1983 Volume 6 Issue 1 Pages 40-46
A rare association of Sjögren syndrome, Basedow's disease and latent renal tubular acidosis occurred in 46-year-old female. She has been suffered from thirst, and generized sweating during the last several years. On August, 1978, she felt dull pains on both lower extremities and the cuccyx, and so she consulted a home-doctor. Taxing the drugs, she felt palpitation. On October, she was pointed out having dry eye and dry mouth. On admission, she was somewhat nervous. Pulse rate was 104 per minutes, and blood pressure was 164-85. Diffuse goiter without exophthalmos was possitive. Hepatosplenomegaly was negative. Bilateral hand finger tremor was positive. Laboratory data included polyclonal hypergammerglobulinemia, slightly microcytic hypochromic anemia, normal liver function tests, and normal values of BUN, cleatinine, PSP test, Fishberg concentration test, cleatinine clearance and electrolytes. PH in artery blood gas was 7.415. There were positive for anti-DNA antibody (RIA), anti-RNP antibody, anti-Sm antibody, anti-thyroglobulin antibody, and anti-microsome antibody. But RA factor, LE cell, and BFP were negative. Schirmer test and Gum test were abnormal. Sialography showed abnormal shadow of apple tree patterns. Lip biopsy demonstrated chronic sialadenitis. NH4Cl loading test showed latent renal tubular acidosis of distal type. Chest X-P showed interstional fibrosis. Thyroid gland function tests showed hyperthyroid. Thyroid gland biopsy showed that flat and cube-like follicules of various size filled almostly with colloid, where slightly papillary epithelial proliferation were seen. Thyroid function was normalized after Propranol-HCI and Thiamazole administration. Although chronic thyroiditis was associated with about 10% of cases with Sjögren syndrome, the combination of Basedow's disease, latent renal tubular acidosis and Sjögren syndrome has been rarely reported. The speculative pathogenesis and the clinical problems were discussed.
