Lobasso Antonio, Nappi Liliana, Barbieri Letizia, Peirce Carmela, Ippolito Serena, Arpaia Debora, Rossi Francesca Wanda, de Paulis Amato, Biondi Bernadette
Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.
Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Front Endocrinol (Lausanne). 2017 Sep 20;8:241. doi: 10.3389/fendo.2017.00241. eCollection 2017.
Thyroid function abnormalities and thyroid autoantibodies have been frequently described in patients with systemic autoimmune diseases as systemic sclerosis (SSc). Serum TSH levels are higher in SSc patients with more severe skin diseases and a worse modified Rodnan skin score. Asymptomatic esophageal involvement due to SSc has never been described as a cause of severe hypothyroidism due to l-thyroxine (l-T4) malabsorption in patients with Hashimoto's thyroiditis (HT) and SSc.
Here, we report a case of a 56-year-old female affected by both SSc and HT who developed severe hypothyroidism due to the loss of therapeutic efficacy of l-T4. Therapeutic failure resulted from the altered l-T4 absorption because of SSc esophageal complications. Clinical findings improved after the administration of oral liquid l-T4. Thyroid function completely normalized with a full clinical recovery, the disappearance of the pericardial effusion and the improvement of the pulmonary pressure.
A recognition of a poor absorption is crucial in patients with hypothyroidism and SSc to reduce the risk of the subsequent adverse events. This case suggests the importance of clinical and laboratory surveillance in patients with SSc and HT because the systemic complications of these dysfunctions may worsen the prognosis of hypothyroid SSc/HT patients.
甲状腺功能异常和甲状腺自身抗体在系统性自身免疫性疾病患者中经常被描述，如系统性硬化症（SSc）。在患有更严重皮肤病和改良Rodnan皮肤评分更差的SSc患者中，血清促甲状腺激素（TSH）水平更高。从未有过因SSc导致的无症状食管受累被描述为桥本甲状腺炎（HT）和SSc患者中左旋甲状腺素（l-T4）吸收不良导致严重甲状腺功能减退的原因。
在此，我们报告一例56岁女性，患有SSc和HT，因l-T4治疗效果丧失而出现严重甲状腺功能减退。治疗失败是由于SSc食管并发症导致l-T4吸收改变。口服液体l-T4后临床症状改善。甲状腺功能完全恢复正常，临床完全康复，心包积液消失，肺动脉压改善。
认识到吸收不良对甲状腺功能减退和SSc患者至关重要，以降低随后不良事件的风险。该病例表明对SSc和HT患者进行临床和实验室监测的重要性，因为这些功能障碍的全身并发症可能会使甲状腺功能减退的SSc/HT患者的预后恶化。
