Vitamin D, selenium in type 2 diabetes and Hashimoto's thyroiditis: Is it effective?

The study by Feng et al,explores treatment approaches for these coexisting conditions.It emphasizes the potential advantages of selenium and vitamin D supplementation but also raises methodological and patient selection concerns.Findings indicate a complex interplay between interventions and disease markers,prompting the need for further research.Despite limitations,the study offers valuable insights into managing the intricate relationship between type 2 diabetes mellitus and Hashimoto's thyroiditis.The authors'contributions shed light on potential treatment avenues,although careful consideration of study design and patient characteristics is warranted for future investigations in this domain.

Vitamin D and selenium for type 2 diabetes mellitus with Hashimoto’s thyroiditis:Dosage and duration insights

This letter discusses the publication by Feng et al.Iodine,selenium,and vitamin D are closely associated with thyroid hormone production in humans;however,the efficacy of selenium and vitamin D supplementation for type 2 diabetes mellitus(T2DM)patients with Hashimoto’s thyroiditis(HT)remains controversial.In the retrospective study we discuss herein,the authors highlighted significant improvements in thyroid function,thyroid antibodies,blood glucose,and blood lipid in T2DM patients with HT following addition of vitamin D and selenium to their antidiabetic regimens,underscoring the value of these supplements.Our team is currently engaged in research exploring the relationship between micronutrients and HT,and we have obtained invaluable insights from the aforementioned study.Based on this research and current literature,we recommend a regimen of 4000 IU/day of vitamin D and 100-200μg/day of selenium for over three months to six months for patients with HT,particularly for those with concurrent T2DM.

Effect of Hashimoto’s Thyroiditis on Efficacy of 131I Ablation Therapy in Intermediate- and High-Risk of Thyroid Papillary Carcinoma

Objective: The purpose of this study was to investigate the effect of Hashimoto’s thyroiditis on efficacy of 131I ablation in intermediate- and high-risk of thyroid papillary carcinoma patients. The findings will help to develop a personalized treatment plan for patients with thyroid papillary carcinoma complicated with Hashimoto’s thyroiditis. Material and Methods: From January 2016 to December 2020, patients who were diagnosed with intermediate- and high-risk PTC with lymph node metastasis were analyzed retrospectively, excluding patients with incomplete clinical data, distant metastasis, positive TGAb, TSH Results: A total of 525 patients (166 males and 359 females) were included in the study, including 368 patients in ER group (70.1%) and 157 patients in NER group (29.9%). Eleven factors including combining Hashimoto’s thyroiditis, pre-ablative Tg levels, sex, tumor diameter, extraglandular invasion, multifocal, bilateral lesions, central lymph node metastasis, lateral lymph node metastasis, lymph node metastasis rate, thyroglobulin were statistically different between ER group and NER group with significance at P Conclusion: Hashimoto’s thyroiditis, Ps-Tg level and lateral lymph node metastasis are potential predictors for short-term efficacy of 131I treatment in intermediate- and high-risk thyroid papillary carcinoma. Hashimoto’s thyroiditis, high Ps-Tg level and increased number of lateral lymph node metastasis reduce the efficacy of 131I therapy in patients with intermediate and high risk thyroid papillary carcinoma.

Profile of Autoimmune Polyendocrinopathies at the Medical Clinic II of the Abass Ndao Hospital: About 40 Cases

Introduction: Autoimmune polyendocrinopathies (AP) represent a group of rare concomitant pathologies, making them underdiagnosed. The objective was to study their profile at the Medical Clinic II of the Abass Ndao Hospital. Patients and Methods: This was an observational, descriptive and analytical study, lasting 24 months, from January 1, 2020 to December 31, 2022. We assessed the epidemiological, clinical and paraclinical characteristics of the patients and classified the APs found. Results: We included 40 patients divided into type III (38 cases) and IV (2 cases). A female predominance was noted with a sex ratio of 0.21. The mean age was 38.6 years. A family history of component diseases of autoimmune polyendocrine syndrome (APS) was found in 62.5%. Goiter (80%) was the main clinical sign present. All 38 patients with ISAP-3 had autoimmune thyroiditis, including 29 cases of Graves’ disease (72.5%) and 9 cases of Hashimoto’s thyroiditis (22.5%). They were associated with either type 1 diabetes (57.9%), Biermer’s disease (21.1%), vitiligo + alopecia (18.4%), lupus (2.6%). The 2 patients with AP-4 had Biermer’s disease associated with either Addison’s disease or type 1 diabetes. Management depended on the pathologies present and their possible complications. The immunological phenomena were also controlled. Conclusion: This series is globally similar to the literature. The polymorphous character of the clinical pictures requires a better collaboration between specialists leading to a clinical and holistic synthesis.

Th1/Th2、CD28、ICOS、PD-1和CTLA-4在桥本甲状腺炎患者外周血中的表达及与甲状腺相关实验室指标的相关性

目的探讨辅助性T淋巴细胞1与辅助性T淋巴细胞2比值(Th1/Th2)、CD28、可诱导共刺激分子(ICOS)、程序性死亡受体1(PD-1)和细胞毒性T淋巴细胞相关抗原4(CTLA-4)在桥本甲状腺炎(HT)患者外周血中的表达及与甲状腺相关实验室指标的相关性。方法收集2021年在该院门诊或住院治疗的HT患者40例为HT组,另选择同期健康体检者40例为对照组。采用全自动化学发光免疫分析仪检测血清甲状腺过氧化物酶抗体(TPOAb)、促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)水平,采用酶联免疫吸附试验检测血清γ干扰素(IFN-γ)、白细胞介素(IL)-2、IL-4和IL-10水平,采用流式细胞仪检测外周血中Th1与Th2细胞,以及CD3^(+)CD4^(+)T淋巴细胞表面共信号分子CD28、ICOS、PD-1、CTLA-4水平。结果HT组血清FT4和TPOAb水平均明显高于对照组,TSH、FT3水平明显低于对照组,差异有统计学意义(P<0.05)。HT组外周血中Th1细胞及其相关细胞因子IFN-γ和IL-2水平,以及Th1/Th2明显高于对照组,差异有统计学意义(P<0.05)。HT组外周血CD3^(+)CD4^(+)T淋巴细胞表面CD28、ICOS和PD-1水平明显高于对照组,差异有统计学意义(P<0.05);两组CTLA-4水平比较,差异无统计学意义(P>0.05)。FT4水平与Th1细胞、Th1/Th2水平呈正相关(P<0.05);TSH水平与Th1细胞、Th1/Th2和IL-2水平呈负相关(P<0.05);TPOAb水平与Th1细胞、Th1/Th2、IFN-γ、IL-2、CD28及ICOS水平呈正相关(P<0.05)。结论HT患者外周血中Th1细胞及其相关细胞因子IFN-γ和IL-2水平较健康体检者均明显上调,其CD3^(+)CD4^(+)T淋巴细胞表面CD28、ICOS和PD-1的表达也均明显上调。Th1细胞及其相关细胞因子,以及CD28、ICOS和PD-1可能在HT的发病机制中发挥了重要作用。

Coexistence of papillary thyroid microcarcinoma and mucosa-associated lymphoid tissue lymphoma in a context of Hashimoto's thyroiditis

Papillary thyroid cancer(PTC)represents 80%-85%of thyroid cancer and its prevalence has been rising in the last decades.Primary thyroid lymphoma(PTL)accounts for 3%of extranodal lymphomas and about 5%of thyroid malignancies,having a prevalence of one or two cases per million people.Mucosa-Associated Lymphoid Tissue lymphoma represents approximately30%of PTL.Both entities have an indolent course and a very good prognosis.Diagnosis is made by ultrasound and fine needle aspiration(FNA)or surgery specimen pathology.They have also been associated with Hashimoto’s thyroiditis(HT),but pathogenesis and its links remains to be known.Treatment remains controversial and surgery is generally accepted in cases of disease limited to thyroid,as the present.Patients with thyroid nodules should be observed and followed.If there is an enlargement by ultrasound or clinical symptoms,FNA should be performed promptly.Patients with HT deserve additional surveillance,since this condition is associated with both PTC and PTL.In this case,the management with surgery and radioactive iodine ablation therapy was effective for both entities.Patients with thyroid nodules should be properly evaluated with ultrasound and thyroid function tests.If there is an enlargement of the neck,reported by symptoms or ultrasound,it requires further investigation.HT is associated to both PTC and PTL so if the enlargement of the nodules is on this context additional tests such as FNA should be performed.In this case,the patient was managed with surgery and radioactive iodine ablation therapy and it was effective for both entities.

Ascher syndrome: a rare case of blepharochalasis combined with double lip and Hashimoto’s thyroiditis

Dear Editor,I am Dr. Yao Fu, from the Department of Ophthalmology,Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. I write to present a rare case of Ascher syndrome.Ascher syndrome was described first in 1920, presenting as a combination of blepharochalasis, double lip, and non-toxic goitre(1)It is considered to be a rare, sporadic.

Coeliac disease in Dutch patients with Hashimoto’s thyroiditis and vice versa

AIM: To define the association between Hashimoto’s thyroiditis and coeliac disease in Dutch patients. METHODS: A total of 104 consecutive patients with Hashimoto’s thyroiditis underwent coeliac serological tests (antigliadins, transglutaminase and endomysium antibodies) and HLA-DQ typing. Small intestinal biopsy was performed when any of coeliac serological tests was positive. On the other hand, 184 patients with coeliac disease were subjected to thyroid biochemical (thyroid stimulating hormone and free thyroxine) and thyroid serological tests (thyroglobulin and thyroid peroxidase antibodies). RESULTS: Of 104 patients with Hashimoto’s thyroiditis, sixteen (15%) were positive for coeliac serology and five patients with documented villous atrophy were diagnosed with coeliac disease (4.8%; 95% CI 0.7-8.9). HLA-DQ2 (and/or -DQ8) was present in all the five and 53 patients with Hashimoto’s thyroiditis (50%; 95% CI 43-62). Of 184 patients with coeliac disease, 39 (21%) were positive for thyroid serology. Based on thyroid biochemistry, the 39 patients were subclassified into euthyroidism in ten (5%; 95% CI 2-9), subclinicalhypothyroidism in seven (3.8%; 95% CI 1.8-7.6), and overt hypothyroidism (Hashimoto’s thyroiditis) in 22 (12%; 95% CI 8-16). Moreover, four patients with coeliac disease had Graves’ disease (2%; 95% CI 0.8-5) and one patient had post-partum thyroiditis. CONCLUSION: The data from a Dutch population confirm the association between Hashimoto’s thyroiditis and coeliac disease. Screening patients with Hashimoto’s thyroiditis for coeliac disease and vice versa is recom- mended.

Hashimoto's encephalopathy presenting as acute cognitive decline in an elderly male

Hashimoto’s encephalopathy(HE)is a rare form of reversible encephalopathy characterized by the presence of anti-thyroid antibodies in serum and/or cerebrospinal fl uid.The syndrome is more common in women and the presentation varies considerably.Here,we report a case of an elderly male with a history of Hashimoto’s thyroiditis,presenting with acute cognitive decline.A diagnosis of HE was established based on the presence of antithyroid antibodies in the serum,diffuse electroencephalography changes and lack of an alternative explanation.The patient promptly responded to steroids and was discharged on the 8th day of admission.We suggest that an assessment of thyroid antibodies should be included in anyone presenting with acute cognitive decline in the absence of alternative explanation.

血清Sema 5A、RVE1水平与桥本甲状腺炎患者Th17相关因子、甲状腺功能及相关抗体的相关性研究

目的探讨血清神经轴突导向分子5A(Sema 5A)、溶解素E1(RVE1)水平与桥本甲状腺炎(HT)患者辅助性T细胞(Th)17相关因子、甲状腺功能以及甲状腺特异性自身抗体的相关性。方法选择2019年2月至2021年8月该院收治的109例HT患者(HT组),分为甲状腺功能正常组(39例)、亚临床甲减组(47例)、临床甲减组(23例),另选择58例甲状腺功能正常的体检健康者为对照组。检测各组血清Sema 5A、RVE1、甲状腺激素[促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)]、Th17相关因子[白细胞介素(IL)-17、IL-23]以及甲状腺特异性自身抗体[抗甲状腺球蛋白抗体(TgAb)和甲状腺过氧化物酶抗体(TPOAb)]水平。分析HT患者血清Sema 5A、RVE1水平与TSH、FT3、FT4、IL-17、IL-23、TgAb、TPOAb等的相关性。结果HT组血清Sema 5A、IL-23、IL-17、TSH、TgAb、TPOAb水平,外周血Th17占比高于对照组(P<0.05),血清RVE1、FT3、FT4水平低于对照组(P<0.05)。临床甲减组血清Sema 5A、IL-23、IL-17、TSH、TgAb、TPOAb水平,外周血Th17占比高于亚临床甲减组、甲状腺功能正常组(P<0.05),血清RVE1、FT3、FT4水平低于亚临床甲减组、甲状腺功能正常组(P<0.05)。HT患者血清Sema 5A水平与外周血Th17占比、IL-23、IL-17、TSH、TgAb、TPOAb呈正相关(P<0.05),RVE1与上述指标呈负相关(P<0.05)。结论HT患者血清Sema 5A水平升高,RVE1水平降低,且与TgAb、TPOAb、TSH、外周血Th17占比、IL-17、IL-23水平增加有关。

Pituitary-Thyroid Dysfunction in a Hashimoto’s Encephalopathy Patient

The pathogenesis of Hashimoto’s encephalopathy has not been clearly elucidated and involvement of autoimmune damage has been proposed. We report a 23-year-old man who was emergently hospitalized for paroxysmal syncope and involuntary tremor with normal physical examination except for low heart rate. The patient was characterized by neurological symptoms, mild hypothyroidism, enlarged pituitary gland and extremely elevated thyrotropin, which all were reversed with levothyroxine alone. The case indicated that the pituitary-thyroid dysfunction may play a role in the pathogenesis of Hashimoto’s encephalopathy, hence, evaluation of pituitary gland should be recommended in diagnosis and treatment of Hashimoto’s encephalopathy.

Treatment of Hashimoto's thyroiditis traditional Chinese and western medicine:A review

Hashimoto's Thyroiditis is a common Autoimmune disease,and clinical related research has made great progress.This article summarizes the clinical and experimental studies on Hashimoto's Thyroiditis in recent years,summarizes in five aspects from its western medicine pathogenesis(Genetics,Environment,Gender,Immunity,mi RNA),traditional Chinese medicine etiology and pathogenesis,western medicine treatment(Glucocorticoid therapy,Chemokine receptor antagonist therapy,Nutrition therapy),traditional Chinese medicine therapy(Treatment by type,Treatment by stages,Treatment by liver,Treatment by spleen and kidney,Treatment by gas,blood,phlegm and blood stasis,Prescription of experience,Characteristic theory of physician and Characteristic therapy of Traditional Chinese Medicine)and combine traditional Chinese and western medicine treatment,and puts forward the integrated treatment of traditional Chinese and western medicine is the general trend of future diagnosis and treatment of Hashimoto thyroiditis.

Convulsive Seizures Revealing Hashimoto’s Encephalopathy

Introduction: Hashimoto encephalopathy (HE) is an autoimmune disease with different neurological and psychiatric characteristics. It is associated with increased thyroperoxidase autoantibodies. The diagnosis of HE is clinical and involves the detection of serum thyroperoxidase (TPO) antibodies and the exclusion of other etiologies. A clinical response to corticosteroid therapy supports the diagnosis. We report a case of HE revealed by convulsive seizures and cognitive and behavioral disorders. Observation: She is a 7-year-old child followed in a neurology unit for convulsive seizures for one year. Clinical examination performed in the endocrinology unit later found tachycardia without goiter, behavioral disorders, difficulties to concentrate as well as psychomotor agitation. Biological work up revealed subclinical hypothyroidism, positive anti-TPO antibodies with normal thyroid ultrasound and brain MRI. The cerebrospinal fluid was clear, normotensive and absence of pleocytosis. The sleep-wake electroencephalogram was well organized for her age with a paroxysmal discharge in the left parieto-temporal region. Based on these clinical, biological and morphological data, the diagnosis of HE was retained. Corticosteroid therapy with prednisone at 1 mg/kg/day was initiated for 6 weeks while reducing the dose progressively. There was a good clinical and biological progress under treatment. Conclusion: Hashimoto’s encephalopathy is a rare, but probably unrecognized entity. Over the past decades, knowledge about thyroid, brain, immunity interactions has increased. This indicates the importance of a multidisciplinary approach of endocrinologists, neurologists, psychiatrists and pediatricians for early recognition and treatment.

Efficacy of Xiaojin Capsules Combined with Selenium Yeast Capsules on 120 Cases of Hashimoto's Thyroiditis with Abnormal Thyroid Function

[Objectives]To explore the efficacy of Xiaojin Capsules combined with Selenium Yeast Capsules in the treatment of Hashimoto's thyroiditis(HT)with abnormal thyroid function.[Methods]A total of 180 HT patients who were treated in the First Affiliated Hospital of Henan University and Henan Provincial People's Hospital from December 2020 to December 2021 were selected as the research subjects and randomly divided into the observation group(n=120)and the control group(n=60)in at a tratio of 2∶1 ratio according to their visiting time.The observation group was treated with Xiaojin Capsules(oral,5 capsules each time,twice a day for 12 weeks)and Selenium Yeast Capsules(oral,1 capsule each time,twice a day for 12 weeks).The control group was treated with only Selenium Yeast Capsules(oral,1 capsule each time,twice a day for 12 weeks).[Results]The difference in the levels of thyroid peroxidase antibody(TPO-Ab),thyroglobulin antibody(TGAb),serum free triiodothyronine(FT_(3)),serum free thyroxine(FT_(4)),and thyroid stimulating hormone(TSH)between the observation group and control group was statistically significant(P<0.05).The diameters of thyroid between the observation group and the control group before,during and after treatment were significantly different(P<0.05).The total effective rate of the observation group was 82.5%(99/120),which was significantly higher than 56.67%(34/60)in the control group,and the difference was statistically significant(P<0.05).The cure rate(22.50%)in the observation group was significantly higher than the control group(3.33%),and the difference was statistically significant(P<0.01).The ineffective rate of the observation group was 17.50%,which was significantly lower than that of the control group(40.00%),and the difference was statistically significant(P<0.01).The markedly effective rate of the observation group was 40.83%,which was significantly higher than that of the control group(31.67%),and the difference was statistically significant(P<0.05).The effective rate in the observation group was 191%,and the effective rate in the control group was 21.67%,and the difference was not statistically significant(P>0.05).[Conclusions]Xiaojin Capsules combined with Selenium Yeast Capsules in the treatment of HT can eliminate or alleviate the clinical symptoms and signs,significantly reduce the levels of TPO-Ab and TGAb in serum,restore thyroid function,improve thyroid shape and structure in the treatment of HT,and the clinical effect is satisfactory.

Evaluation of Serum Trace Elements and Vitamin Levels in Hashimoto’s Thyroiditis: Single Centre Experience from Turkey

Aim: To determine levels of serum trace elements and vitamins, and to find out possible correlations between these elements and vitamins with thyroid function tests and thyroid autoantibody levels in patients having Hashimoto’s thyroiditis (HT). Methods: The study included 51 premenauposal women with untreated HT, aged 18 to 56 years without any known chronic diseases or chronic medicine usage, and 27 healthy premenauposal women aged 19 to 42 years old. Trace elements (selenium, zinc, copper, iron levels) and vitamins [A, E, B12, 25-OH-D, 1,25(OH)2D and folic acid levels] were evaluated in patient and control groups. Results: Consequently, serum trace elements and vitamin B12 levels did not significantly differ in patients with HT and control group. Thyroid functioning tests and autoantibody levels did not show any correlation with the levels of trace elements, vitamin A, vitamin E and 25-OH vitamin D. A correlation was detected between vitamin B12 and Anti thyroid peroxidase levels. Conclusion: The negative correlation between vitamin B12 and Anti thyroid peroxidase levels may demonstrate the necessity to screen the patients with HT for atrophic gastritis. We believe that more comprehensive studies with larger sample sizes are needed in which patients are randomized according to their nutritional status.

Advances in the relationship between Hashimoto’s thyroiditis and thyroid cancer

In recent years,the incidence of Hashimoto’s thyroiditis and thyroid cancer has shown a rapid growth trend.These two diseases have severely affected the public health.Many epidemiological studies have shown that thyroid cancer is often associated with Hashimoto’s thyroiditis.Hashimoto’s thyroiditis may promote the occurrence of thyroid cancer,as well as affecting the progression of the tumor,lymph node metastasis,and even the prognosis of patients.In this paper,the relationship between Hashimoto’s thyroiditis and thyroid cancer and the pathogenesis of thyroid cancer are reviewed regarding molecular mechanism,clinical pathology,and serology.

Intratumoral Bacteria Dysbiosis Is Associated with Human Papillary Thyroid Cancer and Correlated with Oncogenic Signaling Pathways

Emerging evidence suggests that microbial dysbiosis plays vital roles in many human cancers.However,knowledge of whether the microbial community in thyroid tumor is related to tumorigenesis remains elusive.In this study,we aimed to explore the microbial community in thyroid tissues and its contribution to papillary thyroid cancer(PTC).In parallel,we performed microbial profiling and transcriptome sequencing in the tumor and adjacent normal tissues of a large cohort of 340 PTC and benign thyroid nodule(BTN)patients.Distinct microbial signatures were identified in PTC,BTN,and their adjacent nontumor tissues.Intra-thyroid tissue bacteria were verified by means of bacteria staining,fluorescence in situ hybridization,and immunoelectron microscopy.We found that 17 bacterial taxa were differentially abundant in PTC compared with BTN,which included enrichment in PTC of the pathobionts Rhodococcus,Neisseria,Streptococcus,Halomonas,and Devosia,and depletion of the beneficial bacteria Amycolatopsis.These differentially abundant bacteria could differentiate PTC tumor tissues(PTC-T)from BTN tissues(BTN-T)with an area under the curve(AUC)of 81.66%.Microbial network analysis showed increased correlation strengths among the bacterial taxa in PTC-T in comparison with BTN-T.Immunefunction-corresponding bacteria(i.e.,Erwinia,Bacillus,and Acinetobacter)were found to be enriched in PTC with Hashimoto’s thyroiditis.Moreover,our integrative analysis revealed that the PTC-enriched bacteria had a positive association with key PTC-oncogenic pathway-related genes,including BRAF,KRAS,IRAK4,CTNNB1,PIK3CA,MAP3K7,and EGFR.In conclusion,our results suggest that intratumor bacteria dysbiosis is associated with the thyroid tumorigenesis and oncogenic signaling pathways of PTC.

Late Onset Peripheral Spondyloarthritis in Woman with Hashimoto’s Thyroiditis: A Case Report

Late onset peripheral spondyloarthritis is a particular clinical form of spondyloarthritis, occurring at the age of 50 years or older. Hashimoto’s thyroiditis (HT) is the most frequent autoimmune thyroid disorder responsible for considerable morbidity. HT is well known to be associated with many systemic autoimmune, it is less clear whether a similar association may also be present for spondyloarthritis. Here, we report a case of late onset peripheral spondyloarthritis in a 62-year-old African woman with a 12-year history of Hashimoto’s thyroiditis, a previously undescribed association in the literature. The diagnosis of Late onset peripheral spondyloarthritis was made according to the Assessment of SpondyloArthritis international Society (ASAS) criteria for peripheral spondyloarthritis (presence of arthritis, enthesitis and Human Leukocyte Antigen B27). She was treated with methotrexate and celebid. After 6 months of treatment, the evolution was favourable with an overall improvement in her symptomatology and quality of life. The coexistence of late onset peripheral spondyloarthritis and Hashimoto’s thyroiditis may be related to the presence of a genetic background predisposing to both diseases.

Subclinical Hypothyroidism, Its Manifestations and Management a Case Report

Introduction: Thyroid states can be associated with psychiatric manifestations, be it hypothyroid, hyperthyroid or even euthyroid. The effect of depression is significant in subclinical hypothyroidism. Sometimes, its signs and symptoms are indistinguishable from Major Depressive Disorder. Our immunological system and early embryologic origins also play a role in the coexistence of other comorbidities like Pernicious Anemia. Case: A 35-year-old Hispanic female presented with significant low mood, somnolence, weight gain, increased hunger, cold intolerance and epigastric pain. It is important to note the variety of clinical manifestations of our hypothyroidism patient to understand its associations and help us with a better approach to treatment. Discussion: Standard approaches to treatment of Subclinical Hypothyroidism will depend mostly on laboratory findings such as TSH levels and free T4. Individualized therapy chosen for our patient was based on his mood symptoms, laboratory findings and coexistence of Pernicious Anemia. The use of daily 0.025 mg of levothyroxine, 10 mg of escitalopram oxalate and weekly injections of cyanocobalamin were treatments of choice. Conclusion: During follow up of our patient, we can conclude that Levothyroxine and Escitalopram Oxalate were able to improve hypothyroidism symptoms, reduce thyroglobulin and peroxidase antibodies and improve mood symptoms including cognitive functions. In addition to this, weekly cyanocobalamin injections were integrated into the management. As parietal cell antibodies decreased, gastrointestinal symptoms also disappeared. By addressing the concerns of our patient, we improved quality of care, and this is reflected in the patient’s wellbeing in physical and psychological.