A case of long-term hypothyroidism converted to hyperthyroidism secondary to an autoimmune trigger
DOI:
https://doi.org/10.18203/2349-3933.ijam20222670Keywords:
Sjogren’s syndrome, Primary hyperthyroidism, Autoimmune switch, Schimmer’s testAbstract
Primary hypothyroidism is a common endocrine condition that is encountered. Graves disease and Hashimoto’s thyroiditis are the most common autoimmune conditions in which conversion of hyperthyroidism to hypothyroidism is seen. Chances of conversion of hypothyroidism to hyperthyroidism is extremely rare. This case highlights that there should be a high index of suspicion for a possible conversion of hypothyroidism to hyperthyroidism. The etiology being an autoimmune switch by an external stimulus in genetically susceptible individuals. Hereby, presenting a case of 53-years female, who is a known case of type II diabetes mellitus, chronic kidney disease, nephrotic syndrome diagnosed with minimal change disease who presented with a hormonal profile showing hyperthyroidism. She had a history of hypothyroidism in the past for 12-years and was treated with levothyroxine and was off treatment for the past 2 years. Further evaluation showed presence of primary Sjogren’s syndrome which has let to this conversion.
References
Ahmad E, Hafeez K, Arshad MF, Isuga J, Vrettos A. Hypothyroidism conversion to hyperthyroidism: it's never too late. Endocrinol Diabetes Metab Case Rep. 2018;2018:18-0047.
Takasu N, Yamada T, Sato A. Graves’ disease following hypothyroidism due to Hashimoto’s disease: studies of eight cases. Clin Endocrinol. 1990;33:687-98.
Takasu N, Yamada T, Sato A, Nakagawa M, Komiya I, Nagasawa Y et al. Graves’ disease following hypothyroidism due to Hashimoto’s disease: studies of eight cases. Clin Endocrinol. 1990;33:687-98.
Joplin GF, Fraser R. Thyrotoxicosis developing in recurrent nodular goitre with focal thyroiditis. Proceedings Royal Society of Med. 1959;52:177-8.
Takasu N, Yamashiro K, Ochi Y, Sato Y, Nagata A, Komiya I et al. TSBAb (TSH- stimulation blocking antibody) and TSAb (thyroid stimulating antibody) in TSBAb-positive patients with hypothyroidism and Graves, patients with hyperthyroidism. Horm Metab Res. 2001;33(4):232-7.
Jara LJ, Navarro C, Brito-Zerón Mdel P, García-Carrasco M, Escárcega RO, Ramos-Casals M. Thyroid disease in Sjögren's syndrome. Clin Rheumatol. 2007;26(10):1601-6.
Ichikawa Y, Fukuda R. Clinical and pathological features of Sjögren's syndrome associated with autoimmune thyroid diseases. Nihon Rinsho. 1995;53(10):2545-50.
Mellgren SI, Göransson LG, Omdal R. Primary Sjogren's syndrome associated neuropathy. Can J Neurol Sci. 2007;34:280-7.
Kaur H, Alazzeh M, Thandavaram A. Increased Threat of Thyroid Diseases in Patients with Sjogren’s Syndrome: A Systematic Review. Cureus. 2022;14(8):e28062.
