Endocrine Abstracts

Introduction

The combination of at least three autoimmune diseases in the same patient is defined as multiple autoimmune syndrome. Recent studies demonstrated a higher prevalence of celiac disease in patients with immune thrombocytopenia when compared to the general population. Here we report the occurrence of celiac disease, Hashimoto’s disease and immune thrombocytopenia in type 2 diabetes patient.

Case report

A 64 years old man was referred for a recently diagnosed corticosteroid induced type 2 diabetes mellitus treated by oral anti diabetic drugs (metformin 2000 mg/j + glimepiride 2 mg/j). Past medical history was significant: immune thrombocytopenia diagnosed at the age of 30 years old treated by corticotherapy in 1986, 2017 and 2019, celiac disease diagnosed at the age of 44 years old treated by gluten free diet, benign stenosis of the common bile duct, hypertension controlled by two antihypertensive drugs (bisoprolol 5 mg/j + loop diuretics 40 mg/j) and atrial fibrillation anticoagulated with Vitamin K antagonists. The physical examination was strictly normal. The biochemical report was: Hb1Ac = 10.3%, triglycerides = 2.45 mmol/l, total cholesterol = 4.03 mmol/l, HDL = 1.05 mmol/l, LDL = 1.86 mmol/l, ASAT = 25 UI/l, ALAT = 54 UI/l, eGE = 116.3 ml/min/1.73 m², white blood cell count = 8000/mm3, hemoglobi n = 14 g/dl and a platelet count = 24 0000/mm³³. The corticosteroid tapering protocol has been started. The patient refused insulintherapy. Medical decision was to intensify the treatment: glimepiride 4 mg/j + metformin 2000 mg/j. Four months later, the biochemical report was HbA1c = 6.5%, fasting blood glucose = 8 mmol/l, elevated TSH (38µUI/ml) and decreased FT4 (8.57 pmol/l). Primary hypothyroidism was diagnosed on routine screening. The patient did not report any hypothyroidism symptoms. Since the main etiology is autoimmune, an access protocol was complemented with antibodies, highlighting the elevation of antiperoxidase antibodies (455.9 UI/ml) concluding diagnosis of Hashimoto’s Thyroiditis. Interconsultation with the cardiology service was initiated, starting treatment with Levothyroxine 12.5 µg/day. Appropriate adjustment of the Levothyroxine therapy is needed to determine the proper dosage.

Conclusion

Patients with autoimmune history should be screened regularly in order to detect the outbreak of new autoimmune diseases, since they have common mechanisms and a shared genetic background.