Hashimoto’s Thyroiditis and Autoimmune Gastritis

Abstract

The term “thyrogastric syndrome” defines the association between autoimmune thyroid disease and chronic autoimmune gastritis (CAG), and it was first described in the early 1960s. More recently, this association has been included in polyglandular autoimmune syndrome type IIIb, in which autoimmune thyroiditis represents the pivotal disorder. Hashimoto’s thyroiditis (HT) is the most frequent autoimmune disease, and it has been reported to be associated with gastric disorders in 10–40% of patients while about 40% of patients with autoimmune gastritis also present HT. Some intriguing similarities have been described about the pathogenic mechanism of these two disorders, involving a complex interaction among genetic, embryological, immunologic, and environmental factors. CAG is characterized by a partial or total disappearance of parietal cells implying the impairment of both hydrochloric acid and intrinsic factor production. The clinical outcome of this gastric damage is the occurrence of a hypochlorhydric-dependent iron-deficient anemia, followed by pernicious anemia concomitant with the progression to a severe gastric atrophy. Malabsorption of levothyroxine may occur as well. We have briefly summarized in this minireview the most recent achievements on this peculiar association of diseases that, in the last years, have been increasingly diagnosed.

Health-related Behaviours of Women Diagnosed with <i>Hashimoto's</i> Disease

“…Other authors have suggested an increased risk of additional diseases in Hashimoto's disease patients e.g. iron deficiency anaemia, pernicious anaemia [12], ischemic heart disease [13], cardiovascular disorders, atherosclerosis [14], idiopathic urticaria [20], thyroid cancer, colon cancer [21]. The most common symptoms in the respondents prior to the diagnosis of Hashimoto's thyroiditis included fatigue/weakness/drowsiness (n=122, 87.7%), difficulty in concentration/weak memory (n=88, 63.3%), increased body weight (n=85, 61.1%), mood swings/depression (n=82, 58.9%), skin lesions (n=80, 57.55%), and nervousness (n=80, 57.55%).…”

“…The immune system in Hashimoto's disease patients is dysregulated; hence, they often develop other autoimmune diseases, e.g. vitiligo, rheumatoid arthritis, celiac disease, type 1 diabetes [10,11], anaemia [12], ischemic heart disease, or atherosclerosis [13,14]. The aetiology of the disease is still unknown.…”

Polyglandular Autoimmune Syndrome Type IIIB: Hyperthyroidism and Pernicious Anemia, a Reminder of the Past

“…However, the exact mechanism linking thyroid and gastric cell dysfunction is still unknown. Here we describe an interesting case that serves as a reminder of this heterogeneous condition and exemplifies the usual presentation of this rare syndrome [3].…”

“…PAS type IIIB, also known as thyrogastric syndrome, was first described in the early 1960s and refers to the presence of thyroid autoantibodies in patients with pernicious anemia [3]. The follicular thyroid cells and the parietal cells both have endodermal origins, are both polarized, are both characterized by the presence of apical microvilli housing enzymatic activities, and both transport iodine across the cell membrane through Na +/I-symporters.…”

Pernicious anaemia and endocrine glands antibodies

“…In patients with diagnosed autoimmune disease, changes in the functioning of other organs/systems often develop with time (or simultaneously). Probably it is the result of general immune disturbances accompanying these diseases as well as cross reactions that show many types of antibodies [13,[16][17][18][19][20][21][22][23][24][25]. Understanding the pathomechanism of the above phenomenon and expanding the diagnosis to detect the dysfunction of the other organ even before a clear clinical manifestation of the primary disease is justified, especially because starting the primary disease treatment can make this diagnosis more difficult.…”