Endocrine Abstracts

Background: Chronic spontaneous urticaria (CSU) is defined by the presence of recurrent urticaria (also called hives or wheals), angioedema, or both, for a period of six weeks or longer. CSU affects just 1% pf the general population and its etiopathogenesis is not well understood. CSU is known to be associated with various autoimmune conditions. However the association CSU and Graves Disease is very rarely seen in clinical practice.

Clinical case: In this case report we present a 48 year old woman with Graves Disease who developed recurrent episodes of urticaria with angioedema. She was extremely sensitive to even minute doses of carbimazole. This resulted in very fluctuating thyroid functions over a six month period with TSH levels being as low as 0.05 to as high as 90. Her TSH receptor antibodies and Thyroid peroxidase antibodies were positive. Additionally, her thyroid ultrasound favoured an autoimmune cause of her hyperthyroidism. It was observed that she had episodes of urticaria with swelling around the eyes which responded very poorly to high doses of antihistamines. However, a positive correlation was seen between normalisation of thyroid hormones and the resolution of urticaria.

Conclusion: Clinicians should be wary of the association between CSU and Graves Disease and are advised to exclude hyperthyroidism as a cause if the CSU is not responding to conventional treatments.

Keywords: Chronic Urticaria, Graves Disease