title: The first childhood case with coexisting Hashimoto thyroiditis, vitiligo and autoimmune hepatitis.
abstract: Hashimoto thyroiditis (HT) is the most common pediatric autoimmune endocrine disorder. It results in autoimmune-mediated thyroid gland destruction and is an organ-specific, typical autoimmune disease. The presence of antithyroid antibodies and the typical pattern on ultrasonography indicate the diagnosis. It is also frequently seen together with other autoimmune disorders including type 1 insulin-dependent diabetes, celiac disease, alopecia and vitiligo. Autoimmune hepatitis (AIH) is a chronic type of liver injury with an immune etiology that can frequently cause end-stage liver disease if left untreated. Autoimmune hepatitis patients may present with hepatitis, and the laboratory tests in the absence of other etiology usually reveal a positive immune serology together with elevated immunoglobulins and abnormal liver histology. It is interesting that HT and AIH are rarely seen together although both have an autoimmune etiology. 14-year-old male who was being followed-up for vitiligo presented with symptoms of a swelling at the neck and fatigue. He was diagnosed with HT after the tests and the liver enzymes were found to be high. The patient was also diagnosed with AIH after tests revealed that the liver enzyme elevation had continued for longer than six months. The thyroid functions and liver enzymes returned to normal and the symptoms decreased after sodium L-thyroxine replacement together with steroid and azathioprine treatment. We present this case as we believe it is the first pediatric patient diagnosed with HT, AIH and vitiligo.
authors.affiliation: Clinic of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey.
authors.forename: Melikşah
authors.initials: M
authors.lastname: Keskin
authors.affiliation: Clinic of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey.
authors.forename: Şenay
authors.initials: Ş
authors.lastname: Savaş-Erdeve
authors.affiliation: Pediatric Gastroenterology Clinic, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey.
authors.forename: Ferda
authors.initials: F
authors.lastname: Özbay-Hoşnut
authors.affiliation: Clinic of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey.
authors.forename: Erdal
authors.initials: E
authors.lastname: Kurnaz
authors.affiliation: Clinic of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey.
authors.forename: Semra
authors.initials: S
authors.lastname: Çetinkaya
authors.affiliation: Clinic of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey.
authors.forename: Zehra
authors.initials: Z
authors.lastname: Aycan
mesh_terms: D000293:Adolescent; D001379:Azathioprine / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D050031:Hashimoto Disease / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D013974:Thyroxine / Q000627:therapeutic use; D014820:Vitiligo / Q000150:complications* / Q000188:drug therapy
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone; D001379:Azathioprine; D013974:Thyroxine
keywords: Hashimoto thyroiditis; autoimmune disorder; autoimmune hepatitis; vitiligo