, Volume 39, Issue 1, pp 41–47 | Cite as

Injections of Clostridium botulinum neurotoxin A may cause thyroid complications in predisposed persons based on molecular mimicry with thyroid autoantigens

  • Edvina Gregoric
  • Jurji Avramovic Gregoric
  • Fabrizio GuarneriEmail author
  • Salvatore Benvenga
Original Article


A woman with Hashimoto’s thyroiditis, under replacement L-T4, repeatedly experienced, over a 10-year period, elevations of serum TSH after eyelid injections of Clostridium botulinum neurotoxin A (Btx). We hypothesized a link between Btx injections and TSH elevations via molecular mimicry, and aimed to verify our hypothesis. Using an in silico approach, we searched first for amino acid sequence homology between Btx and thyroid autoantigens, and next for HLA binding motifs within homologous segments. We found that (i) Btx and thyroid autoantigens share amino acid sequence homology; (ii) some homologous regions contain epitopes of both Btx and thyroid autoantigens; (iii) some of such regions contain HLA-DR3 and/or HLA-DR7 binding motifs, which predominate over other HLA-DRs. This is relevant because the patient’s HLA-DR haplotype was DR3/DR7. In conclusion, clinical and bioinformatics data suggest a possible pathogenetic link between Btx and autoimmune thyroid diseases. Considering the wide and increasing medical and dermocosmetic use of Btx, and the frequently subclinical course of autoimmune thyroid diseases, we think that thyroid “complications” may pass frequently undetected in Btx-treated persons.


Clostridium botulinum neurotoxin A Autoimmune thyroid diseases Thyrotropin Molecular mimicry Amino acid sequence homology 


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Edvina Gregoric
    • 1
    • 2
  • Jurji Avramovic Gregoric
    • 2
    • 3
  • Fabrizio Guarneri
    • 4
    • 7
    Email author
  • Salvatore Benvenga
    • 2
    • 5
    • 6
  1. 1.Department of Nuclear MedicineHospital IzolaIzolaSlovenia
  2. 2.Master of Childhood, Adolescent and Women’s Endocrine HealthUniversità di MessinaMessinaItaly
  3. 3.Department of Internal MedicineHospital IzolaIzolaSlovenia
  4. 4.Istituto di DermatologiaUniversità di MessinaMessinaItaly
  5. 5.Sezione di Endocrinologia, Dipartimento Clinico Sperimentale di Medicina e FarmacologiaUniversità di MessinaMessinaItaly
  6. 6.Programma di Endocrinologia Molecolare Clinica, AOU Policlinico G. MartinoUniversità di MessinaMessinaItaly
  7. 7.MessinaItaly

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