From autoimmune thyroid disease and CREST syndrome to incidental discovery of incipient gastric carcinoma: a case report

Lisandra Damian, Maria Christina Ungureanu, Cristina Mihaela Ghiciuc, Francesca Romana Patacchioli, Lucia Corina Dima-Cozma, Sebastian Cozma, Cătălina Elena Lupușoru


Autoimmune thyroid diseases (AITDs), including Graves’ Disease and Hashimoto’s Thyroiditis (chronic autoimmune thyroiditis), are the most common organ-specific autoimmune disorders, occurring mostly in middle-aged women. AITDs are often associated with other autoimmune diseases such as vitiligo or systemic sclerosis (scleroderma), but there have been only few reports of AITDs concurring with CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasias), a limited form of scleroderma. Furthermore, these disorders have been associated with lymphoid malignancies, but only rarely with other cancers such as lung or breast. We report the case of a 59 year-old female patient who presented at the Endocrinology clinic for vertigo, dysphoria and fatigue. Clinical examination and serologic determinations revealed the diagnosis of an overlap syndrome between euthyroid autoimmune thyroiditis and CREST syndrome. Further investigations led to the detection of an incipient gastric adenocarcinoma which was promptly treated with total gastrectomy.


autoimmune thyroid disease, CREST syndrome, scleroderma, gastric carcinoma

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Swain M, Swain T, Mohanty BK. Autoimmune thyroid disorders - an update. Indian J Clin Biochem 2005; 20(1):9–17.

Fountoulakis S, Tsatsoulis A. On the pathogenesis of autoimmune thyroid disease: a unifying hypothesis. Clin Endocrinol (Oxf) 2004; 60:397–409.

Merrill SJ, Mu Y. Thyroid autoimmunity as a window to autoimmunity: an explanation for sex differences in the prevalence of thyroid autoimmunity. J Theor Biol 2015; 375:95-100.

Tomer Y, Huber A. The etiology of autoimmune thyroid disease: a story of genes and environment. J Autoimmun 2009; 32(3-4):231–239.

Jury EC, D’Cruz D, Morrow WJ. Autoantibodies and overlap syndromes in autoimmune rheumatic disease. J Clin Pathol 2001; 54(5):340–347.

Sung SJ, Hwang SJ, Kim JM, Lee YA, Oh JS, Suh JH, et al. A case of polymyositis associated with Hashimoto’s thyroiditis. Korean J Intern Med 2013; 28(3):380–382.

Antonelli A, Ferri C, Fallahi P, et al. Clinical and subclinical autoimmune thyroid disorders in systemic sclerosis. Eur J Endocrinol 2007; 156(4):431–437.

Elhai M, Avouac J, Kahan A, Allanore Y. Systemic sclerosis at the crossroad of polyautoimmunity. Autoimmun Rev 2013; 12(11):1052–1057.

Robazzi TCMV, Adan LFF. Autoimmune thyroid disease in patients with rheumatic diseases. Rev Bras Reumatol 2012; 52(3):417–430.

Punzi L, Betterle C. Chronic autoimmune thyroiditis and rheumatic manifestations. Joint Bone Spine 2004; 71(4):275–283.

Nakamura T, Higashi S, Tomoda K, Tsukano M, Sugi K. Primary biliary cirrhosis (PBC)-CREST overlap syndrome with coexistence of Sjögren's syndrome and thyroid dysfunction. Clin Rheumatol 2007; 26(4):596-600.

Koyama T, Fujimoto K, Shima M. Acquired von Willebrand syndrome associated with Hashimoto’s thyroiditis and subcutaneous mucosa-associated lymphoid tissue lymphoma. Intern Med 2013; 52(23):2661–2663.

William BM, Harbert T, Ganti AK, Bierman PJ. Small lymphocytic lymphoma in a patient with CREST syndrome. Hematol Oncol Stem Cell Ther 2011; 4(3):132-135.

Bonifazi M, Tramacere I, Pomponio G, et al. Systemic sclerosis (scleroderma) and cancer risk: systematic review and meta-analysis of observational studies. Rheumatology (Oxford) 2013; 52(1):143-154.

Kounalakis N, Pezner R, Staud CL, Kruper L. Partial breast irradiation in a patient with bilateral breast cancers and CREST syndrome. Brachytherapy 2011; 10(6):486-490.

Anastasopoulos G, Marinis A, Konstantinidis C, Theodosopoulos T, Fragulidis G, Vassiliou I. Adenocarcinoma of the third portion of the duodenum in a man with CREST syndrome. World J Surg Oncol 2008; 6:106.

Vanderpump MPJ. The epidemiology of thyroid disease. Br Med Bull 2011; 99:39–51.

Schott M, Scherbaum WA. Autoimmune thyroid disease. Dtsch Arztblt 2006; 103(45):A3023–3032.

Antonelli A, Fallahi P, Ferrari SM, Mancusi C, Giuggioli D, Colaci M, et al. Incidence of thyroid disorders in systemic sclerosis: results from a longitudinal follow-pp. J Clin Endocrinol Metab 2013; 98(7):E1198–1202.

Bonilla-Abadía F, Muñoz-Buitrón E, Ochoa CD, Carrascal E, Cañas CA. A rare association of localized scleroderma type morphea, vitiligo, autoimmune hypothyroidism, pneumonitis, autoimmune thrombocytopenic purpura and central nervous system vasculitis. Case report. BMC Res Notes 2012; 5:689.

Yu H, Qiu H, Pan J, Wang S, Bao Y, Jia W. Hashimoto’s thyroiditis concomitant with sequential autoimmune hepatitis, chorea and polyserositis: a new entity of autoimmune polyendocrine syndrome? Intern Med 2013; 52(2):255–258.

Matsuta M, Chiba C, Akasaka T, Terashima M. A case of systemic sclerosis associated with gastric cancer. J Dermatol 1999; 26(9):611-614.


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