Endocrine Abstracts

A 56 year old female who was referred to the Endocrine clinic with a history of progressive anterior neck swelling, weight gain, memory impairment and sluggishness. On examination she was found to be pale, had an anterior neck mass which moved with swallowing but not with tongue protrusion, is diffuse, firm non tender, measuring 8 × 6 cm. There was associated submandibular lymph node enlargement.

Her thyroid function test revealed primary hypothyroidism (FT₃ 2.5 pmol/l, FT₄ 2.7 pmol/l and sTSH 8.01 μIU/l) and thyroid autoantibodies were markedly elevated (TPOAb 55.5 IU/ml, TgAb 197.3 IU/ml). Her ESR was also markedly elevated (131 mm/h westergren method). A diagnosis of Autoimmune hypothyroidism was made and patient was commenced on L-thyroxine.

6 weeks later she complained of dry mouth and mouth ulcers and further questioning revealed that she had recurrent joint pain and swelling especially of the small joints of the hands, hypopigmentation of the skin and the need to drink water to swallow food. On examination she had bilateral parotid fullness, dry tongue, hypopigmented patches on the hands and swelling of both proximal and distal interphalangeal joints. Spit test was about 1 ml.

LE cells was positive and Antinuclear antibody was positive with homogenous pattern.

Protein excretion in 24 h was 1.2 g end patient was referred to the Nephrologist.

The following diagnoses were considered; autoimmune hypothyroidism, systemic lupus erythematosus with nephritis and Sjogren syndrome. She was subsequently treated with L-thyroxine, prednisolone and cyclophosphamide and is presently on follow up.

Conclusion: Autoimmune diseases are not uncommon in older women. The presence of one warrants an intense search for others.