Systemic Lupus Erythematous and Graves Disease

Le résumé fourni par la source

Despite the common genetic predisposition and autoimmune features of both disorders, Graves disease (GD) has been described quite infrequently in patients with systemic lupus erythematous (SLE; average incidence of 2.8% vs. 1.9% in general population). We present a patient with SLE who developed hyperthyroidism. A 57-year-old woman, followed since 1998 for lupus nephritis, was admitted for clinical evaluation of hyperthyroidism 5 years after the diagnosis of SLE. Her symptoms included heat intolerance, tremor, and irritability. Clinical examination showed diffuse thyroid gland enlargement with a vascular murmur on auscultation. Hormonal assays showed markedly increased free T3 and T4 levels and suppressed thyroid-stimulating hormone levels with circulating thyroid-stimulating hormone receptor antibodies. Graves disease responded well to carbimazole treatment and beta-blockers. The patient had a subtotal thyroidectomy, later. The patient was on 10 mg of prednisolone maintenance therapy when hyperthyroidism was discovered. Concomitantly, a slight increase in serum creatinine and serum levels of anti-DNA antibodies and complement activation without other abnormalities were found. A third renal biopsy showed mononuclear interstitial infiltration but no glomerular signs of lupus activity. Patients with SLE are likely to be at increased risk for thyroid disease.

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