PMID- 22136271
OWN - NLM
STAT- MEDLINE
DCOM- 20120403
LR  - 20161125
IS  - 1557-9077 (Electronic)
IS  - 1050-7256 (Linking)
VI  - 21
IP  - 12
DP  - 2011 Dec
TI  - Simultaneous occurrence of subacute thyroiditis and Graves' disease.
PG  - 1397-400
LID - 10.1089/thy.2011.0254 [doi]
AB  - BACKGROUND: Rare cases of Graves' disease occurring years after subacute 
      thyroiditis (SAT) have been reported. Here, we present the first known case of 
      simultaneous occurrence of Graves' disease and SAT. PATIENT FINDINGS: A 
      41-year-old woman presented with 10 days of neck pain, dysphagia, and 
      hyperthyroid symptoms. Neck pain had initially started at the base of the right 
      anterior neck and gradually spread to her upper chest, the left side of her neck, 
      and bilateral ears. Physical examination revealed a heart rate of 110 
      beats/minute and a diffusely enlarged tender thyroid gland without evidence of 
      orbitopathy. There was a resting tremor of the fingers and brisk deep tendon 
      reflexes. Laboratory values: thyrotropin<0.01 mcIU/mL (nL 0.39-5.33), free 
      thyroxine 2.0 ng/dL (nL 0.59-1.60), free T3 6.6 pg/mL (nL 2.3-4.2), thyroglobulin 
      20.1 ng/mL (nL 2.0-35.0), thyroglobulin antibody 843 IU/mL (nL 0-80), 
      thyroperoxidase antibody 130 IU/mL (nL 0-29), thyroid stimulating hormone 
      receptor antibody 22.90 IU/L (nL<1.22), thyroid stimulating immunoglobulins 299 
      units (nL<140), erythrocyte sedimentation rate 120 mm/h (nL 0-20), and C-reactive 
      protein 1.117 mg/dL (nL 0-0.5). Human leukocyte antigen (HLA) typing revealed 
      DRB1, DR8, B35, B39, DQB1, DQ4, and DQ5. A thyroid ultrasound showed an enlarged 
      heterogeneous gland with mild hypervascularity. Fine-needle aspiration (FNA) 
      biopsies of both thyroid lobes revealed granulomatous thyroiditis. The thyroid 
      scan showed a diffusely enlarged gland and heterogeneous trapping. There was a 
      focal area of relatively increased radiotracer accumulation in the right upper 
      pole. The 5-hour uptake ((123)I) was 6.6% (nL 4-15). The patient was 
      symptomatically treated. Over the next several weeks, she developed 
      hypothyroidism requiring levothyroxine treatment. SUMMARY: This case illustrates 
      a rare simultaneous occurrence of Graves' disease and SAT. Previous case studies 
      have shown that Graves' disease may develop months to years after an episode of 
      SAT. A strong family history of autoimmune thyroid disorders was noted in this 
      patient. Genetic predilection was also shown by HLA typing. CONCLUSION: Although 
      the occurrence of SAT with Graves' disease may be coincidental, SAT-induced 
      autoimmune alteration may promote the development of Graves' disease in 
      susceptible patients. Genetically mediated mechanisms, as seen in this patient by 
      HLA typing and a strong family history, may also be involved.
FAU - Hoang, Thanh D
AU  - Hoang TD
AD  - Department of Endocrinology, National Naval Medical Center, Bethesda, Maryland 
      20889-5600, USA.
FAU - Mai, Vinh Q
AU  - Mai VQ
FAU - Clyde, Patrick W
AU  - Clyde PW
FAU - Shakir, Mohamed K M
AU  - Shakir MK
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - Thyroid
JT  - Thyroid : official journal of the American Thyroid Association
JID - 9104317
RN  - 0 (Biomarkers)
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Adult
MH  - Biomarkers/blood
MH  - Biopsy, Fine-Needle
MH  - Female
MH  - Genetic Predisposition to Disease
MH  - Graves Disease/*complications/diagnosis/genetics/immunology/therapy
MH  - HLA Antigens/genetics/immunology
MH  - Humans
MH  - Pedigree
MH  - Phenotype
MH  - Predictive Value of Tests
MH  - Radionuclide Imaging
MH  - Thyroid Gland/diagnostic imaging/*immunology/pathology
MH  - Thyroiditis, Subacute/*complications/diagnosis/genetics/immunology/therapy
MH  - Treatment Outcome
MH  - Ultrasonography, Doppler, Color
EDAT- 2011/12/06 06:00
MHDA- 2012/04/04 06:00
CRDT- 2011/12/06 06:00
PHST- 2011/12/06 06:00 [entrez]
PHST- 2011/12/06 06:00 [pubmed]
PHST- 2012/04/04 06:00 [medline]
AID - 10.1089/thy.2011.0254 [doi]
PST - ppublish
SO  - Thyroid. 2011 Dec;21(12):1397-400. doi: 10.1089/thy.2011.0254.