Endocrine Abstracts

Introduction: Hashimoto’s thyroiditis (HT) is one of the commonest endocrine disorder. Often, HT is associated with a plethora of autoimmune co-morbidities (AIC) such as vitiligo, arthitides, pernicious anaemia, skin allergy, thrombocytopenia, addison’s disease, type 1 diabetes, celiac disease, eosinophilia etc., The etiology of these AIC in HT is enigmatically idiopathic and hypothesized to be autoimmune in origin. Many studies suggests that thyroid specific antibodies have shared epitopes of antigens in other organ systems such as skin, connective tissue, skeletal, visceral systems making them potential targets of AIC in HT. The treatment is symptomatic and supportive with euthyroidism, but no curative option. There are meagre anecdotal reports of thyroidectomy role for cure in HT. In this context, we report our experience on impact of total thyroidectomy on AIC in HT.

Material & Methods: This is a retrospective study conducted in Endocrine Surgery department of tertiary care Hospital. In all, 25 patients with HT and various AIC combinations are included in this study. All the clinico-investigative and operative data are scrutinized and analysed. All of them underwent total thyroidectomy. Informed consent obtained. The surgical indications were large goiter/painful thyroiditis/ cosmetic/pressure symptoms and not AIC. Mean follow-up after surgery was 1.6±0.8 years (1.3–2.9).

Results: F:M ratio was 3:1 and mean age was 44.5±4.4 (24–52). There was no hypoparathyroidism or recurrent laryngeal nerve palsy in any case. None had associated hypertension, migraine, diabetes or any other neurological illnesses. All of them had Preoperative serum anti-thyroperoxidase antibody (Anti-TPO Ab) above the upper reference limit of 60 IU/L and was 434±103.2 IU/L (244–608) and post operative level was 52.75±25 IU/L(22-101). 19/25 (76%) had resolution or significant alleviation of AIC manifestations. The major improvement in AIC were skin allergy (9/12), eosinophilia (14/15), arthritides (5/14), vitiligo (3/8), celiac disease symptomatic episodes (1/4); but type 1 diabetes and addison’s disease showed static response.

Conclusions: Retrospectively, Surgical thyroidectomy appears to have beneficial role in alleviation of AIC making it a potential additional surgical indication in HT. Anti-TPO Ab related autoimmunity appears to play a role in AIC. Long term impact and multi-institutional results are required to validate the curative role of surgery for HT associated AIC.

Keywords: Thyroidectomy, Hashimoto’s thyroiditis, hypocalcemia, thyroid peroxidase antibody, autoimmune disease