Rheumatic Disorders and Autoimmune Thyroid Disease. A Common Co-occurrence With an Unusual Presentation- A Case Report

Introduction Graves’ disease (GD) and systemic lupus erythematosus (SLE) are two autoimmune disorders well known for their co-existence. Shared genetic susceptibility loci are being increasingly identified, confirming the causal bidirectional association between the two. Case Presentation Our case involves a young woman who presented with chronic symptoms of hyperthyroidism along with anemia, goitre, respiratory distress, and a recent onset of rheumatism. Diagnostic investigations fulfilled the criteria of GD along with SLE and Sjogren’s overlap. Pulmonary arterial hypertension (PAH) was detected via echocardiography, likely indicating the complex interplay between SLE and GD. Significant fetal and embryonic mortality raised the suspicion of anti-phospholipid syndrome, leading to the detection of anti-phospholipid antibodies. The likelihood of adrenal insufficiency and Autoimmune Polyglandular syndrome type 2 was also addressed. The patient was managed with anti-thyroid medications, steroids, and PAH-specific therapy. Our case is unique, as it involves multiple autoimmune disorders of rheumatic and endocrine origin in the same patient. The uniqueness also lies in the temporal sequence of the disorders, with GD being antecedent to SLE, contrary to what the literature suggests. Conclusion Although the patient tragically died, the goal here was to reinforce the idea that autoimmune disorders are complex, revealing themselves in various forms. Scouting for comorbidities and adapting a holistic treatment approach is prudent when dealing with these ailments. The social and financial dilemmas leading to noncompliance with treatment and its detrimental effects are also highlighted.