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Introduction: Thoracocervical ecchymosis can be produced by trauma, dissecting aortic aneurysm and complications due to medical procedures and hemorrhage of parathyroid adenoma. Extracapsular hemorrhage is a rare interpretation of a parathyroid adenoma (1). We presented our case with spontaneous thoracocervical ecchymosis who was on follow-up for parathyroid adenoma. Case: 64 year old man arrived our clinic with complaint of painful discoloration on his neck and chest which appeared one day ago spontaneously. The area of ecchymoses was located centrally through neck extanding to thorax (Figure 1). Before the admission, he had been followed up by our institution for primary hyperparathyroidism and primary hypothyroidism. In his medical history there was also Behcet's disease and he was on colchicine, levothyroxine 50 mcg/day used regularly and acetyl salicylic acid which he used seldomly. His vital signs were absolutely normal just like his coagulation studies and hemoglobin level. He was hospitalized regarding complicational risks due to hematoma's localization. In his latest follow-up before hematoma formation, in thyroid ultrasonography (USG) there was moderate heterogeneity, a 2x3x4 mm hypoechoic nodule in left upper pole and a 9x11x17 mm hypoechoic lesion compatible with parathyroid adenoma in left thyroid lobe inferoposterior region. Tc 99 m parathyroid scintigraphy revealed a hyperactive lesion in the same localization with the susceptible parathyroid lesion in USG. After the formation of ecchymoses the novel ultrasonographic investigation revealed a heterogenic area surrounding the left thyroid lobe, extanding to common carotid artery laterally. Due to this heterogeneity the former parathy-

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C Co oe ex xi is st te en nc ce e o of f A Au ut to oi im mm mu un ne e a an nd d A Al ll le er rg gi ic c D Di is se ea as se es s w wi it th h A Au ut to oi im mm mu un ne e T Th hy yr ro oi id d D Di is se ea as se es s O Ot to oi im mm mü ün n T Ti ir ro oi id d H Ha as st ta al lı ık kl la ar rı ıy yl la a B Bi ir rl li ik kt te e S Se ey yr re ed de en n O Ot to oi im mm mü ün n v ve e A Al ll le er rj ji ik k H Ha as st ta al lı ık kl la ar r Ankara University Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey *Ankara University Faculty of Medicine, Department of Gastroenterohepatology, Ankara, Turkey Background: Sometimes, the patients with autoimmune thyroiditis show certain symptoms despite having serum thyroid hormone levels within the desired range. In addition, the dose of levothyroxine replacement may vary in the patients with hypothyroidism. These factors directly inuence clinical practices and may, to some extent, be associated with other immunological/allergic diseases that accompany autoimmune thyroid diseases (ATDs). Purpose: To document the other autoimmune/allergic disorders in patients during follow-up for ATDs. Materials and Methods: During the study period, 274 patients diagnosed with, and/or at follow-up for Hashimoto's thyroiditis (HT), and 53 with Graves' disease (GD) were included in the study. All the patients were examined and were subjected to further investigations when the presence of other autoimmune/allergic diseases was suspected.Results: A total of 65 patients with HT (23.8%) and seven patients with GD (13.2%) had at least one additional clinical autoimmune/allergic disorder. Twentyeight (10.2%) patients with HT had gastrointestinal disorders (chronic atrophic gastritis and celiac disease), 19 (6.6%) had allergies (asthma, chronic urticaria, and rhinosinusitis), 12 (4.4%) had rheumatological disorders (rheumatoid arthritis), 10 (3.7%) had skin problems (vitiligo and psoriasis), four (1.5%) had endocrinological disorders (hypoparathyroidism, type-1 diabetes mellitus, and hypophysitis), one (0.4%) had hematological disease (idiopathic thrombocytopenic purpura), and one (0.4%) had renal disorder (crescentic glomerulonephritis). The prevalence patterns were similar in the patients with GD. In addition, 50 (18.2%) patients with HT and one (1.9%) with GD were observed to have vitamin B12 decient-anemia (p=0.001). Furthermore, 28 (10.2%) patients with HT and one (1.9%) with GD had dimorphic anemia (both vitamin B12 and iron deciencies). Discussion: The patients with ATDs are prone to additional autoimmune/allergic diseases, and it can be said that the patients with autoimmune thyroid diseases sometimes have more than just thyroid disease. The most involved organ system in both HT and GD is the gastrointestinal tract. This involvement probably plays a role in the exacerbation of some symptoms by causing anemia resulting from a deciency of both vitamin B12 and iron, especially in patients with HT.