Autoimmune Polyglandular Syndromes (Types I, II and III)

What is Autoimmune Polyglandular Syndromes?

Autoimmune polyglandular syndromes are clusters of two or more autoimmune endocrine diseases in the same person.^[1] They are divided into types I, II and III, and they need lifelong medical care from an endocrinologist, often with other specialists.^[2]

Common symptoms

Symptoms depend on which glands are affected. Type I classically combines low parathyroid function, adrenal failure (Addison's disease) and chronic yeast infection of the skin and mucous membranes.^{[2, 3]} Addison's disease can cause fatigue, weakness and a vague illness that is often diagnosed late, sometimes only when an adrenal crisis occurs.^[4]

Type II is defined by Addison's disease, autoimmune thyroid disease and type 1 diabetes in varying combinations.^[1] Type III usually describes autoimmune thyroid disease together with another autoimmune condition, without adrenal failure. Hashimoto's thyroiditis, the most common cause of an underactive thyroid in developed countries, can occur alone or as part of a polyglandular syndrome.^[5]

Causes and risk factors

Type I is caused by mutations in the AIRE gene and is inherited in a recessive pattern. It usually shows itself in childhood.^{[2, 3]} Type II has polygenic inheritance, meaning many genes contribute.^[1] Type III is less sharply defined, and its exact causes are not fully worked out.

Women are affected more often by autoimmune thyroid disease.^[5]

How it is diagnosed and treated conventionally

Type I is supported by blood antibodies or confirmed by finding AIRE gene mutations.^[2] Types II and III are diagnosed from the gland problems themselves, using hormone levels and antibody tests. Because these conditions tend to appear over time, your physicians may keep watching for new ones.

Treatment replaces the hormone each failing gland no longer makes, such as cortisol for the adrenals, thyroid hormone for the thyroid and insulin in type 1 diabetes. It also treats infections or other conditions as they arise. Even with steroid replacement, people with Addison's disease have more illness and a lower quality of life than average.^[4]

Why Autoimmune Polyglandular Syndromes calls for a whole-person approach

These syndromes affect several organs at once, so no single specialist sees the whole picture. Management takes teamwork across specialties.^[2]

Many people have symptoms that persist even when blood tests are in range. Addressing everyday factors such as fatigue, stress, sleep and pain can matter to quality of life, as long as the hormone care stays in the hands of your physicians.

Fatigue and persistent symptoms

Some people with Hashimoto's thyroiditis continue to feel unwell despite normal thyroid blood tests, and researchers are still working out why.^[6] Replacement therapy for adrenal failure cannot fully copy the body's natural cortisol rhythm.^[4]

Stress and adrenal crisis risk

Adrenal crises can be triggered by illness or stress, and behavioral and social factors play a part.^[4] Stress management therefore matters, but any stress plan must include your physician's sick-day rules for steroid doses.

Several conditions at once

Each added condition brings its own symptoms and medicines. Keeping track of how they interact is part of care, and a complete medicine and supplement list is the first step in that.

Acupuncture as supportive care in Autoimmune Polyglandular Syndromes

What the research shows

No clinical trials of acupuncture for the polyglandular syndromes themselves turned up in a PubMed search. Acupuncture cannot replace hormones or change the autoimmune process.

A narrative review of 29 clinical studies (1,757 patients) found reduced symptoms and improved biomarkers when acupuncture was used for thyroid disorders, but the authors said better-designed research is needed.^[7] Reviews of this kind are not strong evidence, so the finding is preliminary.

For fatigue, a meta-analysis of 16 trials in chronic fatigue syndrome (1,346 participants) found acupuncture helped more than sham acupuncture in four trials and more than other treatments, but the evidence was low certainty, most studies were of low quality, and the authors reached no firm conclusion.^[8] An overview of 51 reviews in cancer-related conditions reported benefit for fatigue, insomnia and pain, but nearly all of the reviews were rated low or very low quality.^[9] Neither addresses endocrine disease, so the results may not apply.

How acupuncture may work

No studies explain how acupuncture might affect these syndromes. We do not claim it acts on the immune system or on gland function in this setting.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. A course of several visits is followed by reassessment. Our aim would be comfort, energy and sleep, not changes to hormone levels.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker. Also tell us about low blood sugar episodes, recent illness or any sign of adrenal crisis.

Ayurvedic medicine as supportive care in Autoimmune Polyglandular Syndromes

The Ayurvedic view

Ayurveda has no single classical name for these syndromes. Practitioners may describe the affected glands in terms of the doshas, agni (digestive and metabolic fire) and ojas (vitality). For example, an underactive thyroid is sometimes discussed as a Kapha pattern. These are traditional frameworks, not medical diagnoses.

Therapies that may be used

Care is individualized and traditionally includes:

• Diet and daily routine, such as regular meals and steady sleep hours, coordinated with any diabetes or low-sodium plan from your physician
• Gentle oil massage and relaxation practices for stress
• Herbs prescribed individually by a qualified practitioner
• Yoga and breathing practices, adjusted to your energy and blood pressure

Panchakarma is a traditional set of cleansing procedures. It is not appropriate during pregnancy, acute illness or frailty, and it is not suitable for people with adrenal insufficiency, unstable diabetes or low calcium unless your endocrinologist agrees. Fasting or purging can be dangerous for these conditions.

What the research shows

No clinical trials of Ayurvedic treatment for the polyglandular syndromes were found, so the evidence for the disease is none.

Evidence exists for symptoms. A meta-analysis of 12 trials found ashwagandha reduced anxiety and stress compared with placebo, though the certainty was low.^[11] A meta-analysis of five trials found a small improvement in sleep, with limited safety data.^[12] One small placebo-controlled trial of 50 people with subclinical hypothyroidism reported improved thyroid blood tests after 8 weeks of ashwagandha, but it was a single-center pilot study.^[13] A clinical review concluded that ashwagandha has little to no evidence of an effect on thyroid disorders.^[14] Ashwagandha may change thyroid hormone levels, so it is a herb that needs your endocrinologist's input first.^{[13, 15]}

Herbal medicine as supportive care in Autoimmune Polyglandular Syndromes

Herbs and formulas that have been studied

No herbal formulas have been tested in the polyglandular syndromes. The closest research is on Hashimoto's thyroiditis, where Chinese herbal formulas such as Yiqi Huayu Recipe, Liqi Xiaoying decoction and Shugan Sanjie therapy have been compared in trials.^[16]

What the research shows

A network meta-analysis of 16 trials found that Chinese herbal formulas lowered thyroid antibody levels and improved traditional symptom scores in Hashimoto's thyroiditis without affecting thyroid function, with no serious adverse events reported. The authors called the findings preliminary and said better evidence is needed.^[16] Lower antibody levels have not been shown to change long-term outcomes.

A review of persistent symptoms in Hashimoto's thyroiditis notes that emerging evidence suggests herbal medicine and acupuncture may help as complementary strategies, but that high-quality studies are needed.^[6] None of this covers adrenal failure, type 1 diabetes or type I syndrome.

Safety and herb-drug interactions

Herbs can interact with the hormone and diabetes medicines these conditions require, and a review of herb-drug interactions found serious consequences can occur.^[17] Herbs that affect thyroid function, blood sugar, blood pressure or fluid balance are of particular concern, so each one must be reviewed against your medicine list.^[15] Never use herbs in place of your hormone replacement, and make sure your physician knows about any you take.

Herbal and dietary supplements account for about 20% of cases of drug-related liver injury in the United States.^[18] About one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic, so products must come from tested sources.^[19] Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

This section is interpretation, not equivalence. Chinese medicine may describe fatigue and weakness in these conditions as deficiency of qi or of kidney and spleen function. Ayurveda may describe it as depleted ojas or weak agni. Researchers studying symptoms in endocrine disease look at things that loosely parallel these ideas, including cortisol rhythm, thyroid hormone balance and the stress response.^{[4, 6]}

The biological process in these syndromes is autoimmune destruction of glands.^[1] No study shows that a TCM pattern or a dosha corresponds to that process.

How this care fits with your medical care

Supportive care here sits alongside your endocrinologist's treatment. Never stop, lower or skip hormone replacement, steroids, insulin or any other prescribed medicine on your own, because doing so can be dangerous. We do not diagnose or manage these syndromes, adjust medicines, or replace your physicians.

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Please bring your diagnosis, a full list of medicines and supplements, your steroid sick-day plan, and recent blood test results.

When to seek urgent medical care

Adrenal failure and very low calcium can become emergencies, and an adrenal crisis can develop in people with Addison's disease.^[4]

• Severe weakness, dizziness or fainting, especially with vomiting or diarrhea
• Severe abdominal pain, confusion or drowsiness
• Muscle cramps, tingling around the mouth or seizures
• Extreme thirst, frequent urination or fruity-smelling breath in someone with diabetes
• Fever or serious illness while taking steroid replacement, or being unable to keep medicine down

If you have any of these, call 911 or go to the nearest emergency department.