Henoch Schönlein Purpura IgA Vasculitis in Association with Thyrotoxicosis

It can lead to highly critical conditions, such as central nervous system dysfunction, hypothermia, respiratory failure, and circulatory failure (3). Thus, although the incidence of myxedema coma is low, early diagnosis and avoidance of overlooking this disease are required for successful treatment (2). The patient successfully completed the desensitization protocol; however, his levothyroxine dose remained subtherapeutic. As a result, it was deemed clinically necessary to slowly up-titrate levothyroxine further to 150 µg daily; the rash reoccurred at 88 mcg dosage.

• However, we checked all the medical records and found that all patients included had no history of previous thyroid disease.
• Vasculitis causes changes in the walls of blood vessels, including thickening, weakening, narrowing and scarring.
• We expect to conduct a large-scale, multi-center collaborative study to investigate overall characteristics.
• The clinical features of AAV were compared between patients with and without hypothyroidism (Table 2).

(D) Chest computed tomography showed atelectasis and mild pulmonary congestion. (E) Thyroid echo showed diffuse atrophy of the thyroid gland, irregular surface, and rough and low echo levels inside the thyroid gland. The thickness of the isthmus is 2.6 mm in diameter, which is indicated as broken line 1.

Henoch–Schönlein Purpura (IgA Vasculitis) in Association with Thyrotoxicosis

Pearson’s correlation coefficient was used to describe the linear correlation between normally distributed data, and Spearman’s correlation coefficient was used to describe the linear correlation between non-normally distributed data. Kaplan–Meier analysis was used to analyze survival rates of the normal thyroid function group and thyroid dysfunction group and to create graphs of the observed survival curves, while the log-rank test was used to compare curves from different groups. Logistic regression was used to analyze the risk factors related to thyroid dysfunction.

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There were many AAV patients who did not have thyroid function data because different physicians had different habits of screening for thyroid function. The screening of thyroid function was very frequent in recent years, which might be due to the awareness of the association between thyroid function and kidney disease. Many AAV patients included in years much further back had no data of thyroid function, which made the sample size small.

3. Relationship between Thyroid Hormone and Clinical Parameters in AAV Patients with Renal Injury

Combination therapy with LT4 and LT3 may be useful for patients with myxedema come who require supra-physiological glucocorticoid administration. Dynamic exacerbations of the patient’s condition led us to establish the diagnosis of myxedema coma. Furthermore, T3 depression was highlighted in the clinical features of this case that was treated using glucocorticoids at a pharmacological dose. Clinicians should be aware of myxedema coma as a critical disorder that can cause rapid deterioration. Review of the literature showed a relationship between propylthiouracil overdose and the following Henoch–Schönlein purpura (IgA vasculitis) as a side effect. 3 It has been well documented that propylthiouracil could induce antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis, which predominantly affects small vessels.

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All patients with clinical features suggestive of urticarial vasculitis were confirmed by biopsy. Thyroid function tests (T3, T4, TSH) were categorized into normal, below normal or above normal, while AAbs (antithyroperoxidase, antithyroglobulin antibodies) where dichotomized as absent or present. The diagnostic definitions used for chronic spontaneous urticaria and urticarial vasculitis are summarized in Table 1 5–8. Firstly, it was a single-center study, and the data were collected retrospectively from clinical databases. There might be a possible bias that the included patients might be suspected of having thyroid dysfunction. However, we checked all the medical records and found that all patients included had no history of previous thyroid disease.

Their major concern is that our study does not support our statement that the use of anti-thyroid agents does not account for many cases of ANCA-Small Vessel Vasculitis (ANCA-SVV) in the general population, a contention we continue to support. Urticarial vasculitis (UV) is a protean disorder that can be triggered by a myriad of causes although it is often idiopathic. Treatment is often successful with corticosteroids and/or immunosuppressive drugs. However, when a cause is found, specific treatment of the underlying problem or removal of an offending agent will resolve the symptoms. This report describes a patient with UV triggered by thyroid replacement, necessitated by Hashimoto’s thyroiditis, which can itself cause UV. In this unusual presentation, rather than thyroiditis, thyroid replacement was the trigger for the vasculitis.

A high prevalence of thyroid dysfunction has been reported in autoimmune diseases and kidney diseases, such as systemic lupus erythematosus and nephrotic syndrome 11,12. Previous studies also reported an increased risk of thyroid dysfunction in AAV patients 13,14. Lionaki et al. and Prendecki et al. reported that the prevalence of thyroid dysfunction in AAV patients was about 20%, which was significantly higher than its prevalence in the general global population (0.5–5.3%) 15. In addition, compared to AAV patients without thyroid dysfunction, they found that those with thyroid dysfunction were more likely to be women and MPO-ANCA-positive 16,17. However, the thyroid function status in AAV patients with renal injury remains unclear. Moreover, the clinical and prognostic relevance of thyroid dysfunction in AAV patients with renal injury is also unclear.

We expect to conduct a large-scale, multi-center collaborative study to investigate overall characteristics. Further investigation into the underlying mechanisms and potential treatment strategies may be a direction of future research. There were twenty-four patients (13.79%) in the group of AAV propranolol synthroid patients with normal thyroid function. The thyroid dysfunction group consisted of one hundred and fifty (86.21%) individuals.

This study aimed to investigate thyroid function in AAV patients with renal injury and to explore the clinical relevance of renal dysfunction in the patients. T3 administration should be considered an alternative treatment for patients with myxedema coma who require concomitant glucocorticoid administration. Myxedema coma is often treated with LT4 alone, as recommended by the guidelines in the United States (25) and Latin America (26).