Multiple autoimmune syndrome involves someone having three or more autoimmune conditions. I’ve mentioned in past blog posts how someone who has one autoimmune condition has a good chance of developing additional autoimmune conditions. In fact, even though I primarily see people with Graves’ disease and Hashimoto’s thyroiditis, it’s common for people with these conditions to have other autoantibodies.
But why do some people develop multiple autoantibodies? Is it because they are exposed to multiple triggers? Or does a single environmental factor cause the development of multiple autoantibodies? Either one of these scenarios is a possibility. For example, certain infections such as Epstein-Barr and Cytomegalovirus can lead to the development of different types of autoantibodies. In other words, Epstein-Barr and Cytomegalovirus can trigger multiple autoimmune conditions in the same person. However, it’s also possible for someone to have multiple triggers which are responsible for different autoantibodies.
The Triad of Autoimmunity
In the past I discussed the triad of autoimmunity. According to this triad the following three components are necessary in order for someone to develop an autoimmune condition:
1. A genetic predisposition
2. An environmental trigger
3. A leaky gut
So according to the triad of autoimmunity, in order for someone to develop multiple autoimmune conditions they need to have a genetic predisposition for each of these conditions. As I mentioned earlier, some of these people will have multiple autoimmune triggers, while others will have one or two environmental triggers which caused the development of all of the person’s autoantibodies. Either way the goal should be to detect and remove these triggers.
The third component of the triad of autoimmunity is a leaky gut, which is also known as an increase in intestinal permeability. So even if someone has a genetic predisposition for one or more autoimmune conditions AND they’re exposed to one or more environmental triggers, according to the triad of autoimmunity, the person won’t develop an autoimmune condition if they don’t have a leaky gut. This is one reason why it’s important to try to avoid anything that can cause a leaky gut while trying to restore your health. An example of this is gluten, as even if you remove the environmental trigger but continue to eat gluten (or other foods which can increase gut permeability), then you most likely won’t reverse the autoimmune component.
3 Categories of Multiple Autoimmune Syndrome
Multiple autoimmune syndrome (MAS) is classified into three groups:
Type 1: type 1 MAS includes myasthenia gravis, thymoma, polymyositis and giant cell myocarditis
Type 2: type 2 MAS includes Sjögren’s syndrome, rheumatoid arthritis, primary biliary cirrhosis, scleroderma, and autoimmune thyroid disease
Type 3: type 3 MAS groups together autoimmune thyroid disease, myasthenia gravis and/or thymoma, Sjögren’s syndrome, pernicious anemia, idiopathic thrombopenic purpura, Addison’s disease, type 1 diabetes mellitus, vitiligo, autoimmune hemolytic anemia, systemic lupus erythematosus, and dermatitis herpetiformis.
You’ll notice that autoimmune thyroid conditions are in the second and third categories of multiple autoimmune syndrome. So if someone has Graves’disease or Hashimoto’s thyroiditis, depending on their genetic predisposition they might be more likely to develop one or more of the other autoimmune conditions listed under the second category (Sjögren’s syndrome, rheumatoid arthritis, primary biliary cirrhosis, scleroderma), or they might develop one or more of the autoimmune conditions listed in the third category.
Which Autoimmune Conditions Are Commonly Associated with Graves’ Disease and Hashimoto’s?
Sjögren’s syndrome. This is a systemic autoimmune condition, and one study showed that Sjögren’s syndrome was 10 times more frequent in patients with autoimmune thyroid disease, and autoimmune thyroiditis was 9 times more frequent in Sjögren’s syndrome (1).
Celiac disease. I’ve written a separate article entitled “Celiac Disease and Thyroid Health“, and how this condition is more common in those people with Graves’ disease and Hashimoto’s. There is some evidence that the risk of thyroid disease is threefold higher in those with Celiac disease (2). I should mention that while Celiac disease is common in those with autoimmune thyroid conditions, Celiac disease is not included in the classification of multiple autoimmune syndrome.
Vitiligo. In many people with multiple autoimmune syndrome vitiligo is the first autoimmune disease to be diagnosed. This shouldn’t be too surprising since vitiligo represents the most common cause of acquired skin, hair, and oral depigmentation, affecting 0.5–1% of the population worldwide (3). A few different studies show that vitiligo is more common in Graves’ disease and Hashimoto’s thyroiditis (4) (5) (6).
Systemic lupus erythematosus. Many people with systemic lupus erythematosus (SLE) have thyroid autoantibodies. One study I came across showed that the prevalence of Hashimoto’s thyroiditis in those with SLE was 12.6% (7). Another study showed that patients with SLE had a higher prevalence of hypothyroidism and than hyperthyrodism (8). I did come across a case study where a woman developed SLE one year after being diagnosed with Graves’ disease (9).
Rheumatoid arthritis. The prevalence of thyroid autoimmunity in those with rheumatoid arthritis has ranged from 0.5% in Morocco (10) to 27% in Slovakia (11). Not only does the incidence vary between regions, but ethnicities as well. One study involving 800 patients with rheumatoid arthritis showed that 37.8% had thyroid peroxidase antibodies and 20.8% had elevated thyroblogulin antibodies (12).
Type 1 diabetes mellitus. There are numerous journal articles that show a relationship between type 1 diabetes and thyroid autoimmunity. A few of these studies show an association between type 1 diabetes and Hashimoto’s (13) (14), while a couple of other studies show a link between type 1 diabetes and Graves’ disease (15) (16).
Conventional vs. Natural Treatment Options
Is there a different treatment approach when someone has multiple autoimmune conditions? Not necessarily, as regardless of whether someone has a single autoimmune condition or multiple autoimmune conditions, the goal is to find and remove the triggers. I commonly have patients who have the autoantibodies for both Graves’ disease and Hashimoto’s thyroiditis. While the management of these two conditions differ, finding the triggers involve a similar process. That being said, someone with autoantibodies for both Graves’ disease and Hashimoto’s very well might have multiple triggers. This is one reason why you might see one type of autoantibody decrease while other antibodies don’t decrease.
For example, some people have thyroid peroxidase antibodies, thyroglobulin antibodies, and thyroid stimulating immunoglobulins. While ideally you want to see all of these gradually decrease over time, this isn’t always the case. While fluctuations in thyroid antibodies commonly occur, when you see one or two of these antibodies decrease consistently and yet another antibody not decrease, then this very well might be because one or two environmental triggers have been detected and removed, but another one remains.
In summary, if you have Graves’ disease or Hashimoto’s, then there is an increased risk of having additional autoimmune conditions. If you have three or more autoimmune conditions then this is classified as multiple autoimmune syndrome. In this blog post I discussed the 3 categories of multiple autoimmune syndrome, along with some autoimmune conditions that are commonly associated with Graves’ disease and Hashimoto’s. I also discussed how some people have a single trigger responsible for all of their autoimmune conditions, although it’s more common to have multiple triggers, which can make it more challenging to restore one’s health.
Do you have more than one autoimmune condition? If so please feel free to share your experience in the comments below!
I have had Hashimoto thyroditis for years. I cannot take any hormones for it because I feel even worse with the consumption of any type of related medication.
I have now developed vitiligo which is becoming increasingly aggressive in its progress. I am also recently experiencing pain and stiffness in ALL my joints and muscle the cause of which is yet to be diagnosed, but my osteopath believes it is an autoimmune condition.
I’m so sorry that you are experiencing pain and stiffness in all of your joints and muscles. It’s very possible that this is also related to an autoimmune condition. Autoimmunity is complex, but hopefully your osteopath is trying to get to the underlying cause of your condition.
Hello, I have antibodies for Grave’s and Hashimomoto’s. I also have scalp issues but have never had any tests for that since the thyroid stuff was quite enough to deal with. My trigger is mainly stress but also sugar and caffeine. I have cut out gluten and eat less dairy. Also getting exercise helps a lot.
Gabi, thank you for sharing your experience with everyone. Stress is of course a common trigger, and I’m glad that you avoid gluten and minimize your consumption of dairy. If you haven’t yet tried following a strict autoimmune Paleo diet then this is something you might want to consider, although keep in mind that there can be triggers other than food and stress.
Does anyone have Grave’s and MS?
Hi Julie,
I had Graves and my daughter who 34, was diagnosed with MS last year. My Aunt had MS on my Mother’s side and my sister had Graves also. Seems like these two things are in the same family. I also know of other people in the same situation, Mother Graves and son MS,
Susan
I had Graves’ disease over nine years ago and had ablation not long after diagnosis. It was my chiropractor who enlightened me about diet telling me that I should never eat grains or legumes, dairy is also out if it comes from cows. Before my thyroid condition I experienced neuropathy in my feet and finally in my left hand when I was getting ablation treatment. I have read that peripheral neuropathy can be an autoimmune condition. I also suffer with multiple chemical sensitivities and have a genetic disposition autoimmune conditions. Excercise and eating real food is my biggest help and trying to avoid stress.
Susan, peripheral neuropathy itself isn’t necessarily an autoimmune condition, although it can be a symptoms of numerous autoimmune conditions. And of course non-autoimmune conditions can also cause peripheral neuropathy (i.e. Lyme disease). Keep up the good work with your diet, and stress management is always a work in progress.
Hi.
I have hyperthyroidism, graves disease and vitiligo and had thyroid eye disease. I seem to be restoring my health quite well now that I no longer eat gluten and very little added sugar, basically my diet is as natural as I can get it. Oh and I think I have celiac disease as I notice a major difference in my healthy and gut health since cutting out all GLUTEN around a year ago.
Dianne, I’m so glad to hear that changing your diet has done wonders for your health! Based on what you said in your comment I would recommend avoiding gluten permanently, which it sounds like you’re on board with since you have been avoiding it for approximately one year.
I died in the ER for 24 minutes followed by a long coma, kidney failure, dialysis multiple organs failed, pneumonia, shock, 11 bags of blood, and was told that I would likely die within a year. That was 2011.
Several diagnoses later, the current ones still include allergies, iron deficiency anemia, vitiligo, pernicious anemia, hypoglycemia, Hashimotos thyroid, LADA, stiff person syndrome, Lupus, and eventually Lyme disease with bartonella and Babesia.
Going back for physical with 231=glucose, 119 Alkaline Phosphatase, 205 cholesterol total, LDL 123, A1c 10.2, TSH 8.5, TPO 91. All other numbers normal.
Hoping to avoid more medication and miscellaneous things prescribed, I prefer natural approach and have made it this far. Any suggestions?
That’s some story…I’m glad you’re still with us! As for suggestions, with a hemoglobin A1C of 10.2 and blood glucose of 231 I of course would start with eating a healthy diet, cutting out the sugars, limiting the carbs, etc. Keep in mind that inflammation is a big factor with insulin resistance, and so if you clean up your diet and your blood sugar remains high this is something to consider. I wrote a blog post on this topic:
https://www.naturalendocrinesolutions.com/archives/insulin-resistance-hypoglycemia-thyroid-health-part-1/
I was diagnosed with Graves disease when I was 17 years old. I took antirhyroid medication (ptu) for 7 years, (had bad reaction to beta blocker propanlol, i had to suffer through it for years trying to find the right disage of medication. Even took radioactive iodide and did nany scans) when I was pregnant it went into remission. 2 weeks after having my daughter they told me my levels looked good and to come back in a year. 2months later I felt so sluggish and out of it. I was told I had developed hashimotos disease and peroxidase was 709.2. Since then I have been taking 100mcg of levothyroxine for 14 years now and recently I had to bring the dose down to 88mcg because I was becoming overactive from too much hormone, and i felt really terrible, sweaty, palpitations, tired,thirsty and I knew something was wrong. This has never happened before and my doctor is sure this can’t cure itself and that my thyroid is dead, shriveled, and can never be taken out because of that.
I want to say having experienced both diseases I would have to say the graves disease is horrible I would not wish it on my worst enemy ever. Is there any cases of someone’s thyroid coming back to life? Can an autoimmune disease correct itself once triggered; so long later?
Thanks for the great information. Some of this I never heard about before and it really gives insight to my disease. Also it shows that research and time has been put into studying this disease. Not too long ago in the past it was under-researched and under funded. (A thanks to George and Barabra Bush.) .
Hope, sometimes the autoimmune component will “calm down” on its own, but if the cause hasn’t been addressed it’s very likely to flare up again in the future. As for whether someone’s thyroid health can be restored after receiving RAI, it is possible in some cases. Here is an article I’ve written on this topic:
https://www.naturalendocrinesolutions.com/archives/can-your-thyroid-health-be-restored-after-receiving-radioactive-iodine-treatment/
I was recently diagnosed with Graves disease after suffering the loss of my husband. Prior to that I was diagnosed with uranium poisoning (it was in my well water) and have Behcet’s disease (a rare auto-immune disorder) which began when I was about 12 but wasn’t diagnosed until I was 27 and completely miserable. I haven’t had much luck with anti-thyroid medications and really don’t know who to turn to because my endocrinologist has told me she can’t help with anything but Graves disease (and she is doing a terrible job in my opinion). I was extremely disappointed to find out that it was common to have more than one auto immune disorder as Behcet’s disease is really difficult to manage let alone Graves disease in addition to it. Starting work on my diet again after already eating fairly clean is tough!
Wendy, I am so sorry for the loss of your husband, and I’m also sorry that your endocrinologist hasn’t been too supportive (although unfortunately this is quite common). I’m glad to hear that you’re starting to work on your diet again, as this is a great place to start. If improving your diet doesn’t help much I definitely would recommend working with a natural healthcare practitioner to help identify some of your triggers and other underlying imbalances.
I was diagnosed with Graves Disease about 10 years ago. I was put on Methemazole and later went into a mild on and off remission. This year I was diagnosed with Hashimotos. Both have been very difficult to deal with. Before I was diagnosed, it almost cost me my marriage (due to the intence mood swings). The doctor did what I think was called a reverse t3 uptake test and found that now I have to take a T3/T4 combo to help with absorption of t3 and improved energy. This week I’ve received information from a DNA sample that shows I have a genetic trace for Celiac. I have been trying low carb and intermittent fasting since September of this year. I’ve lost 14 lbs and I’m hoping this way of eating helps my body to heal. I’m so over being sick and tired.