AITD: autoimmune thyroid disease TPOAb: antithyroid peroxidase antibody TSH: thyroid-stimulating hormone T he association of vitiligo with autoimmune thyroid disease (AITD) is taught as a basic tenet in dermatology. Indeed, a recent metaanalysis estimated the prevalence of thyroid dysfunction and thyroid autoantibodies in patients with vitiligo at 15.1% and 20.8%, respectively, with corresponding relative risk of 1.9 and 5.2.1z In addition, a genetic co-localization between vitiligo and thyroid autoantibodies has been established. Vitiligo may precede the onset of AITD by years. As such, screening patients with vitiligo for thyroid disease and thyroid autoantibodies is common practice among dermatologists, presumably in an effort to detect undiagnosed thyroid disease, assess risk of future thyroid disease, or both. However, recommendations in dermatology textbooks and published guidelines vary widely regarding whom to screen, when to screen, and what tests to use (Table I). Given these inconsistent recommendations, we sought to explore the rationale and evidence behind screening asymptomatic patients with vitiligo for thyroid autoimmunity, thyroid dysfunction, or both.
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