Indroduction: Graves and Hashimotos thyroiditis are the most common autoimmune thyroid diseases. After Graves, hypothyroidism can develop spontaneously or as a result of medical treatment, radioactive iodine therapy or surgery. Development of Graves after Hashimotos thyroiditis is a rare condition. Alopecia areata (AA) is an autoimmune disease. It has association with other autoimmune diseases such as thyroid disorders, anemias and other skin disorders. We present a 41 years-old woman with Alopecia areata associated with Graves disease who was previously diagnosed as Hashimoto disease.
Case report: Forty one year-old female patient admitted to emergency department with the complaint of excessive sweating, palpitation, discomfort, weight loss, trembling in hands, and diarrhea. She had been followed up with the diagnosis of Hashimoto disease for the last 6 years. TSH was <0.005 IU/ml, fT3: 17.01 pmol/l, fT4: 4.35 pmol/l. L-thyroxine was stopped and propranolol was started. After 1 week, TSH was detected <0.005 IU/ml, FT3 was 14.34 pmol/l and FT4 was 4.06 pmol/l. TSH receptor antibodies were >50 U/l. Power Doppler of thyroid gland showed pattern of thyroid inferno (Figure 1). Propylthiouracil was added. Alopecia areata was observed during this period (Figure 2). After decline of fT3 and fT4 levels, Alopecia areata recovered.
Conclusion: The development of Graves disease after Hashimoto disease is a rare condition. Alopecia areata can be associated with both Hashimotos and Graves diseases. It is the first case of Alopecia areata seen at the time of conversion of Hashimoto to Graves with increased TRAB levels. alopecia areata recovered completely after the decline of fT3 and fT4 levels with treatment.
27 Apr - 01 May 2013
European Society of Endocrinology