Endocrine Abstracts

JOINT198

Introduction: Bullous dermatoses encompass a range of skin disorders, with pemphigus vulgaris being one of the most severe. Pemphigus is a chronic, recurrent and severe bullous skin disease with acantholysis in the epidermis. In some investigations, thyroid diseases have been found to be a comorbidity of several skin diseases, such as alopecia, vitiligo, chloasma and Sjogren’s syndrome. A recent study showed that the relatives of pemphigus patients seemed more prone to thyroid diseases. And about 34% of pemphigus vulgaris patients had hypothyroidism, Graves’ disease, toxic multinodular goiter or follicular carcinoma This report presents a case of pemphigus vulgaris associated with thyroid dysfunction, highlighting the potential interplay between autoimmune skin diseases and thyroid pathology.

Case Report: A 25-year-old female patient was admitted in dermatology hospital, where she was diagnosed with pemphigus vulgaris. She was treated with corticosteroids, and the disease course was marked by recurrent flare-ups. After 19 years of disease progression, the patient developed hyperthyroidism, accompanied by a firm goiter and bilateral exophthalmos. Laboratory tests revealed positive antibodies for antithyroid peroxidase (AAT) and anti-TSH receptor antibodies, leading to the diagnosis of Graves’ disease. The patient was subsequently treated with a course of radioactive iodine (RAI), which resulted in hypothyroidism 10 months later. She has since been treated with L-thyroxine. HLA typing revealed the haplotype HLA_AB:A1, A white, B17, B40 (BW4, BW6).

Discussion: Some explanations regarding the coexistence of the two conditions are below. First, pemphigus and AITD may have a common susceptibility gene or allele, but show different phenotypes influenced by various genetic and environmental factors. Meanwhile, there may exist a common environment triggering the autoimmune pathogenesis of both. Second, HLA alleles related to the disease may express similar autoantigen epitopes in different tissues. The case underscores the importance of considering thyroid dysfunction in patients with autoimmune skin disorders. A thorough evaluation for thyroid disease is recommended in patients with chronic autoimmune conditions such as pemphigus vulgaris, especially when new symptoms suggest thyroid involvement.

Conclusion: This case illustrates the rare coexistence of pemphigus vulgaris and thyroid dysfunction, specifically Graves’ disease. The presence of autoimmune thyroid markers in this patient highlights the potential for autoimmune diseases to be interrelated.