Endocrine Abstracts

Background: Hashimoto’s thyroiditis is an autoimmune thyroid disorder. Being a chronic inflammatory process, thyroidits has been recognised as a risk factor for thyroid lymphoma. We present a case of a female with Hashimoto’s thyroiditis, who suffered an out of hospital cardiac arrest and later on died in hospital.

Case report: A 30-year-old lady with a background history of Down’s syndrome was referred to endocrinology clinic in 2003 with 6 months history of slowly enlarging goitre without any obstructive symptoms.

She had compensated hypothyroidism with a TSH of 7.35 iu/l (0.27–4.2) and FT₄ of 12.1 pmol/l (11–22) and positive TPO antibodies, 743 μ/ml (<5). Ultrasound confirmed a multinodular goitre. A diagnosis of Hashimoto’s thyroiditis was made and she was started on 25 μg/d of levothyroxine.

In 2007, she started coughing and wheezing and 2 days later suffered a cardiac arrest out of hospital. She later on died on her 8th day in the ITU.

A post mortem examination confirmed the cause of death as acute respiratory distress syndrome secondary to aspiration pneumonia on a background of thyroid enlargement due to haematological malignancy (previously unrecognised) and congenital laryngeal stenosis causing upper airway obstruction. Histology of the thyroid showed changes consistent with haematological malignancy of a high grade.

Congenital tracheal stenosis is a well recognised association with Down’s Syndrome. The overall lumen of trachea is said to be smaller in these children. Depending on the size of the segment, either slide tracheoplasty or resection with end to end anastomosis is performed.

Conclusion: Our case raises the following questions; (1) do patients with Hashimoto’s thyroidits need a long term follow up in secondary care and (2) do these patients need a tissue diagnosis even though they do not have any obstructive symptoms, pain or rapid enlargement of the gland?