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Betterle C, Furmaniak J, Sabbadin C, Scaroni C, Presotto F. Type 3 autoimmune polyglandular syndrome (APS-3) or type 3 multiple autoimmune syndrome (MAS-3): an expanding galaxy. J Endocrinol Invest 2023; 46:643-665. [PMID: 36609775 DOI: 10.1007/s40618-022-01994-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/13/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The number of recognised distinct autoimmune diseases (AIDs) has progressively increased over the years with more than 100 being reported today. The natural history of AIDs is characterized by progression from latent and subclinical to clinical stages and is associated with the presence of the specific circulating autoantibodies. Once presented, AIDs are generally chronic conditions. AIDs have the tendency to cluster and co-occur in a single patient. Autoimmune thyroid diseases (AITD) are the most prevalent of AIDs in the world population, and about one-third of the AITD patients also present with a non-thyroid AID during their life-span. Furthermore, patient with non-thyroid AIDs often presents with a form of AITD as a concurrent condition. Many of the clusters of AIDs are well characterized as distinctive syndromes, while some are infrequent and only described in case reports. PURPOSE In this review, we describe the wide spectrum of the combinations and the intricate relationships between AITD and the other AIDs, excluding Addison's disease. These combinations are collectively termed type 3 Autoimmune Polyglandular Syndrome (APS-3), also called type 3 Multiple Autoimmune Syndrome (MAS-3), and represent the most frequent APS in the world populations. CONCLUSIONS Numerous associations of AITD with various AIDs could be viewed as if the other AIDs were gravitating like satellites around AITD located in the center of a progressively expanding galaxy of autoimmunity.
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Affiliation(s)
- C Betterle
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy.
- Chair of Clinical Immunology and Allergy, Department of Medical and Surgical Sciences, University of Padua Medical School, Via Ospedale Civile 105, 35128, Padua, Italy.
| | | | - C Sabbadin
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - C Scaroni
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - F Presotto
- Unit of Internal Medicine, Ospedale Dell'Angelo, Mestre-Venice, Italy
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Polyakova I, Iannucci G, George R, Gill A, Patel DG, Rouster-Stevens K. Simultaneous Presentation of Crohn's Disease and Takayasu Arteritis in a Teenage Patient. J Investig Med High Impact Case Rep 2021; 8:2324709620977317. [PMID: 33238761 PMCID: PMC7705765 DOI: 10.1177/2324709620977317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 14-year-old female with no significant medical history presented with
hypertensive urgency, in the setting of 4 to 6 weeks of diarrhea,
abdominal pain, headaches, anemia, weight loss, and high blood
pressures. Her evaluation revealed signs of a systemic inflammatory
process that was most suspicious for inflammatory bowel disease.
However, when her hypertension was evaluated with a renal Doppler
ultrasound, there were signs of narrowing, stenosis, and hypoplasia
that led to a diagnostic angiogram of the abdominal aorta. Full body
positron emission tomography scan revealed multiple areas of stenosis
and aortic thickening with enhancement compatible with Takayasu
arteritis. She received prednisone, methotrexate, and infliximab with
marked improvement in her clinical symptoms and inflammatory
markers.
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Affiliation(s)
- Inna Polyakova
- Emory University, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
| | - Glen Iannucci
- Emory University, Atlanta, GA,
USA
- Sibley Heart Center Cardiology,
Atlanta, GA, USA
| | - Roshan George
- Emory University, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
| | - Anne Gill
- Emory University, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
| | - Dinesh Govind Patel
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- GI Care for Kids, Atlanta, GA,
USA
| | - Kelly Rouster-Stevens
- Emory University, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Kelly Rouster-Stevens, MD, MS,
Children’s Healthcare of Atlanta, 1400 Tullie Drive NE, Atlanta, GA
30329, USA.
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Concomitant Thyroid Disorders and Inflammatory Bowel Disease: A Literature Review. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5187061. [PMID: 27042663 PMCID: PMC4794572 DOI: 10.1155/2016/5187061] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/30/2016] [Accepted: 02/16/2016] [Indexed: 02/06/2023]
Abstract
The aim of this report was to review and summarize the literature on cases of concomitant inflammatory bowel disease (IBD) and thyroid diseases. We included the following previous case reports of concomitant IBD and thyroid diseases: 16 cases of ulcerative colitis (UC) and Graves' disease (GD), 3 cases of Crohn's disease (CD) and GD, 10 cases of CD and Hashimoto's thyroiditis (HT), 4 cases of IBD and subacute thyroiditis (SAT) or SAT-like symptoms, and 13 cases of IBD (12/13 cases were CD) and amyloid goiter. There might be no obvious differences of prevalence of thyroid dysfunction (hyper- or hypothyroidism), GD, and thyroid cancer between IBD patients and general populations. However, concomitant UC and HT might be relatively common in patients with multiple autoimmune disorders, and AG is one of the complications with CD patients. There might be no obvious differences of fatal prognoses between IBD patients with thyroid diseases and patients with thyroid diseases without IBD.
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Arnaud L, Haroche J, Limal N, Toledano D, Gambotti L, Chalumeau NC, Boutin DLTH, Cacoub P, Cluzel P, Koskas F, Kieffer E, Piette JC, Amoura Z. Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine (Baltimore) 2010; 89:1-17. [PMID: 20075700 DOI: 10.1097/md.0b013e3181cba0a3] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We conducted a single-center retrospective study to compare the characteristics of Takayasu arteritis (TA) among white, North African, and black patients in a French tertiary care center (Hospital Pitié-Salpêtrière, Paris). Eighty-two patients were studied (82.9% female) during a median follow-up of 5.1 years (range, 1 mo to 30 yr). Among these 82 patients, 39 (47.6%) were white, 20 (24.4%) were North African, and 20 (24.4%) were black patients. Median age at diagnosis was 39.3 years (range, 14-70 yr) in white patients vs. 28.4 years (range, 12-54 yr) in North African (p = 0.02), and 28.0 years (range, 13-60 yr) in black patients (p = 0.08). Patients aged >40 years at TA onset were more frequently white than non-white (40.0% vs. 18.6%, p = 0.03). North African patients had more frequent occurrence of ischemic stroke (p = 0.03) and poorer survival (p = 0.01) than white patients. Type V of the Hata classification was the most frequent type among white (38.5%), North African (65.0%), and black patients (40.0%). Corticosteroids were used in 96.1% of patients. Fifty-three percent of white and North African patients, and 44% of black patients required a second line of immunosuppressive treatment (p = 0.60). Vascular surgical procedures were respectively performed in 46.1%, 50.0%, and 55.0% of white, North African, and black patients, p = 0.81. The 5-year and 10-year survival rates were 100% and 95.0%, respectively, in white patients; 67.4% at both 5 years and 10 years in North African patients; and 100% at both 5 years and 10 years in black patients. This study is one of the first direct comparisons of TA profiles among patients of distinct ethnic backgrounds. Our data support the idea that late-onset TA or an overlap between TA and large-vessel giant cell arteritis may be observed in white patients. North African patients have a higher occurrence of ischemic stroke and poorer survival than white patients.
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Affiliation(s)
- Laurent Arnaud
- From Service de Médecine Interne (LA, JH, NL, NCC, DB, P Cacoub, JCP, ZA), Service de Radiologie (DT, P Cluzel), Service de Santé Publique (LG), and Service de Chirurgie Vasculaire (FK, EK); and Hôpital Pitié-Salpêtrière, AP-HP, Université Paris 6, Paris, France
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Katoh N, Kubota M, Shimojima Y, Ishii W, Matsuda M, Akamatsu T, Ikeda SI. Takayasu's arteritis in a patient with Crohn's disease: an unexpected association during infliximab therapy. Intern Med 2010; 49:179-82. [PMID: 20075586 DOI: 10.2169/internalmedicine.49.2491] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We report a 20-year-old woman with Crohn's disease (CD) who developed anterior neck pain while being treated with the anti-tumor necrosis factor (TNF)-alpha monoclonal antibody, infliximab. She showed no symptoms suggestive of active CD except for tenderness along the left common carotid artery with marked increases in serum TNF-alpha and inflammatory reactions. Based on thickened walls of large vessels with enhancement effects on computed tomography, she was diagnosed as having associated Takayasu's arteritis (TA), which was successfully treated with corticosteroid. Even if CD is controlled by infliximab, other autoimmune disorders, such as TA, may develop as a complication.
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Affiliation(s)
- Nagaaki Katoh
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, and Department of Endoscopy, Shinshu University Hospital, Matsumoto
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Bank I, Busari JO. Crohn's disease, autoimmune thyroiditis, and beta-thalassemia trait in an adolescent: an unusual combination of diseases. Eur J Pediatr 2008; 167:1343-6. [PMID: 18246369 DOI: 10.1007/s00431-008-0676-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Accepted: 01/17/2008] [Indexed: 12/01/2022]
Abstract
An adolescent with complaints of fatigue, tachycardia, abdominal discomfort, and blood-stained diarrhea is presented. Clinical and laboratory evaluation revealed a microcytemic anemia with iron deficiency, beta thalassemia, and thyrotoxicosis with thyroid antibodies. Crohn's disease was confirmed on endoscopy. A rapid normalization of clinical and laboratory parameters was observed following the initiation of therapy and further exacerbation of her illness was prevented. Although the simultaneous occurrence of Crohn's disease, autoimmune thyroiditis, and a beta-thalassemia trait is likely to be coincidental, the combination of an autoimmune thyroid disease and Crohn's disease is rare in pediatrics. Several issues of importance in the treatment of these conditions are discussed. Rectal blood loss associated with Crohn's disease may lead to severe iron deficiency, especially in patients with preexistent beta-thalassemia trait, and those with thyroiditis are prone to developing hypothyroidism following treatment, requiring that they be monitored closely.
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Affiliation(s)
- Ivan Bank
- Department of Hematology, Leiden University Medical Center, Leiden, Netherlands
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Abstract
BACKGROUND AND PURPOSE Acute cerebral ischemia has been described in different diseases of the thyroid gland, and not only as a result of thyrotoxic atrial fibrillation and cardioembolic stroke. The purpose of this review is to summarize the studies on the relationship between thyroid diseases and cerebrovascular diseases, discussing the main findings for overt hyperthyroidism and hypothyroidism, as well as for subclinical thyroid dysfunction. SUMMARY OF REVIEW In overt hyperthyroidism, cardioembolic stroke is clearly associated to thyrotoxic atrial fibrillation, and in subclinical hyperthyroidism with serum thyroid-stimulating hormone levels <0.1 mU/L, the incidence of atrial fibrillation is increased. Although in vitro and in vivo studies indicate a hypercoagulability state in hyperthyroidism, there is insufficient evidence to prove that this state leads to an increased risk of cardiac emboli. However, the hypothesis that overt hyperthyroidism may cause acute cerebral venous thrombosis is intriguing. Possible associations between hyperthyroidism and Moyamoya or Giant cell arteritis have only been described in case reports. There is enough evidence that overt hypothyroidism is associated with several traditional and newer atherosclerotic risk factors, especially hypertension, hyperlipidemia, and hyperhomocysteinemia. For subclinical hypothyroidism, these associations are less certain. Hypothyroidism has been associated with signs of aortic or coronary atherosclerosis, but no case-control or cohort studies have ever investigated hypothyroidism as a possible risk factor for atherothrombotic stroke. CONCLUSIONS Hyperthyroidism is associated with atrial fibrillation and cardioembolic stroke. Hypothyroidism is associated with a worse cardiovascular risk factor profile and leads to progression of atherosclerosis. Associations between hyperthyroidism and acute cerebral venous thrombosis, Moyamoya, and Giant cell arteritis have been suggested, but sound evidence is lacking. Additional studies are needed to clarify these issues.
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Affiliation(s)
- A Squizzato
- Department of Vascular Medicine, Academical Medical Center, Amsterdam, The Netherlands.
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Inokuchi T, Moriwaki Y, Takahashi S, Tsutsumi Z, KA T, Yamamoto T. Autoimmune thyroid disease (Graves' disease and hashimoto's thyroiditis) in two patients with Crohn's disease: case reports and literature review. Intern Med 2005; 44:303-6. [PMID: 15897640 DOI: 10.2169/internalmedicine.44.303] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
An increased prevalence of the association between autoimmune thyroid diseases and ulcerative colitis has been suggested, however, not with Crohn's disease, as only 7 cases of thyroid disease coexisting with Crohn's disease have been reported. Herein, we describe 2 patients with Crohn's disease complicated with Graves' disease or autoimmune thyroiditis, and also review other cases with those complications. Some immunological processes are suggested to be implicated in the pathogenesis of this association, however, the exact mechanism remains unclear.
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Affiliation(s)
- Taku Inokuchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya
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