Autoimmune overlap: a case study on coexisting systemic lupus erythematosus and hashimoto

Tajudin Adetunji; Gbenga Odunlami; Bolanle Omotoso; Meveilleoux Frankpeace; Adeyemi Adefidipe; Francis Igwe; Airenakho Emorinken; David Soyoye; Babatope Kolawole; Rosemary Ikem

doi:10.1530/endoabs.109.P273

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Endocrine Abstracts (2025) 109 P273 | DOI: 10.1530/endoabs.109.P273

SFEBES2025 Poster Presentations Thyroid (41 abstracts)

Autoimmune overlap: a case study on coexisting systemic lupus erythematosus and hashimoto’s thyroiditis in southwestern nigeria

Tajudin Adetunji ¹ , Gbenga Odunlami ¹ , Bolanle Omotoso ¹ , Meveilleoux Frankpeace ² , Adeyemi Adefidipe ² , Francis Igwe ² , Airenakho Emorinken ³ , David Soyoye ¹ , Babatope Kolawole ¹ & Rosemary Ikem ¹

Author affiliations

¹Obafemi Awolowo University, Ile-Ife, Nigeria; ²Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria; ³Irrua Specialist Teaching Hospital, Irrua, Nigeria

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder with a predilection for women of reproductive age and is characterized by multi-organ involvement. Hashimoto thyroiditis, an autoimmune thyroid disease mediated by thyroid-specific antibodies, anti-thyroid peroxidase (TPO-Ab), often presents with hypothyroidism and goiter. Although autoimmune thyroid diseases are known to coexist with other autoimmune disorders, association of Hashimoto thyroiditis with SLE is rare, particularly in Sub-Saharan Africa. Here, we present a case of coexistent Hashimoto thyroiditis and SLE in a young lady.

Case Summary: A 23-year-old Nigerian lady presented with a 10-month history of goiter and symptoms including lethargy, cold intolerance, weight gain, and menorrhagia. Physical examination revealed a diffusely enlarged, warm goiter (17 x 12 cm). Laboratory results indicated hypothyroidism with elevated TSH (74.29 uIU/mL), low fT4 (3.46 pmol/l), and normal fT3 (3.74 pmol/l). Anti-TPO antibodies were >2000 IU/mL Thyroid ultrasound showed diffusely enlarged lobes with heterogeneous echo-pattern and thyroid inferno on Doppler. She was diagnosed with Hashimoto thyroiditis and commenced on levothyroxine. Subsequently, the patient developed joint pain, frothy urine and facial edema, leading to further investigations. Notably, ANA was 1:2560 (speckled pattern), anti-dsDNA and anti-Sm antibodies were both elevated >200 U/mL, fulfilling the 2012 SLICC criteria for SLE. The hemogram showed anemia, leukopenia, and raised ESR. Urinalysis showed nephrotic-range proteinuria and hematuria while lipid profile was deranged. Renal biopsy was indicative of Class V lupus nephritis. She was started on prednisolone, hydroxychloroquine, mycophenolate mofetil, atorvastatin, and supportive therapies. Her symptoms and laboratory features improved within two months of treatment and remained clinically stable.

Conclusion: This case underscores the potential for coexistence of SLE and Hashimoto thyroiditis, possibly due to shared autoimmune and demographic features. We suggest thyroid assessment in SLE patients, as early diagnosis and treatment of thyroid involvement may improve clinical outcomes.