Reversible hypothyroidism and Whipple's disease

Huy A Tran

doi:10.1186/1472-6823-6-3

Abstract

BackgroundThe major cause of primary hypothyroidism is autoimmune mediated with progressive and permanent destruction of the thyroid gland resulting in life-long replacement therapy. Treatable and reversible hypothyroidism is unusual and here forth is such a case due to infection of the thyroid gland with Tropheryma whippleii, Whipple disease.Case presentationA 45 year-old female presented with symptoms and signs consistent with primary hypothyroidism, which was also confirmed biochemically. Her response to thyroxine replacement therapy was poor however, requiring a significantly elevated amount. Further investigation revealed the presence of Whipple's disease involving the gastrointestinal trace and possibly the thyroid gland. Her thyroxine requirement decreased drastically following appropriate antimicrobial therapy for Whipple's disease to the extent that it was ceased. Thyrotropin releasing hormone testing in the steady state suggested there was diminished thyroid reserve due to Whipple's disease.ConclusionThis is the first ante-mortem case report studying the possible involvement of the thyroid gland by Whipple's disease. Despite the normalization of her thyroid function test biochemically after antibiotic therapy, there is diminished thyroid reserve thus requiring close and regular monitoring.

Highlights

The major cause of primary hypothyroidism is autoimmune mediated with progressive and permanent destruction of the thyroid gland resulting in life-long replacement therapy
This is the first ante-mortem case report studying the possible involvement of the thyroid gland by Whipple's disease
(page number not for citation purposes) http://www.biomedcentral.com/1472-6823/6/3 appreciated that the correlation between systemic Whipple's disease and its polymerase chain reaction (PCR) positivity is far from perfect and the use of mononuclear cells (MNC) PCR to monitor response to therapy remains controversial at this stage [15,17]

Summary

Conclusion

The case highlights thyroid involvement by TW, causing significant thyroid failure. Despite the evidence of TW present in the duodenum and circulating leucocytes, its presence in thyroid tissue could be indirectly proven. The successful reversibility of the primary hypothyroidism in response to long-term anti-biotic therapy indicates strongly that WD involves the thyroid gland in the absence of alternative causes. The damage to the thyroid has resulted in permanent and reduced thyroid reserve as demonstrated by repeated TRH stimulation tests but with normal thyrotropin levels. This is only the second report that convincingly describes the putative link between primary hypothyroidism and WD and the first in a live patient with excellent recovery

Background

Findings

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