Schmidts syndrome atypical case
Larisa Dzeranova & Olga Gerasimenko
Thyroid pathology, as a part of Schmidts syndrome, could be presented as a chronic autoimmune thyroiditis (9597%) or as a Graves disease (35%). Usually refractory hypothyroidism develops after a chronic autoimmune thyroiditis occurs, so the permanent thyroid hormone replacement is necessary during all life. But we are investigating a different course of that disease.
A 31-year-old woman had been sick from 2003, when Schmidts syndrome was diagnosed by typical clinical and laboratory symptoms. Thyroid pathology was presented as a hypothyroidism after autoimmune thyroiditis, so a replacement therapy by thyroid hormones, mineralocorticoids, corticosteroids was administered. After hormones administration her general condition improved quickly and had been good until 2007; laboratory data demonstrated compensation of thyroid and adrenal insufficiency. In 2007, the patient appeared with weight loss, weakness, severe tachycardia, anxiety. Laboratory data revealed that a thyroid-stimulating hormone (TSH) serum level decreased below 0.01 mIU/l, free thyroxin elevated to 58.8 pmol/l. L-thyroxin dose was reduced, but symptoms of thyrotoxicosis remained. After that a thyreostatic therapy with thyrozol administration was provided. The patients condition and laboratory data were controlled each three months, so the therapy type thyrozol or L-thyroxin, or combination was changed according to the investigation results. In June 2008, it was decided to cancel the whole thyroid therapy, after that and until recent time the patient felt good, and the laboratory investigation during this period demonstrated euthyroidism.
Its well known that a similar disease course of thyroid pathology could occur in case of an isolated autoimmune thyroiditis, but we did not find such a clinical case description as a part of Schmidts syndrome in literature. Thyrotoxicosis combined with the adrenal insufficiency becomes a more dangerous condition than when alone, so in Schmidts syndrome case that condition should be diagnosed and treated in early stages.