Endocrine Abstracts

Introduction: Thyroid-gastric autoimmune syndrome (TGS), described in the 1960s, is the autoimmune association of thyroid disease (Hashimoto’s or Graves’ disease) and gastric mucosal disease (Biermer’s disease) in the same patient. Although this association is part of the autoimmune polyendocrinopathies, its prevalence is largely underestimated in the literature. We report the case of a 56-year-old female patient with TGS.

Observation: Patient aged 56; followed for mitral stenosis on VKA, followed for Biermer’s disease discovered during an etiological workup of macrocytic anemia with positive anti-parietal cell and anti-FI Ac levels, the patient was put on Hydroxocobalamin. The patient consulted for asthenia and recent weight gain considered moderate, a TSH us requested returned at 22.4 mUI/l, thyroid ultrasound objective an aspect of thyroiditis, anti TPO Ac returned positive confirming the diagnosis of Hashimoto’s thyroiditis. The patient was put on a progressive dose of Levothyroxine in view of the atrial fibrillation she presented on ECG.

Discussion: Biermer disease (BD) is an autoimmune atrophic gastritis causing vitamin B12 deficiency, frequently associated with other autoimmune diseases, notably endocrinopathies. Autoimmune thyroid disease generally has a favorable course, but when associated with autoimmune gastritis, there is a risk of developing gastric tumors. Digestive malabsorption also affects medications (levothyroxine), making it difficult to substitute for hypothyroidism. The prevalence of BD is around 10-15% in prospective series of autoimmune thyroiditis. The search for this association is important because of its frequency and its therapeutic and prognostic implications.

Conclusion: Systematic thyroid assessment during BD is necessary to detect and treat these thyroid disorders, which are sometimes in the sub-clinical stage.