Intersection of systemic lupus erythematosus and autoimmune thyroid disease: Shared pathophysiology, epidemiology, diagnosis, and management

Abstract

Systemic lupus erythematosus (SLE) and autoimmune thyroid disease are frequently coexisting autoimmune conditions that reflect shared mechanisms of immune dysregulation and polyautoimmunity. This narrative review examines the overlap in pathophysiology, epidemiology, diagnostic considerations, and clinical management of these disorders. Evidence indicates that patients with SLE have a higher prevalence of thyroid dysfunction and antithyroid antibodies compared with the general population, with hypothyroidism—particularly subclinical hypothyroidism—being more common than hyperthyroidism. Shared pathogenic features include genetic susceptibility, B‐cell hyperactivity, autoantibody production, and T‐helper cell–mediated immune responses. Clinically, overlapping nonspecific symptoms and the presence of euthyroid sick syndrome complicate diagnosis, necessitating routine thyroid function and antibody screening in SLE patients. Management of thyroid dysfunction in SLE generally follows standard endocrine guidelines; however, immunosuppressive therapies used in SLE may influence thyroid function and autoimmunity. Recognition of this overlap is essential for optimizing patient outcomes through early detection and integrated care. Further research is needed to clarify causal mechanisms and to develop targeted therapeutic strategies addressing shared immune pathways.