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Original Research Thyroid Disorders Thyroid Disease in Alopecia Areata, Lichen Planopilaris, and Frontal Fibrosing Alopecia—A Case Control Study of 144 Patients Thu Q Nguyen, 1 Monica Tsai, 2 Tristan Grogan, 3 and Carolyn Goh 1 1. Department of Medicine, Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, US; 2. Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, US; 3. Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, US B ackground: Hair loss can be a troublesome aspect of thyroid disease for some patients. In addition to diffuse hair thinning, thyroid disease has been associated with clinically significant forms of alopecia, including alopecia areata (AA) and telogen effluvium. The role of thyroid disease in other causes of alopecia, such as lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA), remains unclear. This study retrospectively assessed the role of thyroid dysfunction in AA, LPP and FFA. Methods: A systematic chart review of 144 patients was performed from September 2010 to July 2013. Data were analyzed using multivariate logistic regression to test for a relationship between thyroid disease and type of alopecia. Results: A total of 113 alopecia patients were analyzed. A positive history of thyroid disease was found in 16.0% of AA, 25.0% of FFA, 17.1% of LPP, and 15.1% of control patients. After controlling for age and sex, alopecia was not found to be a statistically significant predictor of thyroid disease. Conclusions: Although alopecia patients in this study had rates of thyroid dysfunction higher than the U.S. population, there were no significant differences in rates of thyroid dysfunction compared to the control group. Keywords Hair loss, alopecia areata, frontal fibrosing alopecia, lichen planopilaris, thyroid disorders Disclosure: Thu Q Nguyen, Monica Tsai, Tristan Grogan, and Carolyn Goh have nothing to disclose in relation to this article. No funding was received in the publication of this article. Compliance with Ethics: Patient data were retrospectively evaluated for this study. Institutional approval was obtained, and the study was deemed exempt from the need to procure subject consent. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: October 10, 2016 Accepted: December 8, 2016 Citation: US Endocrinology, 2016;12(2):85–6 Corresponding Author: Monica Tsai, 8700 Beverly Blvd, Los Angeles, CA 90048, US. E:monicastsai@gmail.com Thyroid disease has commonly been associated with hair loss, predominantly manifesting as diffuse thinning of the scalp and the lateral eyebrows. This can be of particular concern to patients, and may motivate some to seek medical evaluation. Indeed, thyroid disease has also been linked to clinically significant types of alopecia, including alopecia areata (AA) 1–3 and telogen effluvium. 4–6 The role of thyroid disease in other causes of alopecia including lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) remains unclear. AA is an autoimmune process involving non-scarring hair loss that affects between six to seven million individuals in the US. 7 LPP and FFA are clinical variants of scarring alopecia that are indistinguishable on histopathology. LPP is a follicular form of lichen planus that results in scarring hair loss generally in multifocal regions of the scalp. In contrast, FFA is a variant of LPP that causes gradually progressive hair loss at the frontotemporal hairline of postmenopausal women. This study retrospectively assessed the role of thyroid dysfunction in AA, LPP and FFA. Methods A systematic chart review of all patients seen in the UCLA Hair Disorders Clinic from September 2010 to July 2013 was performed. All patients with a diagnosis of FFA or LPP and a randomized subset of 50 patients with AA were included in the study. An age- and sex-matched control group was randomly selected from other patients seen in the UCLA Dermatology Clinic who did not have alopecia. Data obtained from chart review included gender, age, history of dermatologic conditions, TSH levels, and history of thyroid dysfunction. Patients were defined as having thyroid dysfunction if they had been diagnosed with hypothyroidism, hyperthyroidism, Hashimoto’s thyroiditis, thyroid cancer, and other/not specified thyroid dysfunction. Univariate and multivariate logistic regression models were constructed to predict thyroid disease using alopecia group, gender, age, and TSH. Results The UCLA Hair Disorders Clinic served more than 5,548 patients between 2010 and 2013, including 28 patients with FFA, 35 with LPP, and 269 with AA. A total of 113 alopecia patients were analyzed (Table 1). Of the 81 alopecia patients with documented thyroid-stimulating hormone (TSH) levels, the average level was 2.12 mIU/L, whereas the control group had an average of 1.93 mIU/L among 19 patients. A positive history of thyroid disease was found in 16.0% of AA, 25.0% of FFA, 17.1% of LPP, TOU CH MED ICA L MEDIA 85