Graves’ Disease Occurring After Hyperparathyroidism and Subacute Thyroiditis

Renedo, María F.

doi:10.4158/ep.10.6.509

Cited by 6 publications

(7 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With regard to demographics, 26 of the 31 reported cases (84%) were women over the age of 40 years, similar to what has been seen in cases in which GD or SAT occurs alone. [1][2][3][4][5][6][7][8][9]11,[13][14][15] Race was not documented in all the cases, but reports originated from many different countries. We did not find documentation of the Chinese race in any of the reported cases or any reports originating from China.…”

Section: Discussionmentioning

confidence: 99%

“…We identified 14 publications reporting 31 cases of GD after SAT ( Table ). 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 Demographics, features used to diagnose SAT and GD, including antibody status, and genetic test results were compared. The criteria for SAT, including tender goiter and either elevated ESR and/or low RAIU, were documented in 29 of 31 cases (93.5%) 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ; histologic findings of SAT were reported in 4 of the 31 cases (13%).…”

Section: Discussionmentioning

confidence: 99%

“… 1 Graves disease (GD) after SAT is rare, with only approximately 31 cases described in the literature, and has been reported to occur in <1% of patients presenting with GD or SAT in a Japanese study. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 Thyroid antigen release in patients with SAT is thought to trigger thyroid autoimmunity and GD. 2 Certain human leukocyte antigen (HLA) genes are associated with susceptibility to either GD or SAT alone, but there are inadequate data regarding associations between specific HLA alleles and the risk of GD after SAT.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Graves Disease Following Subacute Thyroiditis in a Chinese Man

Al-Bacha¹,

Lahiri²

2022

AACE Clinical Case Reports

View full text Add to dashboard Cite

Background/Objective: The development of Graves disease (GD) after subacute thyroiditis (SAT) is rare, with approximately 31 reported cases, of which only 5 occurred in men. We describe a case of GD diagnosed based on newly elevated thyroid-stimulating immunoglobulin (TSI) and thyroid-stimulating hormone (TSH) receptor autoantibody (TRAb) levels after SAT. Case Report: A 32-year-old Chinese man presented with right anterior neck pain, swelling, sore throat, cough, and fever. He had a diffuse tender goiter but no proptosis, lid lag, or stare. His TSH level was 0.03 mIU/mL (normal range [NR] 0.45-5.33 mIU/mL), serum free thyroxine (FT4) level was 2.40 ng/dL (NR 0.61-1.44 ng/dL), total triiodothyronine (TT3) level was 113 ng/dL (NR 87-178 ng/dL), TSI level was <0.10 IU/L (NR < 0.10 IU/L), and erythrocyte sedimentation rate was 21 mm/h (NR < 15 mm/h). After 7 weeks of prednisone, the symptoms resolved, FT4 level was 0.95 ng/dL, and TT3 level was 91 ng/dL. At 11 weeks after SAT onset, the TSH level was <0.01 mIU/mL, TT3 level was 257 ng/dL, FT4 level was 3.03 ng/dL, TSI level was 1.94 IU/L, then 3.42 IU/L 2 weeks later, TRAb level was 8.72 IU/L (NR < 2 IU/L), and erythrocyte sedimentation rate was 4 mm/h. After 1 month of methimazole, the FT4 level was 1.32 ng/dL and TT3 level was 110 ng/dL. Genetic testing revealed human leukocyte antigen-B35 and DRB1*15:01 positivity. Discussion: GD after SAT is thought to be due to the activation of thyroid autoimmunity induced by SAT in genetically susceptible individuals. Conclusions: This case illustrates the induction of thyroid autoimmunity after SAT, resulting in GD, supporting TSI and/or TRAb testing if hyperthyroidism recurs. The presence of HLA alleles associated with SAT and GD suggests a genetic contribution to the development of thyroid autoimmunity.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Graves Disease Following Subacute Thyroiditis in a Chinese Man

Al-Bacha¹,

Lahiri²

2022

AACE Clinical Case Reports

View full text Add to dashboard Cite

show abstract

“…Cases of synchronous thyroid pathology have been observed in patients presenting with primary hyperparathyroidism (PHPT), suggesting the importance of preoperative evaluation of thyroid gland [1,2]. We have previously reported the coexistence of thyroiditis and thyroid nodules with parathyroid disorders [4,5] and the development of PHPT after radioactive iodine-131 (RAI) treatment for Graves' hyperthyroidism [6,7]. Wahl et al [8] found that the prevalence of PHPT was about 1% among 5450 patients referred for thyroid surgery, which can create a challenge in the clinical decision making and management of these patients.…”

Section: Introductionmentioning

confidence: 99%

Hypercalcemia Caused By Concomitant Graves g Disease and Primary Hyperparathyroidism

Wang

2018

JETR

Self Cite

View full text Add to dashboard Cite

Here, we present the clinical course, laboratory results and management and review pertinent literature for a rare case of concomitant Graves' disease and primary hyperparathyroidism associated with hypercalcemia. A 71 years old African American woman presented with generalized fatigue, polyuria, polydipsia, and poor appetite for a few weeks. On admission, laboratory values showed serum calcium level of 12.3mg/dL, albumin of 3.6g/dL, iPTH of 37pg/mL, PTH related peptide of 0.2pmol/L, 25(OH) vitamin D of 65ng/mL, TSH of 0.01uIU/mL, and free T4 of 7.1ng/dL. I-123 uptake and scan of the thyroid showed 44% homogeneous uptake at 24 hours. The patient was initially diagnosed with hypercalcemia related to hyperthyroidism. She received intravenous hydration and was treated with 25.9mCi of I-131 2 months later. The serum calcium remained 10.4-10.7mg/ dL (range, 8.6-10.4mg/dL) after freeT4 normalized to 1.58ng/dL. Repeat labs revealed serum ionized calcium of 5.9mg/dL, iPTH of 65pg/mL and 24-hour urinary calcium of 166.4mg, which is consistent with primary hyperparathyroidism. Hypercalcemia in Graves' hyperthyroidism should warrant a thorough investigation for concomitant primary hyperparathyroidism.

show abstract

“…However, we encountered 7 patients with Graves' disease following subacute thyroiditis. In the literature, 26 patients with Graves' disease following subacute thyroiditis have been reported (Sheets 1955;Perloff 1956;Werner 1979;Wartofsky and Shaaf 1987;Fukata et al 1992;Bartalena et al 1996;Bennedbeak et al 1996;Grunenberger et al 1998;Iitaka et al 1998Iitaka et al , 2001Wang and Renedo 2004). The diagnosis of Graves' disease in such patients is always difficult because of atypical signs and symptoms and an unclear onset time.…”

mentioning

confidence: 99%