Endocrine Abstracts

Introduction: Behcet’s disease (BD) is a systemic inflamatory disorder characterized by recurring oral and genital ulcers, uveitis, and skin lesions. Graves’ thyrotoxicosis is caused by an autoimmune reaction to thyroid autoantigens. Thyroid receptor antibody testing is used to diagnose Graves’ thyrotoxicosis. There has previously been no evidence of a link between thyroid autoimmunity and BD. We present a case of an adult male with BD coexistence, which is uncommon.

Case Report: A 49-year-old male patient presented with complaints of palpitations, marked sweating and weight loss (11 kg) for 4 months. The patient had deep vein thrombosis 8 years ago and was diagnosed with Behçet’s syndrome while investigating the cause. He was receiving colchicine 2*1 treatment for Behçet’s syndrome. On examination, the patient was sweaty and had hand tremors compatible with thyrotoxicosis. The patient had painless red eyes but no exophthalmos. Mild signs of thyroid eye disease were present. Blood tests revealed biochemical evidence of severe thyrotoxicosis and thyroid receptor antibody levels were elevated. Ultrasound scan of the thyroid and radioactive iodine uptake scan showed features consistent with Graves’ thyrotoxicosis and a diagnosis of Graves’ thyrotoxicosis was made. The patient was started on methimazole 30 mg and propranolol 20 mg twice daily. After treatment, the patient responded well with improvement of clinical symptoms and normalisation of thyroid functions. The patient is still being followed up in the internal medicine clinic for 4 years under colchicine, methimazole and propranolol treatment.

Discussion: BH can be considered an autoimmune disease due to its many features, including spontaneous remissions and relapses. There are reports that BD is associated with other autoimmune diseases. Since autoimmunity is responsible for the etiology of BH, the possibility of an increased incidence of autoimmune thyroiditis should be considered. Furthermore, there is a significant overlap in clinical features between different conditions such as oral ulcers, uveitis, and arthralgia, and this may occur in many of these conditions. However, the hypothesis regarding the role of antibodies in BD may also share a common ground in the pathogenesis of other autoimmune diseases. Although the limited data do not provide concrete evidence of any association between the two conditions, this case highlights the question of whether their coexistence is due to a pathogenic relationship rather than mere coincidence.