Pseudohypoparathyroidism and Graves'disease: a rare combination of two endocrinological diseases

Abstract

We report a 26-year-old woman presented at the day of admission in the I.C.U. with increased perspiration, plethora and distinct tetany of both legs. Particularly unusual was an exophthalmus on both sides, a rectal temperature of 38.3 degrees Celsius and a blood pressure of high level (180/110 mmHg). Laboratory findings were a low serum calcium concentration of 2.86 mval/l, a hyperphosphataemia (5.0 mg/dl), free thyroxine of 31.7 pmol/l, TSH basal of < 0.01 U/ml and positive MAK and TRAK. Serum parathormone concentration was excessively high: 766 ng/l (12-72). Ultrasound of the thyroid gland revealed a normal size with a volume of 10.4 ml; the echosonic state was not typical for Graves' disease. The initial treatment consisted of high dose thiamazole and hydrocortisone intravenous, calciumcarbonate and propranolol per os. After acute situation the treatment continued with thyreostatics, calcitriol and calciumcarbonate. The symptoms at the day of admission (tetany) disappeared within 2 days; only local paraesthesia of fingers persisted longer. Normalization of thyroid parameters was reached after 11 days; the serum calcium concentration persisted on an increasing but still lower level than standard (3.8 mval/l). During substitution parathormone decreased to 443 ng/l. What is unusual about this case is the combined appearance of autoimmunethyreoiditis (Graves' disease) and pseudohypoparathyroidism.

New insights into thyroid dysfunction in patients with inactivating parathyroid hormone/parathyroid hormone-related protein signalling disorder (the hormonal and ultrasound aspects): One-centre preliminary results

“…There are only a few detailed reports on the coincidence of autoimmune thyroiditis and iPPSD (23,24,(43)(44)(45)(46). The coincidence of Graves' disease (with positive TRAb) and clinically diagnosed iPPSD2 was described by Uchimura et al and iPPSD3 by Gerhardt et al (23,46).…”

“…There are only a few detailed reports on the coincidence of autoimmune thyroiditis and iPPSD (23,24,(43)(44)(45)(46). The coincidence of Graves' disease (with positive TRAb) and clinically diagnosed iPPSD2 was described by Uchimura et al and iPPSD3 by Gerhardt et al (23,46). Mukherjee et al described a case of iPPSD that subsequently developed multiple autoimmune disorders, such as celiac disease, hypothyroidism, and type 1 diabetes (43).…”

“…Studies on thyroid imaging in iPPSD are insufficient (7,(23)(24)(25). Elli et al found normal thyroid scans in a cohort of patients (7).…”

“…There are few reports of thyroid ultrasound evaluation in iPPSD (7,(23)(24)(25). From a clinical paediatric endocrine standpoint, it is interesting and of practical value to determine how TSH resistance extrapolates to the ultrasound structure of the thyroid gland.…”

Association of Pseudohypoparathyroidism and Autoimmune Polyglandular Syndrome: Causal or Coincidental?

“…In our patient who initially diagnosed to have PHP progressively developed PAS type III which, with best of our knowledge reported first time in the literature. There are only few case reports which had shown association of PHP with autoimmune disorders like systemic lupus erythematosus, graves' disease and Evan's syndrome [2][3][4]. Zeng WH and colleagues reported a patient of Turner's syndrome who simultaneously had PHP and autoimmune thyroiditis [5].…”