Simultaneous thyroid and gastric autoimmune disease: clinical aspects of 78 cases
Miguel Paja, Aitzol Lizarraga, Cristina Moreno, Estíbaliz Ugarte, Josu Pérez-Yéboles & Amelia Oleaga
Autoimmune polyendocrinopathy syndromes (APS) gather a wide range of diseases. The association of autoimmune thyroid disease (ATD) with other organ specific diseases is frequent. Atrophic body gastritis (ABP) is characterized by the loss of ClH and intrinsic factor (IF) production. Both ATD and ABP are known to be associated since 1960 but there are scarce publications describing its clinical features.
We review patients with this association selected from the clinical database of our outpatient endocrine clinic (20002009). Mayor criteria were evidence of ATD (regardless thyroid function) as well as B12vitamin deficiency and/or ABP in gastroscopy and/or hypergastrinemia (neither taking gastric acid antisecretory drugs nor renal insufficiency). ATD patients with antiparietal cell antibodies (PCAb) and unexplained iron deficiency or other autoimmune disease patients were also selected even if gastrine had not been measured nor gastroendoscopy performed. The chief complaint of the patients, B12 levels, analytic and immunologic tests and gastroscopic features were colleted. We included 78 (9 men), aged 24 to 85 years (mean 53), 67 with mayor criteria. Goiter or thyroid dysfunction were the most frequent presenting symptom (62) followed by pernicious anaemia (8).In ATD patients ABG was discovered in 28 due to B12 deficiency, and 22 due to iron deficiency. Immunologic studies showed PCAb in 62/72 and IFAb in 7/30. Gastrine levels ranged from 30 to 3513 pg/ml. Chromogranine A levels were over 1000 pg/ml in 18/21. There were other autoimmune diseases in 23 (vitiligo in 11). At the time of diagnosis of ABP 45 patients had received thyroid treatment (9 hyperthyroidism). Results of gastroendoscopy were obtained in 45 cases with evident gastric atrophy in 32 and 1 single case with neuroendocrine hyperplasia.
Diagnosis of the named thyrogastric syndrome is increasingly diagnosed in recent years. Detection of this association and gastroscopy surveillance seems to be mandatory since its increased risk of gastric cancer and carcinoids.