Endocrine Abstracts

Introduction: Graves’ disease is an autoimmune disease that affects the thyroid gland and leads to a state of hyperthyroidism. This disease is caused by the production of antibodies that bind to and activate the thyroid-stimulating hormone (TSH) receptor. In some cases, Grave’ disease may be associated with other organ-specific or systemic autoimmune disorders. One of the most frequent multisystemic autoimmune disorders is Systemic lupus erythematosus (SLE). Many studies have described the association between SLE and thyroïde disease but mostly hypothyroidism. However, a limited number of cases of Graves’ disease have been also reported in SLE patients.

Observation

We describe a case of a 29 years old female without a particular medical family history, with a history of two precocious miscarriages who has been diagnosed with LES associated with Sjogren syndrome in July 2019.

The patient presented a deterioration of the general status and a tumoral syndrome, a biological inflammatory status with pancytopenia and complement consumption. The diagnosis was confirmed by the presence of positive antinuclear antibodies. She was treated with Hydroxychloroquine and corticoids.

In August 2019, the patient was addmitted with a fever, tachycardia and a continuous loss of weight that was initially attributed to an acute episode of her disease. We noticed the presence of a minor exophthalmia and fine tremors but there was no palpable goiter.

The hormonal tests showed a status of hyperthyroidism ; a suppressed thyroïde stimulating hormone (< 0.15 mUI/l) and a high FT4 level (64.8 pmol/l). Measurement of TSH receptor antibody was positive and the thyroid Ultrasonogram with Doppler showed an heteromultinodular hypervascular gland. The diagnosis of Grave’ disease was posed and the patient was treated with Antithyroid drugs.

Conclusion: The clinical manifestations of LES and Grave’ disease can be similar. This association even if not frequent should be suspected in the presence of subtle signs of hyperthyroidism. Since both are autoimmune diseases that can have severe complications.