A Rare Case of Severe Type 4 Polyglandular Autoimmune Syndrome in a Young Adult

Abstract

Objective. The association of type 1 diabetes mellitus with autoimmune thyroiditis or with celiac disease is frequently mentioned in literature, but the concomitant presence of these three autoimmune diseases, especially in adults, represents a rarity. Case report. We present the case of a young man with severe generalized oedema admitted to the emergency department and diagnosed with severe hypothyroidism (TSH=100 μUI/mL, fT4 = 0.835 pmol/L) in the context of a long-lasting autoimmune thyroiditis (anti-TPO antibodies 64 UI/mL, anti-TG antibodies 17 UI/mL, the thyroid ultrasonography). At the same time, he was diagnosed with type 1 diabetes mellitus. He was also submitted to further tests which confirmed the diagnosis of celiac disease (endoscopy with intestinal mucosa biopsy, confirmed by immunological tests). The association of these three diseases slows down the process of reaching a final diagnosis and delays the adoption of a therapeutic strategy. Conclusion. This case underlines the difficulty of differential diagnosis of severe oedema syndrome with polyserositis in a patient with polyglandular autoimmune syndrome. Whenever there is a suspicion of the association of these autoimmune diseases, the evolution of the patient is unpredictable and most medical results are highly dependent upon the decision of applying a concomitant treatment.

The Relationship between Thyroid Hormones, Antithyroid Antibodies, Anti-Tissue Transglutaminase and Anti-Gliadin Antibodies in Patients with Hashimoto's Thyroiditis

“…Ordinal regression analysis with Anti-TPO or Anti-TG antibodies as dependent variables and AGA, ATA antibodies and thyroid hormones as independent variables in patients with Hashimoto's thyroiditis patients with Hashimoto's thyroiditis. Several clinical studies have indicated a significant association between autoimmune thyroid disease especially Hashimoto's thyroiditis and celiac disease (17)(18)(19)(20)(21). Evidences show that 4-19% of patients with celiac disease also have Hashimoto's thyroiditis (9).…”

“…Several studies have suggested the role of common genetic backgrounds such as HLA-alleles including HLA-DQ2 and HLA-DQ8 in pathogenesis of these coexistences (9, 28); therefore, more studies are necessary to identify the main role of celiac disease in pathogenesis of Hashimoto's thyroiditis. From clinical point of view, the undiagnosed celiac disease in Hashimoto's thyroiditis can reduce the iodine absorption and trigger the disease progression (19). Therefore identifying and treatment of celiac disease in patients with Hashimoto's thyroiditis will confer benefits in reducing the complications including malabsorption and infertility and improve the efficacy of Hashimoto-associated medications (28).…”