Endocrine Abstracts

Introduction

Type 3 autoimmune polyendocrine syndrome (APS-3) is defined by the presence of an autoimmune thyroid disease and another autoimmune illness, excluding Addison’s disease; this is a frequent combination. Graves’ disease (GD) is an autoimmune disorder affecting approximately 0.5% of general population. It’s occurrence in autoimmune polyendocrine syndrome (APS) is less common than Hashimoto thyroiditis. The aim of our study was to describe clinico-biological findings, therapeutic management and progess of GD in patients with APS type 3.

Methods

We analyzed clinical and biological findings of 10 patients with GD and APS. Data were gathered from files collected in internal medicine and/or endocrinology department from January 2000 to December 2017.

Results

Ten patients (21.7%) among 46 with APS had GD. GD was suspected face to clinical manifestations of hyperthyroidism in 8 cases and fortuitously in 2 cases. It was about 7 male and 3 female. The mean age of our population was at 31.5 years [14–50]. Among complaints, we found excessive sweating in 8 patients, weight loss with increase appetite in 6 cases, asthenia and tremor in 5 patients each. Diarrhea and nervousness were reported in 1 case each. Physical examination showed protruding eye ball in 6 patients, tachycardia in 5 cases and amyotrophy in 4 cases. Neck examination showed enlarged thyroid gland in all cases. Hyperthyroidism was complicated by cardiothyreosis, neuromuscular signs in 4 cases each and metabolic disorders in 6 cases. Thyroid function tests revealed a suppressed TSH level and elevated levels of serum T4 at 68.3 pmol/l [24.5–116]. Immunologic analysis found anti-TSH receptor antibodies in all cases, anti-thyroid-peroxidase antibodies in 8 cases and thyroglobulinin 3 cases. All patients presented mellitus Type 1 diabetes (DT1). DT1 was diagnosed after GD in 5 cases, before and at the same time of GD in 2 and 3 cases respectively. Anti GAD and anti IA2 antibodies were positive in 8 and 1 cases respectively. APS type 3 was retained in all cases. Treatment by anti thyroid drugs with beta-blokers was used in 9 cases. Radioactive Iodine Therapy (RAI) was performed in 7 cases. Surgical treatment by total thyroidectomy was indicated 1 case. Progress demonstrates remission in 8 cases with average follow-up of 90.5 months [25-156].

Conclusion

Patients with GD are at high risk to develop auto-immune disorders especially APS 3 type like our study. Screening of autoimmune diseases (DT1, Addison disease, celiac disease, pernicious anemia, connectivities…) in patients with GD should be done early and regularly in order to take appropriate action.