Srpski arhiv za celokupno lekarstvo 2016 Volume 144, Issue 11-12, Pages: 639-644
https://doi.org/10.2298/SARH1612639Z
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The onset of systemic lupus erythematosus and thyroid dysfunction following graves’ disease - a case report and literature review
Zhanga Yuanyuan (Qilu Hospital of Shandong University, Department of Nephrology, Jinan, China)
Xiaoa Xiaoyan (Qilu Hospital of Shandong University, Department of Nephrology, Jinan, China)
Haoa Qiufa (Qilu Hospital of Shandong University, Department of Nephrology, Jinan, China)
Lia Xianhua (Qilu Hospital of Shandong University, Department of Nephrology, Jinan, China)
Renb Jianmin (Qilu Hospital of Shandong University, Department of Endocrinology, Jinan, China)
Hu Zhao (Qilu Hospital of Shandong University, Department of Nephrology, Jinan, China)
Introduction. Graves’ disease is a multifactorial autoimmune thyroid disease,
with the presence of typical circulating autoantibodies that can activate the
thyroid hormone receptors, resulting in hyperthyroidism, goiter, and
ophthalmopathy. Systemic lupus erythematosus is a multi-systemic autoimmune
disease that involves almost all the organs of the human body and is
characterized by autoantibodies formation. Several studies have reported that
autoimmune thyroid and rheumatic disorders can present an unusual
relationship. Case Outline. We report a case of a middle-aged woman who
presented with systemic lupus erythematosus one year after being diagnosed
with Graves’ disease. Prednisone and cyclophosphamide were administered to
control the development of systemic lupus erythematosus. Furthermore, a
percutaneous thyroid biopsy was performed for further confirmation of Graves’
disease. Methimazole instead of propylthiouracil was added into the
therapeutic scheme. A month later, the patient’s clinical manifestation and
laboratory tests got significant improvement, except that new thyr o id
dysfunction appeared opposite to the original one. The administration of
anti-thyroid drug was discontinued. With a period of decreased administration
of prednisone, the patient’s thyroid function gradually got back to normal
levels without any levothyroxine replacement. Conclusion. In conclusion, the
clinical use of prednisone and antithyroid drugs may result in instability of
the hypothalamus-pituitary-thyroid axis, and thyroid function should be
carefully monitored in such patients.
This article has been corrected. Link to the correction 10.2298/SARH1702101E
Keywords: Graves’ disease, systemic lupus erythematosus, thyroid dysfunction