Endocrine Abstracts

Background: Thyroid hormone has an important role for skin growth and development. Alopecia is one of the clinical feature of autoimmune hypothyroidism or systemic autoimmune disease

Case Illustration

A 18-year-old Indonesian woman presented with alopecia universalis. It started with a patchy hair loss which then progress to all of her body. At the age of 15 she had complaints of neck enlargement, palpitation, weight loss, and heat intolerance. Physical examination revealed alopecia universalis and diffuse thyroid goiter. She had high TSHs level and positive TPO-Ab. Thyroid ultrasound characteristics were in concordance with thyroiditis. She was then diagnosed with Hashimoto’s thyroiditis and given low dose levothyroxine (LT4), but without any improvement in the alopecia. Screening for other systemic autoimmune disease yielded negative results. She had also toxoplasmosis and has already been given full treatment course.

Discussion: Alopecia areata (AA) is an organ-specific auto-immune disease with genetic predisposition, environmental trigger such as infection, and associated with increased overall risk of autoimmune thyroid disease (TAI) especially those with alopecia universalis (AU). Thyroid autoantibodies were found in AU patients and seem to dysregulate TSH secretion and inflammatory state could mediate its clinical manifestation. The standard treatment of LT4 leads to TSH suppression and reduction of exaggerated inflammatory response in thyroid gland, skin, and decreasing TPO-Ab level.

Conclusions: This indicates the necessity screening for thyroid abnormalities, thyroid autoantibody, and further systemic autoimmune in patients with AU, which is of benefit for early diagnosis and treatment.

Keywords: alopecia areata, alopecia universalis, autoimmune thyroid disease, hashimoto’s thyroiditis