The diagnosis of MNG was based on the result of a thyroid ultrasound performed by an endocrinologist. The study was planned under the Declaration of Helsinki, and it received local ethics committee approval (Comitato Etico di Area Vasta Nord Ovest), and the committee’s reference number is 20070. Statistical analysis Intergroups comparisons were assessed by using Chi-square, t-test and ANOVA. P values < 0.05 were considered significant. The analysis was developed by using IBM SPSS statistics. RESULTS The clinical charts of 191 patients were examined: 125 (65.4%) were female, the mean age was 66.6 ± 13.5 years and the mean disease duration was 9.8 ± 7.4 years. Epidemiological and clinical characteristics of the patients are reported in Table 1 , while the distribution of their diagnosis is reported in Fig. 1 . Figure 1 : Diagnosis distribution in our cohort. Legend: CADM: clinically amyopathic dermatomyositis; DM: dermatomyositis; IBM: inclusion body myositis; IMNM: immune-mediated necrotizing myopathy; JDM: juvenile dermatomyositis; PM: polymyositis. Table 1 epidemiological and clinical characteristics of patients N° of patients 191 Male/Female 66/125 Mean age (year ± SD) 66.6 ± 13.5 Mean disease duration (year ± SD) 9.8 ± 7.4 Muscle involvement 161/191 (84.3%) Esophageal Involvement 114/191 (59.7%) Skin Involvement 100/191 (52.4%) Raynaud Phenomenon 83/191 (43.5%) Lung Involvement 78/191 (40.8%) Articular Involvement 47/191 (24.6%) Cardiac Involvement 12/191 (6.3%) Ninety-nine patients (51.8%) had a TD; 55 patients (55.6%) had hypothyroidism, 3 (3%) hyperthyroidism and 41 (41.4%) had a normal thyroid function. Fifty-three (27.7%) had MNG, 42/191 (22%) had HT and 3/191 (1.6%) GD. One patient (0.5%) had a TPC. Those with hypothyroidism were taking a replacement therapy with levothyroxine. Four patients (2.1%) underwent total thyroidectomy (one patient with TPC and the other three with MNG). TDs occurrence was significantly associated with female sex (p < 0.001), older age (68.5 ± 11.3 vs 64.5 ± 15.2, p = 0.042) and with a longer disease duration (10.8 ± 7.3 vs 8.5 ± 7.2, p = 0.03). No correlation was found between TDs and different subtypes of IIMs, nor with the different myositis-specific autoantibodies (MSA) and myositis-associated autoantibodies (MAA). Among organ involvement the presence of a TD was significantly related with oesophageal involvement (67.7% vs 51.1% p = 0.014); among the different comorbidities, TDs correlates with OP (p < 0.001) and FFx (p = 0.014) development. We also observed that those who have TDs tended to accumulate a greater number of comorbidities than those without (6.6 ± 2.1 vs 2.7 ± 2, p < 0.001). Moreover, patients with a TD showed significantly higher values of cumulative dose of glucocorticoids (GC) (13.7 ± 10.7 vs 8.5 ± 8.8, p = 0.032). Differentiating for each subtype of TD, HT occurrence was associated with female sex (p < 0.001) and OP development (p = 0.002), while MNG occurrence was associated with female sex (p = 0.008), older age (p = 0.008), arterial hypertension (p = 0.013) and OP development (p = 0.005). These correlations remained significant even in multivariate analysis. The association between TDs and OP was independent from the total amount of GC (p = 0.002). Finally, considering patients’ QoL, the presence of a TD was associated with lower values of the SF-36 bodily pain domain (55.9 ± 27.1 vs 71.6 ± 27.8, p = 0.006). Table 2 Take home messages: influence of TDs on IIMs patients Influence of TDs on IIMs patients Activity Esophageal involvement Damage OP, TPC Comorbidities Hypertension, accumulation of comorbidities Quality of Life Increased pain perception DISCUSSION Thyroid plays a pivotal role in myogenesis, muscle regeneration and contractile functionality, by modifying myocyte transcripts and by modulating bioenergetic metabolism ( 13 ). The levels of T3, which represents the bioactive thyroid hormone, have been found to be associated with the functioning of the sarcoplasmic reticulum calcium ATPase (SERCA) pump, within myocytes ( 14 ). Indeed, T3 promotes the pump activity, up-regulating calcium fluxes, thus influencing the energy turnover during the cycle of fibres contraction and relaxation ( 15 ). HT, MNG and GD prevalences in general population (GP) correspond respectively to about 12%, 10% and 1.3% ( 16 ) ( 17 ) ( 18 ). HT is thought to be a risk factor for the development of TPC ( 19 ), which has a prevalence of 0.2% in Italian GP ( 20 ). The rates of the occurrence of every TD we analysed in this study was higher than those reported for GP, more significantly for MNG, HT and TPC; in Fig. 2 we reported the comparison between our IIM cohort and GP for the frequence of TDs. Although the association between IIMs and hypo- and hyper-thyroidism was already reported ( 2 ), no data are actually available at our knowledge about the distribution of the different kinds of thyroid dysfunctions in this subgroup of patients. It is already known that TDs tend to be more frequent in CTDs. Mosca et al. confirmed a higher prevalence of autoimmune TDs in systemic autoimmune rheumatic diseases, particularly in SLE ( 21 ), while Antonelli and colleagues observed a higher prevalence of TPC in SLE patients than in the GP ( 22 ). Moreover, Danieli et al. found that TSH levels were significantly higher in undifferentiated CTD patients than in healthy subjects ( 23 ). In a meta-analysis, 35708 patients with RA showed an increased risk of developing TDs, in particular hypothyroidism ( 24 ). In Primary Sjögren's Syndrome Girón-Pïllado et al. reported a prevalence of TDs in 40% of patients ( 25 ). Finally, recent data from a review on Systemic Sclerosis (SSc) reported the incidence of hypothyroidism ranging from 4% to 33.3% of cases ( 26 ). Exploring the role of TDs in influencing CTDs’ clinical manifestations or comorbidities, Carli et al observed the correlation with a higher risk of OP and FFx in SLE patients ( 5 ), while Cherim and colleagues observed a relationship with digital ulcers, calcinosis, pulmonary arterial hypertension, scleroderma renal crisis and Raynaud’s phenomenon development in patients with SSc ( 26 ). Considering the demographic characteristics of patients, our results confirmed a higher risk of TDs in women. When evaluating IIM’s clinical involvement, we observed a statistically significant association between oesophageal involvement and TDs. This observation is newsworthy, since several works in the literature have shown an association between oesophageal achalasia and TDs and it has been reported that compared to GP, patients with achalasia were 8.5 times as likely to have hypothyroidism. Furthermore, although the aetiology of achalasia is unknown, autoimmunity could be implicated, as already supported by several studies( 27 ) ( 28 ). Finally, hypothyroidism could affect oesophagus motility via both shortened duration and reduced percentage of relaxation, even in patients without any gastrointestinal symptoms ( 29 ). Interestingly, in our IIM patients the presence of TDs appeared associated also with a higher risk of developing comorbidities. In particular, similarly to SLE, TDs are associated with an increased prevalence of both OP and FFx occurrence ( 5 ). Both IIMs and TDs are known as risk factors for OP( 6 ) ( 30 ). The mechanisms on which this relationship is based are likely multifactorial, including systemic inflammation, a treatment with glucocorticoids (GC), a reduced mobility and an impaired calcium/vitamin D homeostasis( 30 ) ( 31 ). Although OP risk was associated with TDs independently from the total amount of GC, the association between TDs and higher steroids doses could partially explain their tendence to accumulate more comorbidities, that often could derive from GC toxicity (for example hypertension or dyslipidaemia). No data are available at the moment about this association; therefore, additional analysis in larger cohorts is advisable, to clarify this result. Taking into account the different kinds of TDs, our data confirmed the association of both HT and MNG with female sex and OP occurrence; moreover, they confirmed also the relationship between MNG and hypertension ( 32 ). Another important finding is that the patients of our IIM cohort appeared at an increased risk of TPC, being about 2.5-fold higher than that of GP; this condition could reasonably further complicate the clinical picture of IIM patients. TDs were shown to have an impact also on QoL, as the occurrence of a thyroid pathology was associated with worse values of the physical pain domain of SF36. This finding agrees with some previous papers on people with TDs, showing that the optimization of thyroid function could determine a global improvement of patients’ QoL ( 33 ) ( 34 ) ( 35 ). Conclusion Patients with IIMs are at high risk of developing a TD, with possible consequences on their disease course and their QoL. Our results partially fill the lack of knowledge about the relationship between TDs and IIMs; however, they surely suggest the opportunity to adhere to shared endocrinological guidelines of thyroid function assessment, both for blood exams and targeted ultrasound, in the regular assessment of IIM patients. Indeed, a thyroid dysfunction could not only aggravate muscle impairment, but also widely influence the clinical spectrum of IIMs patients, from disease activity, to damage, passing by comorbidities and QoL, thus worsening their already complex disease burden (see Table 2 ). Declarations Ethics approval and consent to participate: the study was approved by the local Ethics Committee (Comitato Etico di Area Vasta Nord Ovest), and the committee’s reference number is 20070. Informed consent: all participants signed an informed consent prior to inclusion in the study. Funding: this research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Statement of Contribution: LC: concept, method, writing, review&editing, formal analysis, project administ, data curation, supervision, visualization MD: writing original draft, formal analysis, data curation, investigation CC, FF, EL: investigating, data curation SB: formal analysis, visualization AT: visualization MM: review&editing, supervision, project administration Clinical trial number: not applicable. Author Contribution L.C.: concept, method, writingreview&edit, formal analysis, project administration, data curation, supervision, visualizationM.D.: writing original draft, formal analysis, data curation, investigationC.C.: investigation, data curationS.B.: formal analysis, visualizationF.F., E.L.:investigation, data curationA.T.: visualizationM.M.: writingreview&edit, supervision, project administration Data Availability data and materials are available from the corresponding author upon request. References Lichtiger A, Fadaei G, Tagoe CE. Autoimmune thyroid disease and rheumatoid arthritis: where the twain meet. Clinical Rheumatology. Volume 43. Springer Science and Business Media Deutschland GmbH; 2024. pp. 895–905. Watad A, Bragazzi NL, Damiani G, Nissan E, Comaneshter D, Cohen AD et al. Dysthyroidism in dermato/polymyositis patients: A case-control study. Eur J Clin Invest. 2021;51(5). Lundberg IE, Miller FW, Tjärnlund A, Bottai M. 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Cite Share Download PDF Status: Published Journal Publication published 30 Apr, 2026 Read the published version in BMC Endocrine Disorders → Version 1 posted Editorial decision: Revision requested 06 Nov, 2025 Reviews received at journal 05 Nov, 2025 Reviews received at journal 04 Nov, 2025 Reviews received at journal 03 Nov, 2025 Reviewers agreed at journal 23 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviewers agreed at journal 20 Oct, 2025 Reviewers agreed at journal 19 Oct, 2025 Reviewers agreed at journal 19 Oct, 2025 Reviews received at journal 12 Oct, 2025 Reviewers agreed at journal 28 Sep, 2025 Reviewers invited by journal 26 Sep, 2025 Editor assigned by journal 19 Sep, 2025 Editor invited by journal 16 Sep, 2025 Submission checks completed at journal 12 Sep, 2025 First submitted to journal 12 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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14:52:04\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":127946,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eDiagnosis distribution in our cohort. Legend: CADM: clinically amyopathic dermatomyositis; DM: dermatomyositis; IBM: inclusion body myositis; IMNM: immune-mediated necrotizing myopathy; JDM: juvenile dermatomyositis; PM: polymyositis.\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Picture1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7517793/v1/abe1716212013e933a935a61.jpg\"},{\"id\":93241588,\"identity\":\"82d90f76-53fd-4988-a5c1-907ca18d1d52\",\"added_by\":\"auto\",\"created_at\":\"2025-10-10 14:52:04\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":151621,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003ePrevalence of TDs in our cohort and in general population. Legend: OC: our cohort, GP: general population, HT: Hashimoto thyroiditis, MNG: multinodular goitre; GD: Grave’s Disease; TPC: Thyroid papillary cancer\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Picture2.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7517793/v1/de078ab3014589d23d963f87.jpg\"},{\"id\":108438050,\"identity\":\"b07aa71b-1ea2-4a98-9d0c-7c509d9d8cfe\",\"added_by\":\"auto\",\"created_at\":\"2026-05-04 16:06:01\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":499272,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7517793/v1/4d36f1d2-a832-4d5e-82d1-2cd92f25bb6f.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Thyroid disorders in idiopathic inflammatory myopathies: prevalence and related clinical scenarios\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eThyroid diseases (TDs) are a well-known comorbidity of patients with autoimmune systemic diseases, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e) and might compromise the health status of patients, owing to their possible impact on cardiovascular (CV) risk, bone mineral density (BMD) and muscle function. However, the evidence of a link between thyroid disorders and Idiopathic Inflammatory Myopathies (IIMs) is scarce, although both hyper- and hypothyroidism have been reported (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). IIMs are a heterogeneous group of chronic autoimmune diseases, sharing symptoms of muscle weakness due to muscle tissue inflammation. Other organs, in particular skin, lungs, upper digestive tract and hearth, can be frequently involved by systemic inflammation (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). As a result of both disease activity, drug toxicity and damage accrual, IIM patients tend to have an impaired quality of life (QoL) (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe endocrine system might influence several aspects of muscular functionality, with possible consequences on IIMs\\u0026rsquo; disease course: in particular, thyroid hormones play a pivotal role in controlling myogenesis, damage repair and also transcription profile of muscle fibres (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). Moreover, TDs represent an established cause of high bone turnover with an accelerated bone loss, leading to osteoporosis (OP) and increased susceptibility to fragility fractures (FFx) (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). Finally, TDs might influence the CV) system via plenty mechanisms, including an increased risk of dyslipidaemia, hypertension, systolic and diastolic myocardial dysfunction, as well as endothelial dysfunction (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e), thus potentially amplifying CV damage accrual in IIM patients (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe aim of this study was to evaluate the prevalence of TDs in a monocentric cohort of patients with IIMs, exploring possible correlations with autoantibody profile, organ involvement, comorbidities and patients\\u0026rsquo; QoL.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003cp\\u003eWe retrospectively analysed medical records of patients diagnosed with IIM followed at our specialistic Myositis Clinic (University medical centre of Pisa) from January 2021 to March 2024. Our monocentric cohort included patients with IIM fulfilling the EULAR/ACR 2017 criteria.\\u003c/p\\u003e\\u003cp\\u003eThe following data were collected from clinical charts: demography, subset, disease duration and autoantibody profile, organ involvement (muscle, oesophagus, skin, lung, heart, joints, microcirculation), comorbidities (hypertension, atrial fibrillation, dyslipidaemia, diabetes, obesity, OP, FFx, cataract, dysthymia, chronic renal failure, fibromyalgia, neoplasms, hyperuricemia, gout, myocardial infarction, stroke), family history of autoimmune disease, other autoimmune disease, smoking, obesity and social-economic status.\\u003c/p\\u003e\\u003cp\\u003eIn addition, we evaluated QoL\\u0026rsquo;s outcome by Short-Form 36 (SF36) (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e), Health Assessment questionnaire (HAQ) (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e), Hospital Anxiety and Depression Subscales (HADS) (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e) and Functional Assessment of Chronic Illness Therapy \\u0026ndash; Fatigue (FACIT-F) (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003ePatients\\u0026rsquo; serology was determined by line blot immunoassay (EUROLINE Autoimmune Inflammatory Myopathies 16 Ag, Euroimmun, Lubeck, Germany).\\u003c/p\\u003e\\u003cp\\u003eThe occurrence of Hashimoto Thyroiditis (HT), Multinodular Goitre (MNG), Grave\\u0026rsquo;s Disease (GD) and Thyroid papillary cancer (TPC) and thyroid function were also evaluated systematically in all patients. In particular, thyroid function was assessed by dosing thyroxine (T4), triiodothyronine (T3) and thyroid-stimulating hormone (TSH). Thyroid autoimmunity was assessed on the basis of the presence of anti-thyroperoxidase (TPO), anti-thyreoglobulin (TG) and thyroid-stimulating hormone (TSH) receptor antibodies (TRAb). The diagnosis of MNG was based on the result of a thyroid ultrasound performed by an endocrinologist.\\u003c/p\\u003e\\u003cp\\u003e The study was planned under the Declaration of Helsinki, and it received local ethics committee approval (Comitato Etico di Area Vasta Nord Ovest), and the committee\\u0026rsquo;s reference number is 20070.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e\\u003cp\\u003eIntergroups comparisons were assessed by using Chi-square, t-test and ANOVA. P values\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 were considered significant. The analysis was developed by using IBM SPSS statistics.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eThe clinical charts of 191 patients were examined: 125 (65.4%) were female, the mean age was 66.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.5 years and the mean disease duration was 9.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.4 years. Epidemiological and clinical characteristics of the patients are reported in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, while the distribution of their diagnosis is reported in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eFigure \\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e: \\u003cb\\u003eDiagnosis distribution in our cohort. Legend: CADM: clinically amyopathic dermatomyositis; DM: dermatomyositis; IBM: inclusion body myositis; IMNM: immune-mediated necrotizing myopathy; JDM: juvenile dermatomyositis; PM: polymyositis.\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eepidemiological and clinical characteristics of patients\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"2\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eN\\u0026deg; of patients\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e191\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eMale/Female\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e66/125\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eMean age (year\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD)\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e66.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eMean disease duration (year\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD)\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e9.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.4\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eMuscle involvement\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e161/191 (84.3%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eEsophageal Involvement\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e114/191 (59.7%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eSkin Involvement\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e100/191 (52.4%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eRaynaud Phenomenon\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e83/191 (43.5%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eLung Involvement\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e78/191 (40.8%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eArticular Involvement\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e47/191 (24.6%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eCardiac Involvement\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e12/191 (6.3%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eNinety-nine patients (51.8%) had a TD; 55 patients (55.6%) had hypothyroidism, 3 (3%) hyperthyroidism and 41 (41.4%) had a normal thyroid function. Fifty-three (27.7%) had MNG, 42/191 (22%) had HT and 3/191 (1.6%) GD. One patient (0.5%) had a TPC. Those with hypothyroidism were taking a replacement therapy with levothyroxine. Four patients (2.1%) underwent total thyroidectomy (one patient with TPC and the other three with MNG).\\u003c/p\\u003e\\u003cp\\u003eTDs occurrence was significantly associated with female sex (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), older age (68.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.3 vs 64.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;15.2, p\\u0026thinsp;=\\u0026thinsp;0.042) and with a longer disease duration (10.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.3 vs 8.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.2, p\\u0026thinsp;=\\u0026thinsp;0.03).\\u003c/p\\u003e\\u003cp\\u003eNo correlation was found between TDs and different subtypes of IIMs, nor with the different myositis-specific autoantibodies (MSA) and myositis-associated autoantibodies (MAA).\\u003c/p\\u003e\\u003cp\\u003eAmong organ involvement the presence of a TD was significantly related with oesophageal involvement (67.7% vs 51.1% p\\u0026thinsp;=\\u0026thinsp;0.014); among the different comorbidities, TDs correlates with OP (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and FFx (p\\u0026thinsp;=\\u0026thinsp;0.014) development.\\u003c/p\\u003e\\u003cp\\u003eWe also observed that those who have TDs tended to accumulate a greater number of comorbidities than those without (6.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.1 vs 2.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Moreover, patients with a TD showed significantly higher values of cumulative dose of glucocorticoids (GC) (13.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.7 vs 8.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.8, p\\u0026thinsp;=\\u0026thinsp;0.032).\\u003c/p\\u003e\\u003cp\\u003eDifferentiating for each subtype of TD, HT occurrence was associated with female sex (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and OP development (p\\u0026thinsp;=\\u0026thinsp;0.002), while MNG occurrence was associated with female sex (p\\u0026thinsp;=\\u0026thinsp;0.008), older age (p\\u0026thinsp;=\\u0026thinsp;0.008), arterial hypertension (p\\u0026thinsp;=\\u0026thinsp;0.013) and OP development (p\\u0026thinsp;=\\u0026thinsp;0.005). These correlations remained significant even in multivariate analysis.\\u003c/p\\u003e\\u003cp\\u003eThe association between TDs and OP was independent from the total amount of GC (p\\u0026thinsp;=\\u0026thinsp;0.002).\\u003c/p\\u003e\\u003cp\\u003eFinally, considering patients\\u0026rsquo; QoL, the presence of a TD was associated with lower values of the SF-36 bodily pain domain (55.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;27.1 vs 71.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;27.8, p\\u0026thinsp;=\\u0026thinsp;0.006).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eTake home messages: influence of TDs on IIMs patients\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"2\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eInfluence of TDs on IIMs patients\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eActivity\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eEsophageal involvement\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDamage\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eOP, TPC\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eComorbidities\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eHypertension, accumulation of comorbidities\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eQuality of Life\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eIncreased pain perception\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eThyroid plays a pivotal role in myogenesis, muscle regeneration and contractile functionality, by modifying myocyte transcripts and by modulating bioenergetic metabolism (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe levels of T3, which represents the bioactive thyroid hormone, have been found to be associated with the functioning of the sarcoplasmic reticulum calcium ATPase (SERCA) pump, within myocytes (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). Indeed, T3 promotes the pump activity, up-regulating calcium fluxes, thus influencing the energy turnover during the cycle of fibres contraction and relaxation (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eHT, MNG and GD prevalences in general population (GP) correspond respectively to about 12%, 10% and 1.3% (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eHT is thought to be a risk factor for the development of TPC (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e), which has a prevalence of 0.2% in Italian GP (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe rates of the occurrence of every TD we analysed in this study was higher than those reported for GP, more significantly for MNG, HT and TPC; in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e we reported the comparison between our IIM cohort and GP for the frequence of TDs.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eAlthough the association between IIMs and hypo- and hyper-thyroidism was already reported (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e), no data are actually available at our knowledge about the distribution of the different kinds of thyroid dysfunctions in this subgroup of patients.\\u003c/p\\u003e\\u003cp\\u003eIt is already known that TDs tend to be more frequent in CTDs. Mosca et al. confirmed a higher prevalence of autoimmune TDs in systemic autoimmune rheumatic diseases, particularly in SLE (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e), while Antonelli and colleagues observed a higher prevalence of TPC in SLE patients than in the GP (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e). Moreover, Danieli et al. found that TSH levels were significantly higher in undifferentiated CTD patients than in healthy subjects (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eIn a meta-analysis, 35708 patients with RA showed an increased risk of developing TDs, in particular hypothyroidism (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eIn Primary Sj\\u0026ouml;gren's Syndrome Gir\\u0026oacute;n-P\\u0026iuml;llado et al. reported a prevalence of TDs in 40% of patients (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eFinally, recent data from a review on Systemic Sclerosis (SSc) reported the incidence of hypothyroidism ranging from 4% to 33.3% of cases (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eExploring the role of TDs in influencing CTDs\\u0026rsquo; clinical manifestations or comorbidities, Carli et al observed the correlation with a higher risk of OP and FFx in SLE patients (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e), while Cherim and colleagues observed a relationship with digital ulcers, calcinosis, pulmonary arterial hypertension, scleroderma renal crisis and Raynaud\\u0026rsquo;s phenomenon development in patients with SSc (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eConsidering the demographic characteristics of patients, our results confirmed a higher risk of TDs in women.\\u003c/p\\u003e\\u003cp\\u003eWhen evaluating IIM\\u0026rsquo;s clinical involvement, we observed a statistically significant association between oesophageal involvement and TDs. This observation is newsworthy, since several works in the literature have shown an association between oesophageal achalasia and TDs and it has been reported that compared to GP, patients with achalasia were 8.5 times as likely to have hypothyroidism. Furthermore, although the aetiology of achalasia is unknown, autoimmunity could be implicated, as already supported by several studies(\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e). Finally, hypothyroidism could affect oesophagus motility via both shortened duration and reduced percentage of relaxation, even in patients without any gastrointestinal symptoms (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eInterestingly, in our IIM patients the presence of TDs appeared associated also with a higher risk of developing comorbidities. In particular, similarly to SLE, TDs are associated with an increased prevalence of both OP and FFx occurrence (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eBoth IIMs and TDs are known as risk factors for OP(\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). The mechanisms on which this relationship is based are likely multifactorial, including systemic inflammation, a treatment with glucocorticoids (GC), a reduced mobility and an impaired calcium/vitamin D homeostasis(\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eAlthough OP risk was associated with TDs independently from the total amount of GC, the association between TDs and higher steroids doses could partially explain their tendence to accumulate more comorbidities, that often could derive from GC toxicity (for example hypertension or dyslipidaemia). No data are available at the moment about this association; therefore, additional analysis in larger cohorts is advisable, to clarify this result.\\u003c/p\\u003e\\u003cp\\u003eTaking into account the different kinds of TDs, our data confirmed the association of both HT and MNG with female sex and OP occurrence; moreover, they confirmed also the relationship between MNG and hypertension (\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eAnother important finding is that the patients of our IIM cohort appeared at an increased risk of TPC, being about 2.5-fold higher than that of GP; this condition could reasonably further complicate the clinical picture of IIM patients.\\u003c/p\\u003e\\u003cp\\u003eTDs were shown to have an impact also on QoL, as the occurrence of a thyroid pathology was associated with worse values of the physical pain domain of SF36. This finding agrees with some previous papers on people with TDs, showing that the optimization of thyroid function could determine a global improvement of patients\\u0026rsquo; QoL (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e).\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003ePatients with IIMs are at high risk of developing a TD, with possible consequences on their disease course and their QoL. Our results partially fill the lack of knowledge about the relationship between TDs and IIMs; however, they surely suggest the opportunity to adhere to shared endocrinological guidelines of thyroid function assessment, both for blood exams and targeted ultrasound, in the regular assessment of IIM patients.\\u003c/p\\u003e\\u003cp\\u003eIndeed, a thyroid dysfunction could not only aggravate muscle impairment, but also widely influence the clinical spectrum of IIMs patients, from disease activity, to damage, passing by comorbidities and QoL, thus worsening their already complex disease burden (see Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003ch2\\u003eEthics approval and consent to participate:\\u003c/h2\\u003e\\u003cp\\u003e the study was approved by the local Ethics Committee (Comitato Etico di Area Vasta Nord Ovest), and the committee\\u0026rsquo;s reference number is 20070.\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003ch2\\u003eInformed consent:\\u003c/h2\\u003e\\u003cp\\u003e all participants signed an informed consent prior to inclusion in the study.\\u003c/p\\u003e\\u003c/p\\u003e\\u003ch2\\u003eFunding:\\u003c/h2\\u003e\\u003cp\\u003ethis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.\\u003c/p\\u003e\\u003cp\\u003eStatement of Contribution:\\u003c/p\\u003e\\u003cp\\u003eLC: concept, method, writing, review\\u0026amp;editing, formal analysis, project administ, data curation, supervision, visualization\\u003c/p\\u003e\\u003cp\\u003eMD: writing original draft, formal analysis, data curation, investigation\\u003c/p\\u003e\\u003cp\\u003eCC, FF, EL: investigating, data curation\\u003c/p\\u003e\\u003cp\\u003eSB: formal analysis, visualization\\u003c/p\\u003e\\u003cp\\u003eAT: visualization\\u003c/p\\u003e\\u003cp\\u003eMM: review\\u0026amp;editing, supervision, project administration\\u003c/p\\u003e\\u003cp\\u003eClinical trial number: not applicable.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eL.C.: concept, method, writingreview\\u0026amp;edit, formal analysis, project administration, data curation, supervision, visualizationM.D.: writing original draft, formal analysis, data curation, investigationC.C.: investigation, data curationS.B.: formal analysis, visualizationF.F., E.L.:investigation, data curationA.T.: visualizationM.M.: writingreview\\u0026amp;edit, supervision, project administration\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003edata and materials are available from the corresponding author upon request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eLichtiger A, Fadaei G, Tagoe CE. 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Volume 34. Clinical Endocrinology and Metabolism. Bailliere Tindall Ltd; 2020.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eXu J, Ding K, Mu L, Huang J, Ye F, Peng Y et al. Hashimoto\\u0026rsquo;s Thyroiditis: A Double-Edged Sword in Thyroid Carcinoma. Front Endocrinol (Lausanne). 2022;13.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMiranda-Filho A, Lortet-Tieulent J, Bray F, Cao B, Franceschi S, Vaccarella S, et al. Thyroid cancer incidence trends by histology in 25 countries: a population-based study. Lancet Diabetes Endocrinol. 2021;9(4):225\\u0026ndash;34.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMosca M, Carli L, d\\u0026rsquo;Ascanio A, Tani C, Talarico R, Baldini C, et al. Occurrence of organ-specific and systemic autoimmune diseases among the first- and second-degree relatives of Caucasian patients with connective tissue diseases: Report of data obtained through direct patient interviews. Clin Rheumatol. 2008;27(8):1045\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAntonelli A, Fallahi P, Mosca M, Ferrari SM, Ruffilli I, Corti A, et al. Prevalence of thyroid dysfunctions in systemic lupus erythematosus. Metabolism. 2010;59(6):896\\u0026ndash;900.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDanieli MG, Rossetti L, Fraticelli P, Malcangi G, Testa I, Danieli G. Autoimmune Thyroid Diseases in Patients with Undifferentiated Connective Tissue Disease.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLiu YJ, Miao HB, Lin S, Chen Z. Association between rheumatoid arthritis and thyroid dysfunction: A meta-analysis and systematic review. Frontiers in Endocrinology. Volume 13. Frontiers Media S.A.; 2022.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003e17, Gir\\u0026oacute;n-P\\u0026iuml;llado M, Saavedra-Gonz\\u0026aacute;lez V, Atisha-Fregoso Y, Barraza G et al. Autoimmune Thyroid Disease in Primary Sjogren\\u0026rsquo;s Syndrome Real-life Screening Practice and Clinical Outcomes.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCherim A, Petca RC, Dumitrascu MC, Petca A, Candrea E, Sandru F. Thyroid Disorders in Systemic Sclerosis: A Comprehensive Review. Journal of Clinical Medicine. Volume 13. Multidisciplinary Digital Publishing Institute (MDPI); 2024.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eEmami MH, Raisi M, Amini J, Daghaghzadeh H. Achalasia and thyroid disease. World J Gastroenterol. 2007;13(4):594\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBooy JD, Takata J, Tomlinson G, Urbach DR. The prevalence of autoimmune disease in patients with esophageal achalasia. Dis Esophagus. 2012;25(3):209\\u0026ndash;13.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eİlhan M, Arabaci E, Turgut S, Karaman O, Danalioglu A, Tasan E. Esophagus motility in overt hypothyroidism. J Endocrinol Invest. 2014;37(7):639\\u0026ndash;44.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCox M, Sandler RD, Matucci-Cerinic M, Hughes M. Bone health in idiopathic inflammatory myopathies. Autoimmunity Reviews. Volume 20. Elsevier B.V.; 2021.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eVincze A, Bodoki L, Szab\\u0026oacute; K, Nagy-Vincze M, Szalm\\u0026aacute;s O, Varga J et al. The risk of fracture and prevalence of osteoporosis is elevated in patients with idiopathic inflammatory myopathies: Cross-sectional study from a single Hungarian center. BMC Musculoskelet Disord. 2020;21(1).\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eYazidi M, Chihaoui M, Oueslati H, Chaker F, Rjeb O, Rjaibi S, et al. Cardiothyreosis: Prevalence and risk factors. Ann Endocrinol (Paris). 2019;80(4):211\\u0026ndash;5.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eWatt T, Christoffersen T, Brogaard MB, Bjorner JB, Bentzen J, Hahn CH, et al. Quality of life in thyroid cancer. Best Pract Res Clin Endocrinol Metab. 2023;37(1):101732.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eUslar V, Becker C, Weyhe D, Tabriz N. Thyroid disease-specific quality of life questionnaires - A systematic review. Vol. 5, Endocrinology, Diabetes and Metabolism. John Wiley and Sons Inc; 2022.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSharma A, Stan MN, Rootman DB. Measuring Health-Related Quality of Life in Thyroid Eye Disease. J Clin Endocrinol Metab. 2022;107:S27\\u0026ndash;35.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-endocrine-disorders\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bend\",\"sideBox\":\"Learn more about [BMC Endocrine Disorders](http://bmcendocrdisord.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bend/default.aspx\",\"title\":\"BMC Endocrine Disorders\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7517793/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7517793/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eLittle is known about the relationship between thyroid diseases (TDs) and Idiopathic inflammatory myopathies (IIMs). This study aimed at evaluating the prevalence of TDs in a monocentric cohort of patients with IIMs, exploring possible correlations with clinical phenotype, organ involvement, comorbidities and quality of life (QoL).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe retrospectively analysed medical records of patients with IIM according to the EULAR/ACR 2017 criteria, collecting data about demography, IIM subset, disease duration, autoantibody profile, organ involvement and comorbidities. Besides, we registered the occurrence of Hashimoto Thyroiditis (HT), Multinodular goitre (MNG), Grave’s Disease (GD) and Thyroid papillary cancer (TPC). In addition, some different patient reported outcomes were administered, to collect data on QoL.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA total of 191 patients were enrolled: 125 (65.4%) were female, with a mean age of 66.6±13.5 years and a mean disease duration of 9.8±7.4 years; 111 (58.1%) had dermatomyositis (DM), 50 (26.2%) polymyositis (PM), 11 (5.8%) clinically amyopathic DM or inclusion body myositis, 6 (3.1%) immune-mediated necrotizing myopathy and 2 (1%) juvenile DM.\\u003c/p\\u003e\\n\\u003cp\\u003eNinety-nine patients (51.8%) had a TD; 53/191 (27.7%) had MNG, 42/191 (22%) had HT and 3/191 (1.6%) GD. One patient (0.5%) had a TPC. The presence of a TD was associated with oesophagus’ involvement and with a higher risk of osteoporosis and fragility fractures (p≤0.01).\\u003c/p\\u003e\\n\\u003cp\\u003eMoreover, patients with TDs tended to accumulate a greater number of comorbidities (p\\u0026lt;0.001) and showed higher values of cumulative dose of glucocorticoids (p=0.032). Finally, considering patients’ QoL, the presence of a TD was associated with lower values of the SF-36 bodily pain domain (p=0.006).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMore than half of our IIMs patients had a TD, with a higher prevalence of both MNG and HT. Our results partially fill a lack of knowledge about the relationship between TDs and IIMs, stressing the opportunity of regularly screening patients for thyroid function.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Thyroid disorders in idiopathic inflammatory myopathies: prevalence and related clinical scenarios\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-10-10 14:51:59\",\"doi\":\"10.21203/rs.3.rs-7517793/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-11-06T05:27:08+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-05T17:36:37+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-04T20:41:35+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-03T18:50:21+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"217605310720923943211952206907682839252\",\"date\":\"2025-10-23T12:14:44+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"334297415754199182385812059082419179563\",\"date\":\"2025-10-22T19:27:46+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"150269003542845100441295481810638602507\",\"date\":\"2025-10-20T06:24:29+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"82485795006751542830853497495491320345\",\"date\":\"2025-10-20T02:57:04+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"180806916901413423264989272141065688942\",\"date\":\"2025-10-19T22:29:02+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-10-12T22:12:29+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"66673499450045226942354879489663001665\",\"date\":\"2025-09-28T19:41:37+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-09-26T18:59:39+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-09-19T19:51:03+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-09-16T09:09:20+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-09-12T11:39:51+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Endocrine Disorders\",\"date\":\"2025-09-12T10:02:22+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-endocrine-disorders\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bend\",\"sideBox\":\"Learn more about [BMC Endocrine Disorders](http://bmcendocrdisord.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bend/default.aspx\",\"title\":\"BMC Endocrine Disorders\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"6a41db90-eb84-4770-bc57-c869baff3ed9\",\"owner\":[],\"postedDate\":\"October 10th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-04T16:05:57+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7517793\",\"link\":\"https://doi.org/10.1186/s12902-026-02243-9\",\"journal\":{\"identity\":\"bmc-endocrine-disorders\",\"isVorOnly\":false,\"title\":\"BMC Endocrine Disorders\"},\"publishedOn\":\"2026-04-30 15:57:27\",\"publishedOnDateReadable\":\"April 30th, 2026\"},\"versionCreatedAt\":\"2025-10-10 14:51:59\",\"video\":\"\",\"vorDoi\":\"10.1186/s12902-026-02243-9\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12902-026-02243-9\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7517793\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7517793\",\"identity\":\"rs-7517793\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}