Abstract
An adolescent with complaints of fatigue, tachycardia, abdominal discomfort, and blood-stained diarrhea is presented. Clinical and laboratory evaluation revealed a microcytemic anemia with iron deficiency, beta thalassemia, and thyrotoxicosis with thyroid antibodies. Crohn’s disease was confirmed on endoscopy. A rapid normalization of clinical and laboratory parameters was observed following the initiation of therapy and further exacerbation of her illness was prevented. Although the simultaneous occurrence of Crohn’s disease, autoimmune thyroiditis, and a beta-thalassemia trait is likely to be coincidental, the combination of an autoimmune thyroid disease and Crohn’s disease is rare in pediatrics. Several issues of importance in the treatment of these conditions are discussed. Rectal blood loss associated with Crohn’s disease may lead to severe iron deficiency, especially in patients with preexistent beta-thalassemia trait, and those with thyroiditis are prone to developing hypothyroidism following treatment, requiring that they be monitored closely.
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Abbreviations
- APTT:
-
activated partial thromboplastin time
- ATPO:
-
antibodies to thyroid peroxidase
- HbA:
-
hemoglobin A
- HbA2:
-
hemoglobin A2
- HbF:
-
hemoglobin F
- HbS:
-
hemoglobin S
- MCH:
-
mean corpuscular hemoglobin
- MCHC:
-
mean corpuscular hemoglobin concentration
- MCV:
-
mean corpuscular volume
- PTT:
-
prothrombin time
- TBII:
-
thyroid binding inhibiting immunoglobulins
- 99m Tc:
-
technitium-99m
References
Alderman EM (1996) Adolescent medicine. In: Bernstein D, Shelov SP (eds) Pediatrics. Lippincott Williams & Wilkins, Baltimore, pp 55–68
Biebermann H, Schöneberg T, Hess C, Germak J, Gudermann T, Grüters A (2001) The first activating TSH receptor mutation in transmembrane domain 1 identified in a family with nonautoimmune hyperthyroidism. J Clin Endocrinol Metab 86:4429–4433
Calkins BM, Lilienfeld AM, Garland CF, Mendeloff AI (1984) Trends in incidence rates of ulcerative colitis and Crohn’s disease. Dig Dis Sci 29:913–920
Criswell LA, Pfeiffer KA, Lum RF, Gonzales B, Novitzke J, Kern M, Moser KL, Begovich AB, Carlton VE, Li W, Lee AT, Ortmann W, Behrens TW, Gregersen PK (2005) Analysis of families in the multiple autoimmune disease genetics consortium (MADGC) collection: the PTPN22 620W allele associates with multiple autoimmune phenotypes. Am J Hum Genet 76:561–571
Dayan CM, Daniels GH (1996) Chronic autoimmune thyroiditis. N Engl J Med 335:99–107
Griffiths AM, Hugot JP (2004) Crohn disease. In: Walker WA, Goulet O, Kleinman RE, Schneider BL, Sanderson IR, Sherman PM (eds) Pediatric gastrointestinal disease: pathophysiology, diagnosis, management. BC Decker, Ontario, pp 107–134
Hiatt RA, Kaufman L (1998) Epidemiology of inflammatory bowel disease in a defined northern California population. West J Med 149:541–546
Inokuchi T, Moriwaki Y, Takahashi S, Tsutsumi Z, Ka T, Yamamoto T (2005) Autoimmune thyroid disease (Graves’ disease and Hashimoto’s thyroiditis) in two patients with Crohn’s disease: case reports and literature review. Intern Med 44:303–306
Kettaneh A, Prevot S, Biaggi A, Stirnemann J, Fain O, Hocqueloux L, Mouas H, Levy VG, Thomas M (2003) Hyperthyroidism in two patients with Crohn disease and Takayasu arteritis. Scand J Gastroenterol 38:901–903
Olivieri NF (1999) The beta-thalassemias. N Engl J Med 341:99–109
Shah S, Peppercorn M, Pallotta J (1998) Autoimmune (Hashimoto’s) thyroiditis associated with Crohn’s disease. J Clin Gastroenterol 26:117–120
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Bank, I., Busari, J.O. Crohn’s disease, autoimmune thyroiditis, and beta-thalassemia trait in an adolescent: an unusual combination of diseases. Eur J Pediatr 167, 1343–1346 (2008). https://doi.org/10.1007/s00431-008-0676-3
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DOI: https://doi.org/10.1007/s00431-008-0676-3