Dynamic Autoimmune Thyroiditis in Myelodysplastic Syndrome: From Painless Thyrotoxicosis to Overt Hypothyroidism
https://doi.org/10.15605/jafes.041.S1
- Author:
Dekritiana Dian Pratiwi
1
;
Hemi Sinorita
1
Author Information
1. Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing Gadjah Mada University/ Dr. Sardjito Hospital, Indonesia
- Publication Type:Journal Article
- MeSH:
Myelodysplastic Syndromes;
Thyroiditis, Autoimmune;
Hypothyroidism;
Thyrotoxicosis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):119-120
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Autoimmune thyroid disease can follow a triphasic course:
thyrotoxicosis, a transient euthyroid period, and eventual
hypothyroidism, and may coexist with myelodysplastic
syndrome (MDS) in the context of immune dysregulation.
Case:We describe a 35-year-old male with MDS (multilineage
dysplasia) receiving cyclosporine who initially presented
with painless thyrotoxicosis, with suppressed thyroidstimulating hormone (TSH) and elevated free thyroxine
(FT4). During this hyperthyroid phase, thyrotropin receptor
antibody (TRAb) was positive. Over time, his thyroid
status fluctuated, progressing to overt hypothyroidism,
and he had poor adherence to thyroid medications.
On admission, he had prominent hypothyroid features
(fatigue, cold intolerance, slowed movement, periorbital
puffiness) with severe biochemical hypothyroidism (TSH
49.5 µIU/mL; FT4 0.419 ng/dL). Anti-thyroid peroxidase
(anti-TPO) antibodies 12.62 IU/mL (negative <5.61 IU/mL;
positive ≥5.61 IU/mL) showed an autoimmune response to
the thyroid. Thyroid ultrasound showed heterogeneous,
hyperechoic with some hypoechoic parts, and no
significant increase in thyroid vascularity was observed,
supporting autoimmune thyroiditis representation. His
hematologic profile remained consistent with MDS, with
chronic macrocytic anemia and thrombocytopenia.
Conclusion:This case highlights a dynamic autoimmune thyroiditis
phenotype progressing from a hyperthyroid phase with
TRAb positivity to higher anti-TPO overt hypothyroidism
in a patient with MDS. In individuals with MDS and
changing thyroid function tests, clinicians should keep
autoimmune thyroiditis variants in mind and use thyroid
antibodies together with ultrasound to secure the diagnosis
when the clinical pattern is typical.
- Full text:2026080509520670647EP_A179.pdf
