Graves Disease (Thyroid Storm) with Polyautoimmune Disorders (Autoimmune Hemolytic Anemia and Probable Autoimmune Hepatitis)
DOI:
https://doi.org/10.24293/ijcpml.v28i1.1745Keywords:
Graves' disease, polyautoimmune, autoimmune hemolytic anemia, probable autoimmune hepatitisAbstract
Graves' disease is caused by IgG antibodies that bind to the Thyroid Stimulating Hormone (TSH) receptor on the surface of the thyroid gland. These bonds drive the growth of stimulated thyroid follicular cells causing the glands to enlarge and increase the production of thyroid hormones. Previous studies mention the association of HLA-B8 and HLA-DR3 with Graves' disease and the Cytotoxic T-lymphocyte-associated-4 (CTLA-4) gene on chromosome 2q33 as a result of reducing T-cell regulation, resulting in autoimmune disease. Autoimmune thyroid disease is often found together with other autoimmune disorders (polyautoimmune). A 51-year-old male complained of dyspnea, yellowing of the body, and a lump on the neck. One year ago, he was diagnosed with hyperthyroidism. Graves' disease was suspected due to a score of 22 for the Wayne index, FT4 96.9 pmol/L, TSHs <0.01 μIU/mL, TRAb 10.8 IU/L, thyroid uptake test for toxic diffuse struma. In addition, the patient had atrial fibrillation and a thyroid storm with a Bruch Wartofsky index score of 65. Laboratory examination found normocytic normochromic anemia, thrombocytopenia, reticulocytosis, direct coomb test and auto control results positive one, SGOT 87 U/L, SGPT 59 U/L, alkali phosphatase 166 U/L, total bilirubin 38.13 mg/dL, direct
bilirubin 16.59 mg/dL, indirect bilirubin 21.54, LDH 318 U/L, establishing the diagnosis of Autoimmune Hemolytic Anemia (AIHA). Autoimmune hepatitis score: 15, so a diagnosis of probable autoimmune hepatitis was made.
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