Removing tonsils and an increased risk of autoimmune disease

tonsils, autoimmune disease, Hashimoto's, Hashimoto thyroiditis,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tonsils play an important role in our immune system. Tonsils are a pair of lymphoid tissues located at the rear of the throat and function as the first defence against bacteria and virus. The underlying component of B cells in the germinal centers of the tonsil is activated when a pathogen is present.

Studies show that the pre-existing antigen-specific IgA antibodies in the nasopharynx declined sharply after adenotonsillectomy (surgical removal of the adenoids and tonsils) in children,  suggesting that the tonsils are important for generating mucosal immunity. Moreover, recently been noted that besides thymus tonsils are the reservoir of T cells.

It is thus possible that removing tonsils may lead to future dysfunction of the immune system. Swedish study tested the hypothesis that individuals with tonsillectomy face an increased incidence of autoimmune diseases in their later life. All individuals who underwent a tonsillectomy in Sweden during 1997-2012 were included and explored systematically their subsequent risk of 33 autoimmune diseases. In Sweden, patients with autoimmune diseases are normally diagnosed by two doctors: 1) at a primary health care center and 2) a specialist in the hospital. This can guarantee high accuracy of this study as compared to studies that use self-reported questionnaires.

179 875 individuals received a tonsillectomy between 1997 and 2012 in Sweden. The median age at operation was nine years old. Hypertrophy of tonsils and adenoids (59%) was the most common underlying diseases, followed by chronic tonsillitis and adenoiditis (26.7%) and sleep disordered breathing (3.5%).

From the total of 33 specific autoimmune diseases were examined in this study; 16 of them showed an increased incidence, whereas none of them showed a decreased incidence. A total of 5357 patients were subsequently diagnosed with autoimmune diseases after the tonsillectomy, giving an overall Standardized incidence ratios (SIR) of 1.34. The risk of autoimmune diseases was not different for men and women, with an exception of Hashimoto/hypothyroidism and Sjogren’ssyndrome. SIR for Hashimoto thyroiditis for male is 1.99 and for female 1.50.

The risk of autoimmune diseases was further analysed by the underlying indications of tonsillectomy. The overall risk of autoimmune diseases was 1.36 for chronic tonsillitis and adenoiditis, 1.27 for hypertrophy of tonsils and adenoids, 1.34 for sleep disordered breathing, and 1.50 for other indications. For specific  diseases, the incidence of Hashimoto/hypothyroidism and rheumatoid arthritis was increased after tonsillectomy due to all indications. Some diseases, such as Crohn’s disease, Graves’/hyperthyroidism, Hashimoto/hypothyroidism, psoriasis, and rheumatoid arthritis, showed an increased incidence after tonsillectomy at different ages.

Immune dysfunction due to tonsillectomy may partly explain the association  between tonsillectomy and  autoimmune diseases. As recent evidence suggests tonsils might be the reservoir of T cells outside of thymus. However, future studies are needed to further explain the underlying mechanisms.

Have you had your tonsils removed? If yes, let us know below if you see any relation between tonsillectomy and the occurance of your autoimmune condition?

 

References:

Bitar, M. A., Dowli, A., & Mourad, M. (2015). The effect of tonsillectomy on the immune system: A systematic review and meta-analysis. International Journal of Pediatric Otorhinolaryngology, 79(8), 1184-1191. doi:10.1016/j.ijporl.2015.05.016

Ji, J., Sundquist, J., & Sundquist, K. (2016). Tonsillectomy associated with an increased risk of autoimmune diseases: A national cohort study. Journal of Autoimmunity, 72, 1-7. doi:10.1016/j.jaut.2016.06.007

Leavy, O. (2012). Tonsils turn out T cells too. Nature Reviews Immunology, 12, 232. doi:10.1038/nri3196

 

15 thoughts on “Removing tonsils and an increased risk of autoimmune disease

  • Tonsillectomy age 12, Symptoms of autoimmune dysfunction from age 16. Diagnosis of Hashimoto’s Age 29 after years of misdiagnosis (first clinical evidence found at 21, but ignored by medical practitioners).

  • Tonsillectomy aged 33 and diagnosed with autoimmune several years later: undifferentiated connective tissue disease, symptomatic of reumatitis and chrones . Never had markers prior to tonsil removal..bigest regret to have them removed!

  • Hi, I’m a 19 year old girl who had a tonsillectomy when I was 5 years old. Immediately after I gained weight very quickly, despite my consistent diet from before to after. I hit puberty considerably early at age 9. My symptoms always replicate hypothyroidism, but all my blood tests have been normal (low range) for over 12 years. I have recently developed Complex Regional Pain Syndrome and wonder if this is all linked? I have found many studies suggesting this, but none that have concrete evidence.

    • I do feel your sadness, Lynda. Yes, it is a worldwide issue that often medical professionals do not find necessary to diagnose Hashimoto’s when hypothyroidism is diagnosed. This in my opinion is due to the fact that they don’t have anything else to offer to those patients. Warm regards, Anna

    • Dear Tess, I am so sorry to read about ypu struggle. I don’t know of studies showing a causal link between Complex Regional Pain Syndrome and hupothyroidism. Keep hope alive adn searching. Warm regards, Anna

  • I suffered off & on for two years with tonsillitis from age 14 to 16 yrs. I was given antibiotics each time and eventually it cleared up just before a tonsillectomy was scheduled, so I never had them removed. Fast forward to age 35 and I had a goitre removed and became hypothyroid within 2 months of the operation. I have been on Levothyroxine for 27 yrs and now at 62, I have raised antibodies but doctors in the UK do not seem to recognise Hashi’s. I now believe that my thyroid problems stem from an EBV infection in my teens which lay dormant until my 30’s. It saddens me that so many people are affected by thyroid problems and still the medical bodies do not seems to have a grasp on any of it.

  • I had my tonsils removed when I was 6. Not because I was sick, because my sister was a
    Having hers removed and they thought we could do it together.
    I am 57 years old and diagnosed with Hashimoto 6 months ago.

  • Tonsils removed in 1977 age 7, diagnosed with Hashimotos 3 years ago but recognise know that I was symptomatic since shortly after tonsillectomy

  • I had my tonsils and adenoids removed when I was 4 with tubes also placed in my ears. I was diagnosed with hypothyroid in my early 20’s and then later with Hashimotos… I have very low thyroid symptoms, but my numbers have increased through out the years (about 20 years of knowing that I have it). I also have post nasal drip and I still have drainage issues with my ears.

  • Suffered from bronchitis not long after I had my tonsils removed. Now I am a hay fever patient, just like my mom and brother who both also had their tonsils removed as a child. All three of us also suffer from allergies. Coincidence? I don’ think so.

  • I had a tonsillectomy at 6 years of age. I am now 49 and have Hashimoto’s thyroiditis. My symptoms started immediately after the tonsillectomy but diagnosis took many years.

  • I had tonsils removed at 3. Diagnosed with hashimotos at 38 after thyroid cancer diagnosis. Realize now that ITP was present at 14 – 39 and has reversed thee years after total thyroidectomy. I had a page long list of hashimotos related issues that disappeared after removal of thyroid.

  • Have there been any instances where removing chronically swollen tonsils as an adult have helped improve/lower antibodies? I was diagnosed with Hashimoto’s this year (no noticeable symptoms besides a lingering post-nasal drip and swollen tonsils from a very bad cold/sinus infection 6 years ago). My thyroid numbers have improved on a T3/T4 compound, but my antibodies are still very high. My functional medicine doctor and my endocrinologist suspect maybe a low grade sinus infection is playing a part. After seeing my ENT, he thinks the autoimmune attack we’re looking for could be my swollen/infected tonsils and recommends taking them out. I’m 31 years old. Was sick all the time as a kid, and had at least 2-3 bouts of strep throat when I was younger.

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