Rationale and Comments

Vitiligo is a depigmenting disorder believed to have an autoimmune origin. It is well established that patients with nonsegmental vitiligo have an increased risk of other autoimmune conditions, with subclinical hypothyroidism being the most common. There is also a higher risk of having antithyroid antibodies. Other autoimmune conditions have been associated with vitiligo but less commonly. Recognizing the risk of associated autoimmune conditions has led physicians to screen patients with vitiligo for other diseases. There is no convincing evidence that extensive workups in the absence of specific clinical suspicion improves outcomes for patients, and may in fact beget additional costs and harms. Although many studies suggest ordering these tests, it is based largely on the increased cosegregation of vitiligo and thyroid disease and not on improved outcomes from having identified an abnormal laboratory test result. Therefore, thyroid function testing including screening for thyroid autoimmunity or hypothyroidism is only indicated for clinical findings such as goiter, slow growth and hypothyroid symptoms, or a strong family history of thyroid disease

Sponsoring Organizations

• American Academy of Pediatrics – Section on Dermatology

Sources

• Expert consensus

Disciplines

• Dermatologic

References

• Alvarez Casano M, et al. Review of the natural course of subclinical hypothyroidism and study of its costs. Endocrinol Diabetes Nutr. 2019;66(9):550-554.
  
• Gawkrodger DJ, et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. 2008;159(5):1052-1076.
  
• Gill L, et al. Comorbid autoimmune diseases in patients with vitiligo: a cross-sectional study. J Am Acad Dermatol. 2016;74(2):295-302.
  
• Sawicki J, et al. Vitiligo and associated autoimmune disease: retrospective review of 300 patients. J Cutan Med Surg. 2012;16(4):261-266.
  
• Yuan J, et al. The prevalence of thyroid disorders in patients with vitiligo: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2019;9:803.