Graves� disease following hypothyroidism due to Hashimoto�s thyroiditis in a black South African lady: a case report

Ekpebegh, Chukwuma; Elmezughi, Khaled; Mtingi, Lungiswa

doi:10.11604/pamj.2019.32.186.18713

Cited by 9 publications

(8 citation statements)

References 15 publications

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“…Ultrasound examination after the relapse of Basedow's disease revealed that the thyroid gland was not very hypervascular compared to that at the onset of the disease Hashimoto's disease rather than Basedow's disease [9,10]. There are a few reports showing the transformation of Hashimoto's thyroiditis to Basedow's disease [11][12][13][14][15], but in many of these reports such arguments are based on clinical and laboratory features.…”

Section: Discussionmentioning

confidence: 99%

“…The onset of Basedow’s disease or Hashimoto’s thyroiditis are influenced by balance of Th1/Th2 cytokines and it seems that increase of the Th1/Th2 cell ratio induces Hashimoto’s disease rather than Basedow’s disease [ 9 , 10 ]. There are a few reports showing the transformation of Hashimoto’s thyroiditis to Basedow’s disease [ 11 – 15 ], but in many of these reports such arguments are based on clinical and laboratory features.…”

Section: Discussionmentioning

confidence: 99%

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Basedow’s disease with associated features of Hashimoto’s thyroiditis based on histopathological findings

et al. 2020

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Background: Basedow's disease and Hashimoto's thyroiditis are autoimmune thyroid disorders and usually diagnosed with elevation of serum autoimmune antibodies. Thyrotropin receptor antibodies (TRAb) and/or thyroidstimulating antibody (TSAb) are usually used for diagnosis of Basedow's disease, and thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb) are for diagnosis of Hashimoto's thyroiditis. However, it is difficult to diagnose a subject as Basedow's disease with associated features of Hashimoto's thyroiditis only with elevation of such autoimmune antibodies. Case presentation: A 44-year-old woman with 5-year history of Basedow's disease underwent a total thyroidectomy. She did not have a goiter. TRAb, TSAb, TPOAg and TgAb were all positive before a total thyroidectomy. In histopathological macroscopic examination, diffuse hyperplasia of the thyroid gland was observed. Furthermore, in histopathological microscopic examination, both characteristics of Basedow's disease and Hashimoto's thyroiditis were observed. After a total thyroidectomy, titers of all thyroid-associated autoimmune antibodies were markedly reduced. Conclusion: Herein, we report a subject with Basedow's disease without a goiter whose TPOAb and TgAb were relatively high at the onset of Basedow's disease. In addition, interestingly, the histopathological findings of this subject showed direct signs of Basedow's disease and Hashimoto's thyroiditis in the same thyroid gland. Considering from such findings, she seemed to have Basedow's disease with associated features of Hashimoto's thyroiditis. In conclusion, we should bear in mind the possibility of Basedow's disease with associated features of Hashimoto's thyroiditis in subjects with Basedow's disease, particularly when TPOAb and TgAb as well as TRAb and TSAb are positive.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Basedow’s disease with associated features of Hashimoto’s thyroiditis based on histopathological findings

et al. 2020

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“…Although the conversion of HT to GD is a rare phenomenon and its mechanism is still unclear, a few cases were reported in the medical literature. Table 1 provides a summary of some cases (2,4,(12)(13)(14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Switching of Hashimoto Thyroiditis Into Graves’ Disease: A Case Report and Literature Review

Maksoud

Wannous

et al. 2021

Dis Diagn

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Background: Hashimoto thyroiditis (HT) and Graves’ disease (GD) are autoimmune inflammatory thyroid disorders. The evolution from GD into HT is the most common scenario while the conversion from HT into GD seems to be less common. Case Presentation: A 20-year-old female patient referred to the endocrinology clinic with a three-month history of fatigue, lethargy, lack of appetite, constipation, menorrhagia, cold intolerance, and 5 kg weight gain in the last two months. Clinical examination showed dry skin, scalp hair loss, and painless hard goiter whereas thyroid ultrasound revealed generalized homogeneous hypoechoic thyroid hypertrophy. Laboratory tests demonstrated increased serum thyroid-stimulating hormone (TSH) 210 µIU/L (normal: 0.25-4.50), decreased free thyroxine (FT4) 0.37 ng/L (normal: 0.8-1.8) and free triiodothyronine (FT3) 1.94 pg/mL (normal: 1.8-4.6), and finally, increased thyroid peroxidase antibodies (anti-TPO) 462 IU/mL (normal: up to 34). Based on observations, HT was diagnosed and thus daily treatment with levothyroxine 75 mcg was started for the patient. Two months later, she referred with symptoms suggestive of hyperthyroidism with reduced TSH levels, which did not improve after levothyroxine cessation, thus more laboratory tests were conducted and revealed decreased TSH levels, increased T3 and T4, and TSH receptor stimulating antibody (TSAb)levels, and increased radioactive iodine uptake at 24 hours. Therefore, the diagnosis of GD was made. Five weeks after treatment, she was in full remission. Conclusion: Although the switch from HT into GD is rare, it can occur at any time during the disease. Nonetheless, early diagnosis and treatment would improve the quality of care.

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“…TBAbs rarely cause hypothyroidism by blocking the TSH receptor, although the most common cause of hypothyroidism is Hashimoto's disease due to autoimmune-mediated destruction of the thyroid gland. 8,9 While the causes of conversion of hypothyroidism to hyperthyroidism are not well understood, different theories have been suggested. One possible mechanism is a change in the balance between the activities of TBAbs and TSAbs due to an environmental trigger, such as an infection or neck irradiation, in a genetically susceptible individual, which may alter the clinical presentation.…”

Section: Answermentioning

confidence: 99%

“…5,8,10 Some studies have suggested that switching between blocking and stimulating antibodies occurs in rare cases after using antithyroid drugs for Graves' disease or levothyroxine for hypothyroidism. 8,9 TBAb-induced hypothyroidism and Graves' disease (TSAb-induced) may be two aspects of one condition. 5 Based on the above, the patient might have had TBAb-induced hypothyroidism that then converted to Graves' disease once TSAb became predominant.…”

Section: Answermentioning

confidence: 99%

Development of hyperthyroidism in a hypothyroid patient

Parvazinia¹

2022

Aust J Gen Pract

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Graves� disease following hypothyroidism due to Hashimoto�s thyroiditis in a black South African lady: a case report

Cited by 9 publications

References 15 publications

Basedow’s disease with associated features of Hashimoto’s thyroiditis based on histopathological findings

Basedow’s disease with associated features of Hashimoto’s thyroiditis based on histopathological findings

Switching of Hashimoto Thyroiditis Into Graves’ Disease: A Case Report and Literature Review

Development of hyperthyroidism in a hypothyroid patient

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