Email updates

Keep up to date with the latest news and content from BMC Infectious Diseases and BioMed Central.

Open Access Research article

Common subclinical hypothyroidism during Whipple’s disease

Jean-Christophe Lagier1, Florence Fenollar1, Jacques Chiaroni2, Christophe Picard2, Christiane Oddoze3, Laurent Abi-Rached14 and Didier Raoult1*

Author Affiliations

1 Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, 27 Bd Jean Moulin, 13005 Marseille, France

2 UMR 7268 (ADES), Aix-Marseille Université, CNRS, EFS, 51 Bd Pierre Dramard, 13916 Marseille, France

3 APHM, CHU Timone, Laboratoire de Biochimie, 13005 Marseille, France

4 Centre National de la Recherche Scientifique, Laboratoire d’Analyse, Topologie, Probabilités - Unité Mixte de Recherche 7353, Equipe ATIP, Aix-Marseille Université, 13331 Marseille, France

For all author emails, please log on.

BMC Infectious Diseases 2014, 14:370  doi:10.1186/1471-2334-14-370

Published: 4 July 2014

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.

Conclusion

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.

Keywords:
Tropheryma whipplei; Whipple’s disease; Subclinical hypothyroidism; HLA