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Common subclinical hypothyroidism during Whipple's disease
Jean-Christophe Lagier, Florence Fenollar, Jacques Chiaroni
1Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, 27 Bd Jean Moulin, 13005 Marseille, France. didier.raoult@gmail.com.
BMC Infectious Diseases
|July 6, 2014
Summary
Classic Whipple's disease may cause subclinical hypothyroidism, a condition marked by elevated thyroid-stimulating hormone (TSH). Researchers recommend routine TSH testing for Whipple's disease patients to detect this common comorbidity.
Area of Science:
- Endocrinology
- Infectious Diseases
- Genetics
Background:
- Classic Whipple's disease is caused by Tropheryma whipplei, with genetic predispositions like HLA alleles potentially involved.
- T. whipplei carriage is present in 2-4% of the French population.
- Subclinical hypothyroidism (elevated TSH, normal fT4) has rarely been linked to specific HLA factors.
Purpose of the Study:
- To investigate the association between T. whipplei infection and subclinical hypothyroidism.
- To determine if T. whipplei carriage is linked to thyroid dysfunction.
- To explore potential genetic factors, including HLA types, in Whipple's disease patients with subclinical hypothyroidism.
Main Methods:
- Retrospective analysis of thyroid-stimulating hormone (TSH) levels in 80 Whipple's disease patients and 42 T. whipplei carriers.
- Testing for free-T4, anti-thyroid antibodies, and HLA genotypes in patients with dysthyroidism.
- Monitoring TSH levels in patients treated with antibiotics.
Main Results:
- 17% of Whipple's disease patients (14/80) exhibited elevated TSH, compared to none of the carriers (p<0.01).
- These patients had normal fT4 and no specific antibodies; TSH normalized after antibiotic treatment in four cases.
- One patient experienced recurrent subclinical hypothyroidism during a Whipple's disease relapse, which resolved with antibiotics.
Conclusions:
- Classic Whipple's disease can lead to subclinical hypothyroidism, irrespective of the underlying genetic or clinical presentation.
- Systematic TSH level screening is recommended for all patients diagnosed with Whipple's disease.
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