Endocrine Abstracts

Introduction: Autoimmune hepatitis (AIH) is a generally progressive and chronic liver disease that can occur both in children and adults. Although the cause of AIH is unknown, aberrant auto-reactivity is thought to have a role in its pathogenesis. The diagnosis is based on clinical presentation, biological and histological findings. Like other autoimmune diseases (AD), AIH can be associated with one or more AD either organ-specific or non-organ specific AD.

Materials and methods: It is a descriptive retrospective single institution study. We collected data from 113 patients diagnosed with autoimmune thyroid disease (AITD) associated with another AD over 18 years. This present study reports the association between AITD and AIH.

Results: We registered one case of AIH associated with an AITD. The infertility work-up of the patient revealed hypothyroidism: Hashimoto’s thyroiditis (HT) discovered at the age of 43. Both thyroid peroxidase antibody and thyroglobulin antibody were positive. She was treated by L-thyroxin with a favorable course of progress. At the age of 48 years, the patient presented with a chronic hepatitic cytolysis and the investigations led to the diagnosis of AIH. Antibody testing showed positivity for the smooth muscle antibodies (SMA) and histological findings from the liver biopsy were compatible with AIH. The patient was treated with glucocorticoid therapy and immunosuppressant drugs such as azathioprine.

Discussion and Conclusion: AIH is a heterogeneous group of chronic liver disease characterized by particular lesions on liver histopathology, elevated serum immunoglobulin, liver autoantibodies: SMA, soluble liver antigen autoantibody, Liver Kidney Microsome autoantibody, elevated serum transaminases and negative serology for viral hepatitis. AIH may affect adults of both sexes but affect mainly young women. Different studies estimated the frequency of the association: AIH and AITD around 10%. In our study, it was found to be around 1% which could be explained by the relatively small pool of patients. In 75% of cases, the AITD was HT. The cross reactions between the thyroid auto-antibodies and the presence of auto-reactive T cells or similar epithelial antigens found in the liver and the thyroid could explain the basis of the physiopathological mechanism behind this frequent association. We need to distinguish AIH from other forms of autoimmune liver diseases as it generally responds to anti-inflammatory and/or immunosuppressive treatment. Appropriate management can prolong survival and subsequently improve quality of life.