Premature ovarian failure and thyroid anomalies in patients with autoimmune disturbances

Abstract

Premature ovarian failure is associated with many other autoimmune diseases. We report 3 cases reports in this paper associating thyroid autoimmune disease, and at least 1 more autoimmune pathology. A 45-year female is diagnosed at age of 42 with acute adrenal insufficiency, Hashimoto’s thyroiditis induced hypothyroidism, secondary amenorrhea (follicle-stimulating hormone (FSH) of 18 mUI/ml), and osteoporosis. Adrenal and thyroid substitution was started, and intravenously zoledronic acid. Within 6 months, the thyroid stimulating hormone normalized, and the menses re-started. A 64-year female has premature ovarian failure since age of 40, autoimmune hypothyroidism since age of 54, psoriasis vulgaris, and osteoporosis since the age of 53. Raloxifene was used for 3 years then Dual-energy X-ray Absortiometry pointed osteopenia that was conserved up to the present. A 53-year female with menopause since age of 40 is treated for autoimmune hypothyroidism, while scleroderma was diagnosed. Later esofagitis developed, as well as osteopenia. FSH was not as high as expected for ovarian insufficiency in case 1, suggesting a second mechanism of hypothalamic origin based on consumptive syndrome in severe glucocorticoids deficiency. Transitory secondary amenorrhea is an argument that re-balancing the general biochemical and endocrine parameters, might improve the ovarian function. The cases 2 and 3 had untreated premature ovarian failure but the therapeutic opportunity window was lost at the moment of admission. The skin lesions as psoriasis or sclerodermia are a marker of severity. We highlight the importance of autoimmune clusters including the thyroid pathologies in females underlying premature ovarian failure. We also encourage the routine bone mineral density check since menopausal osteoporosis/osteopenia might be already presented.