title: Common subclinical hypothyroidism during Whipple's disease.
abstract: BACKGROUND
  Classic Whipple's disease is caused by T. whipplei and likely involves genetic predispositions, such as the HLA alleles DRB1*13 and DQB1*06, that are more frequently observed in patients. T. whipplei carriage occurs in 2-4% of the general population in France. Subclinical hypothyroidism, characterized by high levels of TSH and normal free tetra-iodothyronine (fT4) dosage, has been rarely associated with specific HLA factors.
  
  
  METHODS
  We retrospectively tested TSHus in 80 patients and 42 carriers. In cases of dysthyroidism, we tested the levels of free-T4 and anti-thyroid antibodies, and the HLA genotypes were also determined for seven to eight patients.
  
  
  RESULTS
  In this study, 72-74% of patients and carriers were male, and among the 80 patients, 14 (17%) individuals had a high level of TSH, whereas none of the carriers did (p<0. 01). In the 14 patients with no clinical manifestations, the T4 levels were normal, and no specific antibodies were present. Four patients treated with antibiotics, without thyroxine supplementation, showed normal levels of TSHus after one or two years. One patient displayed a second episode of subclinical hypothyroidism during a Whipple's disease relapse five years later, but the subclinical hypothyroidism regressed after antibiotic treatment. HLA typing revealed nine alleles that appeared more frequently in patients than in the control cohort, but none of these differences reached significance due to the small size of the patient group.
  
  
  CONCLUSIONS
  Regardless of the substratum, classic Whipple's disease could lead to subclinical hypothyroidism. We recommend systematically testing the TSH levels in patients with Whipple's disease.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lagier
authors.forename: Florence
authors.initials: F
authors.lastname: Fenollar
authors.forename: Jacques
authors.initials: J
authors.lastname: Chiaroni
authors.forename: Christophe
authors.initials: C
authors.lastname: Picard
authors.forename: Christiane
authors.initials: C
authors.lastname: Oddoze
authors.forename: Laurent
authors.initials: L
authors.lastname: Abi-Rached
authors.affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, 27 Bd Jean Moulin, 13005 Marseille, France. didier.raoult@gmail.com.
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D005602:France / Q000453:epidemiology; D006681:HLA-D Antigens / Q000235:genetics; D006801:Humans; D007037:Hypothyroidism / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D008061:Whipple Disease / Q000453:epidemiology / Q000235:genetics / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D006681:HLA-D Antigens