Background: Sometimes, although the serum thyroid hormone levels are in desired ranges, the patient still has complaints. On the other hand, the dose of levothyroxine replacement may be variable in patients with hypothyroidism. These factors directly influencing the clinical practice may be, to some extent, associated with other immunological/allergic diseases that accompany autoimmune thyroid diseases (ATDs).
Aim: To document the other autoimmune/allergic disorders in patients at follow-up for ATDs in a tertiary care university hospital.
Methods: During the study period, consecutive 274 patients diagnosed with and/or at follow-up for Hashimotos thyroiditis (HT) and 53 with Graves disease (GD) were included in the study. All the patients were examined and when clinically suspected for other autoimmune/allergic disease, further investigations were applied.
Results: 65 (23.8%) patients with HT and 7(13.2%) patients with GD had at least one additional clinical autoimmune/allergic disorder. The distribution of these disorders were as: 28 (10.2%) gastrointestinal (chronic atrophic gastritis, celiac disease, autoimmune pancreatitis, ulcerative colitis, primary biliary cirrhosis), 19 (6.6%) allergic (asthma, chronic urticaria, rhinosinusitis), 12 (4.4%) rheumatological (rheumatoid arthritis, systemic lupus erythematosus, Still disease, Sjögren syndrome, Behçets disease, ankilosying spondylitis), 10 (3.7%) skin (vitiligo, psoriasis, idiopathic pruritus, total alopecia), 4 (1.5%) endocrinological (hypoparathyroidism, type-1 diabetes mellitus, hypophysitis), 1 (0.4%) hematological (idiopathic thrombocytopenic purpura), 1 (0.4%) renal (crescenteric glomerulonephritis) involvements in HT. In GD, these distributions were similar: 2 (3.8%) gastrointestinal, 2 (3.8%) allergic, 2 (3.8%) skin, 1 (1.9%) rheumatological, 1 (1.9%) hematological. Additionally, 50 (18.2%) patients with HT and 1 (1.9%) with GD found to have vitamin B12 deficient-anemia (P=0.001). 28 (10.2%) of HT and 1 (1.9%) of GD patients had dimorphic (both vitamin B12 and iron deficiencies) anemia.
Conclusion: Patients with ATDs are prone to additional autoimmune/allergic diseases. The mostly involved organ system is the gastrointestinal tract in both ATDs. Probably this involvement takes play in exaggaration of some symptoms by leading to anemia caused by both vitamin B12 and iron deficiencies, especially in patients with HT.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
05 - 09 May 2012
European Society of Endocrinology