Mujer de 78 años, con antecedentes de diabetes tipo 2 y vitíligo, que ingresa en la unidad de cuidados intensivos (UCI) de nuestro hospital por insuficiencia respiratoria aguda grave. En el estudio inicial se detecta la elevación de valores plasmáticos de TSH, junto con valores bajos de T4 libre, así como la presencia de anticuerpos antitiroideos y antirreceptor de acetilcolina. La paciente es diagnosticada de hipotiroidismo primario y miastenia grave, instaurándose tratamiento específico para ambos problemas. Con posterioridad, se detectan otras entidades y autoanticuerpos que permitieron establecer el diagnóstico de síndrome pluriglandular autoinmune tipo II (SPGA II). Se discuten las características clínicas y la actitud terapéutica ante el SPGA II.
We describe the case of a 78-year-old woman with a history of type 2 diabetes and vitiligo, who presented to the emergency department with severe acute respiratory failure. Laboratory findings included elevated thyroid-stimulating hormone and low free T4 values as well as high titers of anti-thyroid and anti-acetylcholine receptor antibodies. A diagnosis of primary hypothyroidism and myasthenia gravis was made and specific treatment for both problems was instituted. Subsequently, other associated entities and autoantibodies were detected, and a diagnosis of type II autoimmune polyglandular syndrome was established. The clinical spectrum and treatment modalities of type II autoimmune polyglandular syndrome are discussed.
