Hashimoto’s Thyroiditis is a Frequent Occurrence in Patients with Rheumatic Mitral Stenosis Derun T. Ertugrul 1 , Bunyamin Yavuz 2 , Ahmet A. Yalcin 2 , Metin Kucukazman 1 , Naim Ata 1 , Ezgi C. Yenigun 1 , Zekeriya Ulger 1 , Guler Kizilca 1 , Kadir O. Akin 3 , Yasar Nazligul 1 Departments of 1 Internal Medicine, 2 Cardiology and 3 Biochemistry, Kecioren Research Hospital, Ankara, Turkey Rheumatic heart disease (RHD) is an autoimmune sequel of streptococcal infection complicated by acute rheumatic fever (ARF). Rheumatic mitral stenosis (RMS), which is frequently seen in developing coun- tries and causes significant morbidity and mortality (1), is also known to be caused by ARF. Following the resolution of a streptococcal infection, activated autoreactive T cells react against the body’s own tis- sues and organs, which leads to an autoimmune dis- ease. Between 30% and 45% of children with ARF develop carditis, which in turn causes heart damage associated with pericardial, myocardial and endocar- dial involvement, followed by progressive and perma- nent valvular lesions leading to RHD (2). Hashimoto’s thyroiditis (HT), another autoimmune disease, is recognized as the major form of chronic autoimmune thyroiditis (3) and normally has symp- toms of hypothyroidism. The condition is character- ized by a diffuse goiter, together with a thyroid lym- phocytic infiltrate and autoantibodies to thyroglobulin and thyroid peroxidase. It is very likely that cellular destruction in the thyroid gland is mediated by other cellular mechanisms, such as autoreactive T lympho- cytes, natural killer cells and cytokines (4). It was hypothesized that the coexistence of HT and RMS might have an autoimmune origin, as autoreac- tive T lymphocytes have a role in both diseases. The study aim was to examine the possible existence of this relationship. Clinical material and methods Patients A total of 55 consecutive patients with RMS (38 females, 17 males; mean age 39.9 ± 9.3 years) and 54 healthy controls (39 females, 15 males; mean age 39.6 ± 10.5 years) was examined. The controls were selected from healthy subjects with normal echocardiographic findings. All patients and controls underwent transthoracic echocardiography and thyroid ultra- sonography following a complete medical history and Address for correspondence: Bunyamin Yavuz MD, Department of Cardiology, Kecioren Research Hospital, Kecioren, Ankara, Turkey e-mail: byavuzmd@gmail.com © Copyright by ICR Publishers 2008 Background and aim of the study: Rheumatic mitral stenosis (RMS), an autoimmune sequel of streptococ- cal infection, causes significant morbidity and mor- tality. As Hashimoto’s thyroiditis (HT) is recognized as the major form of chronic autoimmune thyroiditis, it was hypothesized that the coexistence of HT and RMS might have an autoimmune origin. The study aim was to examine this possible relationship. Methods: A total of 55 consecutive patients with RMS was examined and compared to 54 healthy controls with normal echocardiographic findings. All sub- jects underwent transthoracic echocardiography and thyroid ultrasonography after a complete medical history and laboratory examination. Results: The demographic data of the RMS group (38 females, 17 males; mean age 39.9 ± 9.3 years) and con- trol group (39 females, 15 males; mean age 39.6 ± 10.5 years) were similar. HT was found to occur signifi- cantly more frequently in RMS patients (n = 16; 29%) than in controls (n = 6; 11%) (p = 0.019) Conclusion: The higher frequency of HT in patients with RMS than controls may have genetic associa- tions. Hence, further genetic-based studies should be conducted to provide a better understanding of this suggested relationship. The Journal of Heart Valve Disease 2008;17:635-638