Abstract
A 61-year-old female presented with dry eyes and mouth in May 1991. The diagnosis of Sjögren's syndrome (SjS) was made based on positive results of the Schirmer's test, Rose-Bengal staining, salivary scintigraphy and lip biopsy. In January 1992, she complained of general malaise, loss of body weight, hair and memory, then she was hospitalized.
Physical examinations were within normal limits except goiter. Laboratory tests revealed high levels of blood sugar, no response of immuno-reactive insulin to oral glucose tolerance test, low levels of T3, T4 and high level of TSH, and anti-microsomal antibody as well as positive anti-nuclear antibody. The results for anti SS-A antibody and anti SS-B antibody were negative study.
Based on those clinical and laboratory data, she was diagnosed insulin-dependent diabetes mellitus (IDDM) and autoimmune thyroid disease (ATD).
The patient responded well to treatment with injectable insulin and oral T4 medication.
Although the association of IDDM and ATD is not rare, there have been only two other cases reported in the literature in which IDDM, ATD and SjS occurred concomitantly.
This is a rare but valuable case because it may contribute to the understanding of the pathophysiology of SjS in regard to its association with other autoimmune diseases.
