Endocrine Abstracts

Immune supressive patients due to any cause (disease, medication, etc.) rarely have autoimmune diseases. In this presentation, two patients diagnosed with Graves’ disease and subacute thyroiditis while taking cyclosporine therapy will be discussed.

Case 1: A 47-year-old female patient applied with weight loss, sweating and tremor. She had been on cyclosporine therapy for 3 years because of hypoplastic anemia. In laboratory tests; TSH: 0.005 uIU/ml (0.27–4.2), fT₄: 7.77 ng/dl (0.9–1.7), and fT₃: 28.56 pg/ml (1.8–4.6). Anti-TPO, Anti-TG and TSH receptor antibodies were positive. Ultrasound revealed enlarged thyroid gland with diffuse parenchymal heterogeneity. Thyroid scan showed increased uptake, which was diffuse and homogenous in pattern. On radioiodine uptake test: 4th hour uptake was 46% (15–25%) and 24th hour uptake was 27% (25–35%). The patient was diagnosed as Graves’ disease. With thyromazol therapy euthyroid state was achieved.

Case 2: A 41-year-old female patient admitted with pain and tenderness in the thyroid area. She had been using cyclosporine during the last 2 year period for psoriases. In laboratory tests; TSH: 0.015 uIU/ml, fT₄: 1.48 ng/dl, and fT₃: 3.92 pg/ml. Anti-TPO and TSH antibodies were negative while anti-TG antibodies were positive. Ultrasonography showed multiple hypoechoic thyroid nodules with ill-defined margins on the basis of chronic thyroiditis. In the thyroid scan there were supressed areas in nodular pattern and a global nonhomogenous uptake. There was low radioiodine uptake in the radioiodine uptake test. The patient was diagnosed as subacute thyroiditis. Nonsteroidal anti inflamatory drug and beta bloker were given. One month later, her thyroid function tests were within normal limits.

Conclusion: Cyclosporine rarely can be a cause of autoimmune disease by an unknown mechanism of abnormal modulation of the immune system. Patients taking cyclosporine especially those having another autoimmune disease or family history of thyroid disease must be carefully monitorized with thyroid function tests.