ECE2015 Eposter Presentations Clinical Cases–Thyroid/Other (101 abstracts)
Late onset of a rare autoimmune association: coeliac disease and Hashimoto's thyroiditis: hormonal and metabolic implications
Mirela Puiu 1 , Radu Popa 2 , Elena Gologan 3 , Felicia Crumpei 4 , Ioana Armasu 1 , Ioana Vasiliu 1 , Adina Manolachie 1 , Cristina Preda 1 & Carmen Vulpoi 1
1Department of Endocrinology, University of Medicine and Pharmacy ‘Gr.T.Popa’, Iasi, Romania; 2Department of Vascular Surgery, University of Medicine and Pharmacy ‘Gr.T.Popa’, Iasi, Romania; 3Department of Gastroenterology, University of Medicine and Pharmacy ‘Gr.T.Popa’, Iasi, Romania; 4Department of Radiology and Medical Imaging, University of Medicine and Pharmacy ‘Gr.T.Popa’, Iasi, Romania.
Introduction: Several autoimmune determinations have been reported in association with autoimmune thyroidits (AIT). While the classical correlations with other endocrine or general autoimmune diseases like pernicious anemia or vitiligo are frequent and well defined, there are fewer data on other rarer associations, as with celiac disease (CD). In the absence of typical clinical symptoms this association may be overlooked, as in the case we present.
Case presentation: DM, 64 years old female patient, with three recent episodes of persistent diarrhea and weight loss, having negative bacteriologic and imagistic investigations (gastric endoscopy with antral biopsy, colonoscopy, and abdominal CT), was oriented to the Endocrine Department for hypothyroidism associated with severe diselectrolemia. On admission she presented asthenia, hypoanabolic syndrome (BMI 17.5 kg/m2) and inferior limb edema. Biological data confirmed autoimmune thyroiditis with hypothyroidism (TSH=27 μUI/ml, fT4=0.7 ng/dl, ATPO >1000 UI/ml, and ATg >3000 UI/ml), inflammatory syndrome, severe vitamin D deficiency (<3 ng/ml), and severe metabolic disturbances (hypoalbuminemia, hypokaliemia, hyponatremia, hypocalcemia, and acidosis). Markers for digestive neoplasia and NET were negative. Other investigations revealed osteoporosis and profound venous thrombosis with decreased tolerance to cumarinic anticoagulants (INR 7.32) which imposed heparinotherapy. Coeliac disease was suspected, sustained by positive antigliadin antibodies. Patient refused doudenal biopsy. Substitutive L-T4 treatment, vitamin D supplementation and gluten-free diet was started, with rapid and persistent improvement of the general status and biological data.
Conclusion: Undiagnosed CD associated with TAI may determine severe metabolic disturbances due to the vicious circle of malabsorbtion. Low L-T4 absorbtion impose attentive substitution dosage. Most of guides do not recommend systematic search of CD in TAI however, since, as in our patient, CD may be paucisymptomatic and/or with late manifestation, we believe that it may be useful to search it, if not in all AIT patients at least in those with metabolic disturbances.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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