Endocrine Abstracts

Introduction: Both thyroid dysfunction and sexual dysfunction in young women are relatively common. Even is described the correlations between various types of sexual dysfunction in women, and the severity of hyperthyroidism. However, it is known to us a description of the coexistence of vaginismus with arthritis, a relatively rare complication of antithyroid treatment.

Case report: 25-year-old woman was admitted to hospital with symptoms of polyarthritis which occurred during treatment of hyperthyroidism propylthiuracyl. Methimazol previously used, was discontinued due to skin allergy. Clinical and biochemical signs of hyperthyroidism were relatively mild (TSH=0.13 mU/l, FT₃ 4.8 pg/dl, FT₄ 1.65 ng/dl) with slightly elevated antithyroid autoantibody. The ultrasound structure of thyroid was heterogeneous. However, polyarthritis symptoms were quite severe, with the presence of rheumatoid factor. The patient also had complained symptoms of vaginismus, which confirmed her husband. Propylthiouracyl withdrawal was not enough for the resolution of symptoms. After administration of 40 mg of prednisone and 5 mg bisoprolol, joint symptoms subsided and we observed clinical euthyreosis. Further treatment follow in the country of residence of our patients. Thyroidectomy was performed successfully, and the patient’s condition, according to her family remained good. Unfortunately, we know nothing about the further course of vaginismus.

Discussion: Short treatment time did not allow us to more detailed diagnosis of the causes and possible treatment of vaginismus. It is difficult to clearly identify the possible pathological mechanism linking disorders seen in our patient. Because of mild hyperthyroidism, hormonal disturbance are unlikely as a cause of vaginismus. More likely, it seems already described in Sjogren’s syndrome, is autoimmune mechanism However, this remains speculation.