Significant Association Identified Between Alopecia Areata, Autoimmune Thyroid Disease

There is a significant association between alopecia areata and the development of autoimmune thyroid diseases (AITD), according to recent findings.¹

Such conclusions were the result of a recent, large-scale study conducted by investigators such as Yonit Wohl, MD, from the Ariel University Faculty of Medicine in Israel. Wohl and colleagues noted that a few prior studies have examined links between AITD and alopecia areata.^2,3

These prior studies have suggested the existence of a significant association, though variations in previous reporting were also acknowledged by the investigators.

“Therefore, acquiring new, large-scale data from diverse populations worldwide is essential for a more comprehensive understanding,” Wohl and colleagues wrote.¹ “This study sought to explore the association between AA and autoimmune AITD through a population-based case-control design.”

Trial Design Details

The investigators conducted a population-based case-control cohort study that was retrospective in nature, using the Maccabi Healthcare Services (MHS). The MHS is Israel’s second-largest state-mandated health fund, insuring approximately 26% of the population. The trial population itself included patients given an alopecia areata diagnosis in the period between 2005 – 2019.

Diagnoses of Hashimoto’s thyroiditis as well as Graves’ disease were made by general practitioners. The MHS database provided demographic data to Wohl and colleagues, with alopecia areata diagnoses having been confirmed by board-certified dermatologists through comorbidity records, clinical coding, and treatment data.

The investigative team matched each included participant with 2 healthy controls of the same sex, using a 1:2 ratio. Their study’s primary endpoint was to determine the prevalence of AITD among those with alopecia areata compared with these control participants. Logistic regression models were applied to calculate odds ratios (OR) with 95% confidence intervals (CI). Their findings were considered significant at P < .05.

Findings on Alopecia and Thyroid Disease

Wohl et al’s study cohort comprised 33,401 patients with alopecia areata, which represented 1.3% of the MHS-insured population during the study window. These subjects were matched to 66,802 controls. In both arms of the analysis, 56.5% were listed as male. The investigators found that the average age of alopecia areata onset was 29.9 years. Within the overall sample, 5.83% had diangoses of AITD. Such participants included Hashimoto’s thyroiditis among 5.15% and Grave’s disease among 0.68%.

Hashimoto’s thyroiditis was identified in 6.93% of individuals with alopecia areata, compared with 4.26% of the control arm, yielding a significant association (OR = 1.67, 95% CI [1.58–1.77]; P < .01). Wohl and colleagues further highlighted diagnoses of Graves’ disease in 0.93% of those with alopecia areata versus 0.55% of the control population, indicating a significant relationship (OR = 1.68, 95% CI [1.44–1.96]; P < .01).

Temporal analysis revealed that Hashimoto’s thyroiditis was diagnosed before alopecia areata in 55% of affected individuals, while Graves’ disease was present prior to alopecia areata in 75%. In 3.5% of cases, AITD was diagnosed within three months of alopecia areata onset, whereas alopecia areata preceded Hashimoto’s and Graves’ disease in 41.5% and 24.5% of patients, respectively.

These findings align with and expand upon prior literature, including a meta-analysis highlighted by Wohl and coauthors of 17 studies encompassing 2,850 alopecia areata cases and 4,667 controls. This analysis had demonstrated a significantly elevated risk of AITD among those living with alopecia areata (OR = 3.66; 95% CI [2.90–4.61]). They highlighted other research as well which aligned with their findings, including a systematic review of 102 studies that had observed a strong link with Hashimoto’s thyroiditis (OR = 4.31; 95% CI [2.51–7.40]).

“In conclusion, although our study has several limitations related to its retrospective design and the limitation to assess all potential confounding factors, it confirms the significant association between AA and autoimmune AITD,” the research team wrote.¹ “Yet further research is needed to evaluate the clinical usefulness of routine thyroid screening in individuals with AA.”

References

1. Wohl Y, Bentov A, Mashiah J, et al (2025). Risk of autoimmune thyroid diseases in individuals with alopecia areata: A nationwide case-control study. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. https://doi.org/10.1111/ddg.15933.

2. Ly S, Manjaly P, Kamal K, et al. Comorbid conditions associated with alopecia areata: A systematic review and meta-analysis. Am J Clin Dermatol. 2023; 24: 875-893.

3. Lee S, Lee YB, Lee WS, et al. Screening of thyroid function and autoantibodies in patients with alopecia areata: A systematic review and meta-analysis. J Am Acad Dermatol. 2019; 80: 1410-1413.e4.