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Systemic Lupus Erythematous and Graves Disease

Izzedine, Hassane MD*; Roura, Raoul MD†; Bourry, Edward MD*; Georgin-Lavialle, Sophie MD‡; Cacoub, Patrice MD‡; Deray, Gilbert MD*

Case Report

Despite the common genetic predisposition and autoimmune features of both disorders, Graves disease (GD) has been described quite infrequently in patients with systemic lupus erythematous (SLE; average incidence of 2.8% vs. 1.9% in general population). We present a patient with SLE who developed hyperthyroidism. A 57-year-old woman, followed since 1998 for lupus nephritis, was admitted for clinical evaluation of hyperthyroidism 5 years after the diagnosis of SLE. Her symptoms included heat intolerance, tremor, and irritability. Clinical examination showed diffuse thyroid gland enlargement with a vascular murmur on auscultation. Hormonal assays showed markedly increased free T3 and T4 levels and suppressed thyroid-stimulating hormone levels with circulating thyroid-stimulating hormone receptor antibodies. Graves disease responded well to carbimazole treatment and beta-blockers. The patient had a subtotal thyroidectomy, later. The patient was on 10 mg of prednisolone maintenance therapy when hyperthyroidism was discovered. Concomitantly, a slight increase in serum creatinine and serum levels of anti-DNA antibodies and complement activation without other abnormalities were found. A third renal biopsy showed mononuclear interstitial infiltration but no glomerular signs of lupus activity. Patients with SLE are likely to be at increased risk for thyroid disease.

From the *Department of Nephrology and ‡Department of Internal Medicine, Pitié Salpêtrière Hospital, Paris, France, and †Internal Medicine, Cayenne Central Hospital, French Guyana.

Reprints: Hassane Izzedine, MD, Department of Nephrology, Pitié Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital 75013 Paris, France. E-mail: hassan.izzedine@psl.ap-hop-paris.fr.

© 2005 Lippincott Williams & Wilkins, Inc.