Graves' Hyperthyroidism and Moderate Alcohol Consumption

Evidence for Disease Prevention

Allan Carlé Inge Bülow Pedersen; Nils Knudsen; Hans Perrild; Lars Ovesen; Lone Banke Rasmussen; Torben Jørgensen; Peter Laurberg

Disclosures

Clin Endocrinol. 2013;79(1):111-119. 

In This Article

Abstract and Introduction

Abstract

Background We recently demonstrated that moderate alcohol consumption is associated with a considerable reduction in the risk of autoimmune hypothyroidism, similar to findings in other autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. We aimed to study a possible association between alcohol intake and autoimmune Graves' hyperthyroidism.

Design This is a population-based, case–control study.

Methods In a well-defined Danish population (2 027 208 person-years of observation), we prospectively identified patients with new overt thyroid dysfunction and studied 272 patients with Graves' hyperthyroidism. For each patient, we recruited four age–gender–region–matched controls with normal thyroid function (n = 1088).

Measurements Participants gave detailed information on current and previous alcohol intake as well as other factors to be used for analyses. The association between alcohol intake and development of hyperthyroidism was analysed in conditional multivariate Cox regression models.

Results Graves' patients had a lower reported alcohol consumption than controls (median units of alcohol (12 g) per week: 2 vs 4, P < 0·001). In a multivariate regression model, alcohol consumption was associated with a dose-dependent reduction in risk for development of overt Graves' hyperthyroidism. Odds ratios (95% confidence interval) compared with the reference group with a recent (last year) consumption of 1–2 units of alcohol per week were as follows: 0 units/week 1·73 (1·17–2·56), 3–10 units/week 0·56 (0·39–0·79), 11–20 units/week 0·37 (0·21–0·65), ≥21 units/week 0·22 (0·08–0·60). Similar results were found for maximum previous alcohol consumption during a calendar year. No interaction was found with the type of alcohol consumed (wine vs beer), smoking habit, age, gender or region of inhabitancy.

Conclusions Moderate alcohol consumption is associated with a considerable reduction in the risk of Graves' disease with hyperthyroidism – irrespective of age and gender. Autoimmune thyroid disease seems to be much more dependent on environmental factors than hitherto anticipated.

Introduction

Alcohol abuse leads to considerable morbidity[1] and mortality.[2,3] A moderate alcohol consumption has been shown to be protective for many diseases, e.g. ischaemic heart disease[4] and cerebral thrombosis.[5] In terms of autoimmune disorders, moderate alcohol consumption is associated with a lower frequency of rheumatoid arthritis,[6] systemic lupus erythematosus[7] and recently it was shown that alcohol might have a protective role against the development of autoimmune diabetes mellitus.[8] In the thyroid field, we have recently demonstrated a lower incidence of overt autoimmune hypothyroidism among moderate alcohol consumers.[9] With regards to Graves' disease, one study revealed a protective role of alcohol for development of Graves' disease in women only,[10] whereas another reported this without specifying any gender difference.[11] On the other hand, a few studies did not find any association.[12,13,14] None of the studies specified whether the association between alcohol intake and disease is present at different ages, whether it may depend on current or previous alcohol intake patterns, or whether there may be a difference between wine and beer.

To study the association between alcohol intake and the development of Graves' hyperthyroidism in detail, we used data collected as part of the monitoring of the Danish iodization programme.

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