We present the case of a 74 year old patient suffering from primary Non Hodgkin's lymphoma of the thyroid and Sjogren's syndrome. A massively enlarging goitre, causing breathlessness in a female patient previously treated for autoimmune inflammation of the thyroid (Hashimoto's disease) and Sjogren's syndrome, indicated the need for a fine needle aspiration biopsy (FNA) of the thyroid gland. Non Hodgkin's lymphoma of the thyroid was diagnosed and chemotherapy was begun. After 10 months of cytostatic treatment clinical tests and imaging indicated complete local regression. However, two months after cessation of chemotherapy the patient suffered a relapse of the disease owing to infiltration of the central nervous system. During the course of palliative radiotherapy the patient died. The main purpose for presenting this case was to describe the problem of primary lymphoma of the thyroid in cases of autoimmune disease. As many years of immunisation may lead to carcinogenesis it is important to raise awareness among medical staff with regard to cases of chronic autoimmune disease. In cases of Hashimoto's autoimmune disease of the thyroid, monitoring of the anti-thyroid antibodies is indicated, at least annually, as an increase in the concentration of these antibodies over a period of at least seven years would suggest further development of autoimmune disease. If such conditions are accompanied by tumours of the thyroid, surgery should be considered. It is worth keeping in mind that the thyroid can be a site for extra-lymphatic lymphoma.

BACKGROUND:Premature ovarian failure is diagnosed with a picture of amenorrhea, elevated follicle-stimulating hormone (FSH), and age under 40 years. Twenty percent (20%) of patients with premature ovarian failure have a concomitant autoimmune disease. Cases of premature ovarian failure associated with Sjögren syndrome have been reported in the literature.

PATIENT AND METHOD:We report a case of a 42-year-old white woman with Sjögren syndrome and premature ovarian failure who underwent a reversal of her premature ovarian failure and restoration of normal menses using an elimination diet protocol. The patient was diagnosed with her rheumatological condition in 2005 and started on disease-modifying antirheumatoid drugs, which were taken intermittently due to a concern over medication side-effects. Her menses became irregular at the time of initial diagnosis and finally ceased in 2006, with a dramatic elevation in her FSH, indicative of autoimmune-induced premature ovarian failure. In March 2009, she commenced an elimination diet protocol, eliminating gluten, beef, eggs, dairy products, nightshade vegetables, refined sugars, and citrus fruit for 4 months.

RESULTS:Her repeat laboratory tests after 4 months showed a drop in FSH from 88 to 6.5 and a drop in erythrocyte sedimentation rate from 40 to 16. Her menses also resumed and her rheumatological symptoms significantly improved.

CONCLUSIONS:It is hypothesized that the restoration of normal menses was caused by reduced inflammation in the ovarian tissue and supports the hypothesis that the gut immune system can influence autoimmune disease and inflammation.

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