Endocrine Abstracts

Introduction: Subacute thyroiditis is usually a self-limited pathology, possibly of viral aetiology, defined by cervical pain and sometimes systemic symptoms. Its association with autoimmune diseases doesn’t seem to be more frequent than in the general population.

Clinical case: Clinical findings of thyrotoxicosis with 3 weeks of evolution associated with anterior cervical pain and fever up to 38 °C. The patient presented with recurrent mouth sores since childhood and vaginal sores in the prior year. She also presented with hand nail pitting and onycholysis in the former 4 years. The maternal aunt had thyroid cancer and two maternal cousins had multinodular goitre. No family history of autoimmune diseases. The thyroid ultrasound revealed an enlarged lobulated gland with hypoechoic areas. Periodic analytical study was conducted (in 2^nd/ 4^th/ 9^th/ 15^th weeks): TSH – 0,024/ <0,01/ 32,139/ 4,69 μUI/ mL (0,35–4,94); free T3 – 5,33/ 3,27/ 2,81/ 3,19 pg/ mL (1,71–3,71); free T4 – 2,39/ 1,28/ 0,62/ 0,88 ng/ dL (0,70–1,48); C reactive protein – 66,80/ 27/ 0,4/ 0,2 mg/ L (<0,5); anti-thyroid antibodies were negative. Eight months after the beginning of the symptoms, TSH was of 0,894 μUI/ mL. The patient was initially treated with propanolol 20 mg every 8 hours and ibuprofen 400 mg every 8 hours. In this period she referred worsening of the mouth sores. In subsequent consultations the dose of beta-blocker was progressively diminished until its suspension after 2 months. A progressive improvement of the pain symptoms took place with complete disappearance after 6 months. The patient was at the same time observed by the Dermatology speciality which diagnosed nail psoriasis. Despite a period of clear, short, analytical hypothyroidism, it was decided not to initiate levothyroxine given the absence of symptoms related to it. In the beginning of 2017 the patient was observed in the autoimmune diseases consultation were she was diagnosed with Behçet’s Disease. From the undertaken study, it stands out the positivity for HLA-B*35 and HLA-A*02 antigens.

Conclusions: Subacute thyroiditis usually presents a self-limited, typical evolution, and remits without leaving sequelae. In the presented case it was possible to document that particular evolutional pattern, even in the context of significative analytical hypothyroidism. Within our knowledge, the association between Subacute Thyroiditis, Behçet’s Disease and Psoriasis has never been reported. In the first, it is documented an increase in prevalence of antigen HLA-B*35, and in the last two of the antigen HLA-A*02.