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Primary biliary cirrhosis associated with painless thyroiditis.

N Sato1, H Ohira, H Orikasa

  • 1Department of Internal Medicine II, Fukushima Medical University School of Medicine.

Internal Medicine (Tokyo, Japan)
|May 25, 1999
PubMed
Summary

A rare case of anti-mitochondrial antibody-negative primary biliary cirrhosis (PBC) co-occurred with painless thyroiditis. This unique association highlights potential links between autoimmune liver and thyroid diseases.

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Area of Science:

  • Hepatology
  • Endocrinology
  • Autoimmunology

Background:

  • Primary biliary cirrhosis (PBC) is a chronic liver disease often associated with autoimmune conditions.
  • Anti-mitochondrial antibodies (AMA) are typically present in PBC, serving as a key diagnostic marker.
  • Associations between PBC and thyroid disorders, particularly hyperthyroidism, are infrequently reported.

Observation:

  • A 47-year-old woman presented with clinical and histological evidence of PBC, confirmed by elevated gamma-glutamyl transpeptidase and immunoglobulin M levels.
  • The patient was negative for AMA, classifying her case as AMA-negative PBC.
  • She also exhibited symptoms of hyperthyroidism, diagnosed as painless thyroiditis, with suppressed TSH and elevated thyroid hormone levels.

Findings:

  • This case represents the first reported instance of AMA-negative PBC associated with hyperthyroidism secondary to painless thyroiditis.

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  • The liver biopsy revealed characteristic PBC histology: bile duct destruction with mononuclear cell infiltration.
  • Thyroid autoantibodies (anti-microsomal and anti-thyroid peroxidase) were present at low titers, suggesting an autoimmune basis for the thyroiditis.

    • Implications:

    • The findings suggest a potential, albeit rare, association between AMA-negative PBC and autoimmune thyroid disease.
    • This case broadens the understanding of potential comorbidities in PBC, especially in AMA-negative variants.
    • Further research is warranted to explore the immunological mechanisms underlying the co-occurrence of these conditions.