Pulmonary veno-occlusive disease in a patient with a history of Hashimoto's thyroiditis

Pulmonary veno-occlusive disease (PVOD), a rapidly progressive and fatal disorder, is a rare cause of pulmonary hypertension. We report the occurrence of PVOD in a female patient with Hasimoto's thyroiditis. This report emphasises that PVOD can co-exist with Hashimoto's thyroiditis and a high index of clinical suspicion is required to confirm the diagnosis of PVOD.     

Unilateral proptosis due to orbital pseudotumor in a patient with Hashimoto's thyroiditis

A patient with unilateral proptosis and goiter is presented who initially was thought to have Graves' disease. However, the histologic appearance of the orbital tissue and the results of thyroid function and serologic studies were most consistent with the diagnoses of orbital pseudotumor and Hashimoto's thyroiditis, respectively, as the cause of these abnormalities. Two previous instances of an association between orbital pseudotumor and thyroiditis have been reported. A review of the literature shows that the ophthalmologic signs in patients with a pseudotumor superficially resemble those observed in subjects with thyroid ophthalmopathy. However, a palpable supraorbital mass is often present and biopsy of the mass usually demonstrates the heavy lymphocytic infiltration typical of this disease. Since the implications of the diagnosis of pseudotumor differ from those of Graves' disease, this entity should be considered in the differential diagnosis of the patient presenting with unilateral proptosis.     

Development of pemphigus vulgaris in a patient with vitiligo and Hashimoto's thyroiditis

Pemphigus vulgaris is an autoimmune blistering disease. An association of pemphigus vulgaris with vitiligo or Hashimoto's thyroiditis has not been reported before. We reported a 38 yr-old female patient with Hashimoto's thyroiditis and vitiligo who eventually developed pemphigus vulgaris on vitiliginous lesions. A genetic predisposition or a local event on vitiliginous skin may be responsible for the development of pemphigus in this patient.     

Concurrent immune thrombocytopenic purpura and Guillain-Barre syndrome in a patient with Hashimoto's thyroiditis

Immune thrombocytopenic purpura (ITP), Guillain-Barre syndrome (GBS), and Hashimoto's thyroiditis (HT) are autoimmune disorders caused by impaired self-tolerance mechanisms triggered by interaction between genetic and environmental factors. ITP is an immune-mediated destruction of platelets resulting in mucocutaneous bleeding, GBS is an ascending motor paralysis caused by an inflammatory demyelination of peripheral nerves, and HT is characterized by autoimmune-mediated destruction of the thyroid gland. The concurrent development of ITP and GBS has only rarely been reported in the literature, and GBS itself rarely occurs with other autoimmune disorders. We present a 21 year-old patient with known Hashimoto's hypothyroidism that simultaneously developed GBS and ITP after an upper respiratory tract infection. To the best of our knowledge, this is the first reported case of these three autoimmune disorders in the same patient. This points to a possible common genetic predisposition to these disorders.     

Hypersensitivity caused by synthetic thyroid hormones in a hypothyroid patient with Hashimoto's thyroiditis

A 63-year-old hypothyroid woman with Hashimoto's thyroiditis developed fever, eosinophilia, and liver dysfunction in response to replacement doses of triiodothyronine, or L-thyroxine. The symptoms disappeared on cessation of the replacement therapy. Lymphocyte stimulation tests showed high stimulation indexes for both hormones. After an interval of four months, when the patient became severely hypothyroid, treatment with triiodothyronine on a slowly increasing dose program was tried and resulted in a good control without ill response at this time. This observation indicates that, under certain pathologic conditions, hypersensitivity may be induced to thyroid hormones administered exogenously.     

Occult parathyroid carcinoma in a patient with papillary thyroid carcinoma and Hashimoto's thyroiditis

A 47-year-old female patient with a previous history of right thyroid lobectomy was admitted to the hospital because of a 3 cm nodule in the thyroid gland. Hormonal evaluation showed subclinical hypothyroidism with serum levels of thyroid stimulating hormone slightly elevated to 4.4 microg/dl (normal: 0.4-4 microg/dl). Thyroid ultrasound showed diffuse irregularity of the gland and the presence of a solitary nodule (30x18 mm in diameter) localized in the left lobe. A fine needle aspiration biopsy was performed. Cytological analysis revealed papillary thyroid carcinoma and Hashimoto's thyroiditis. Total thyroidectomy was performed. During the operation, two of the parathyroid glands were detected to be hyperplastic. Histopathological examination of the thyroid and parathyroid glands revealed Hashimoto's thyroiditis with papillary thyroid carcinoma and synchronous carcinoma of the parathyroid gland. To our knowledge, this association of occult parathyroid carcinoma in a patient with papillary thyroid carcinoma and Hashimoto's thyroiditis has not been reported in the literature. Given the high prevalence of autoimmune diseases in elderly women, a random occurrence of this triad represents the most likely explanation.     

Intrathyroidal persistence of human parvovirus B19 DNA in a patient with Hashimoto's thyroiditis

Previous studies suggest a role of viral infection in the development of Hashimoto's thyroiditis (HT). Here we report a patient with HT in whom human parvovirus B19 (B19) DNA has been persistently detected in the thyroid regardless of the presence or absence of B19 DNA in peripheral blood mononuclear cells. In contrast to the DNA persistence, however, VP1 capsid protein was not detected in the thyroid by immunohistochemical studies. Thyroid specimens obtained by fine needle aspiration biopsy from two patients with HT and two with Graves' disease were negative for B19 DNA. Thus, whereas a causal link between B19 infection and HT remains to be determined, B19 DNA may persist in the thyroid and B19 infection may facilitate the intrathyroidal inflammatory process in HT patients.     

Myocardial metabolism in a patient with Hashimoto's thyroiditis and hypothyroidism: Case report,with metabolic studies

A case of Hashimoto's thyroiditis with clinical and pathologic evidence of hypothyroidism is presented. Cardiac output, coronary blood flow and myocardial oxygen consumption were within the normal range. Pyruvate and lactate were extracted by the heart during the basal state and released by the heart on exercise. A marked increase in myocardial glucose: oxygen extraction ratio was found and the differences in oxidation reduction potential between arterial and coronary vein blood were positive at rest and exercise. The results suggest glycolysis in the cardiac muscle of this individual in the presence of normal myocardial oxygen usage.     

Maltoma of the thyroid in a man with Hashimoto's thyroiditis

We report the case of a 42-yr-old man with primary thyroid lymphoma arising from mucosa-associated lymphoid tissue (MALT-lymphoma, maltoma). The patient underwent a hemithyroidectomy for a growing mass in the right lobe of the thyroid while being treated with 1-thyroxine for Hashimoto's thyroiditis. The clinical diagnosis of Hashimoto's disease was confirmed by aspiration biopsy of the mass during the course of L-thyroxine treatment. Postoperatively, histology showed atypical lymphoproliferative infiltrates suspicious of low-grade non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue-type, coexisting with a reactive process typical of chronic lymphocytic thyroiditis. Immunophenotyping showed a mixed B- and T-lymphocyte population, which was nondiagnostic. However, Southern blot analysis revealed a clonal rearrangement of the Ig heavy chain gene. This case demonstrates that cytology or histology may not distinguish between reactive or low-grade lymphomatous thyroid processes. The use of molecular technique was essential to prove clonality and the presence of lymphoma.     

Subacute cutaneous lupus associated with Hashimoto's thyroiditis

Subacute cutaneous lupus erythematosus is a widespread, non-scarring, photosensitive form of histologically specific cutaneous LE. These patients frequently have mild systemic illness marked by musculoskeletal complaints and characteristic serologic abnormalities. Hashimoto's thyroiditis coexists with other diseases of presumed autoimmune nature, including systemic lupus erythematosus. The association between subacute lupus and Hashimoto's disease has not been described. We describe here a patient with Hashimoto's thyroiditis and Sj?gren's syndrome who developed subacute cutaneous lupus two years later.     

Turner's syndrome with X-isochromosome and Hashimoto's thyroiditis

OBJECTIVE The higher frequency Of Hashimoto's thyroiditis in Turner's syndrome compared with the general population is well known. We have attempted to establish clearly the more frequent association of thyroiditis with the X-isochromosome, since previous reports of this aspect have included only small numbers of patients. DESIGN Retrospective study of patients with Turner's syndrome investigated within the past 12 years. PATIENTS Sixty-seven cases of Turner's syndrome were reviewed. MEASUREMENTS Peripheral blood leucocyte karyotype and screening for thyroid disturbances on the basis of clinical examination and laboratory evaluation (anti-thyroglobulin and anti-microsomal antibodies, basal TSH levels and TSH levels after TRH stimulation) were made for each patient. RESULTS A diagnosis of thyroiditis, based on the association of positive antibody titres, elevated TSH and an abnormal thyroid gland on clinical examinatlon, was established in 20·9% (14/67) of cases. A significantly higher frequency of thyroiditis was found among the patients presenting with an X-isochromosome (57·3%, 9/16), compared to patients with other karyotypes (9·8%, 5/51) (P = 0·0001). CONCLUSIONS Our results, obtained by Investigation of a larger number of patients with an X-isochromosome karyotype than in previous reports, confirm conclusively that patients with X-isochromosome Turner's syndrome have an increased risk of developing thyroiditis.     

Thymoma associated with pancytopenia and Hashimoto's thyroiditis

Described herein is a twenty year old woman with Hashimoto's thyroiditis in whom thymoma and pancytopenia developed, an association not previously reported. This case represents another example of the relation of thymoma to disorders assumed to be secondary to an autoimmune process.