Incidence of Postradioiodine Immunogenic Hyperthyroidism/Graves' Disease in Relation to a Temporary Increase in Thyrotropin Receptor Antibodies After Radioiodine Therapy for Autonomous Thyroid Disease

Abstract

There is an estimated 1.1% risk of developing postradioiodine immunogenic hyperthyroidism/Graves' disease in patients undergoing radioiodine therapy for autonomous thyroid disease and this increases approximately 10-fold when TPO antibody levels are elevated before radioiodine therapy. Furthermore, there is an estimated 1.3% risk of a temporary increase of TSH receptor antibodies after radioiodine therapy for autonomous thyroid disease without development of clinically overt hyperthyroidism.

Marine-Lenhart syndrome in two adolescents, including one with thyroid cancer: a case series and review of the literature

“…She was later given suppressive doses of T3, which in turn decreased Tc-99 m nodular uptake, thereby confirming the nodular TSH dependence of Marine-Lenhart syndrome. The other frequently described Marine-Lenhart variant comprises patients with autonomous functioning thyroid nodules who were initially treated with RAI and eventually went on to develop GD [12][13][14].…”

An uncommon case of Marine-Lenhart syndrome

“…There is literature on the risk that Graves-like hyperthyroidism may develop after radioiodine treatment in patients with elevated serum TPO-Ab levels at baseline (15,16), as well as in TPOAb-negative patients at baseline who became TPOAb-positive after treatment (17,18). Therefore, it could be hypothesized that, in a subject genetically susceptible to thyroid autoimmunity, follicular cell damage caused by radioiodine could trigger an autoimmune response against TSH receptors, thus explaining the occurrence of Graves' disease after radioiodine therapy (15)(16)(17)(18). Unlike most cases reported in the literature, our particular case of Marine-Lenhart syndrome shows the appearance of an AFTN as a consequence of Graves' disease treatment with radioiodine.…”

“…Since the first description in 1911 by Marine and Lenhart (3), the presence of focal autonomy in patients with Graves' disease has been reported by numerous authors, and with different presentations (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), with an overall prevalence of such association ranging from 2.7% to 4.1% (4). Moreover, during the last years, several papers have been published on the development of Graves' disease shortly after radioiodine therapy for AFTNs (15)(16)(17)(18). The incidence of this event is significantly higher, especially in patients with elevated serum thyroid peroxidase antibodies (TPO-Ab) levels at baseline (15,16), as well as in patients TPOAb-negative at baseline who became TPOAb-positive after treatment (17,18).…”

“…Moreover, during the last years, several papers have been published on the development of Graves' disease shortly after radioiodine therapy for AFTNs (15)(16)(17)(18). The incidence of this event is significantly higher, especially in patients with elevated serum thyroid peroxidase antibodies (TPO-Ab) levels at baseline (15,16), as well as in patients TPOAb-negative at baseline who became TPOAb-positive after treatment (17,18).…”

“…Thus, our patient developed an AFTN three years after the onset of hyperthyroidism due to Graves' disease that was successfully treated with radioiodine. Looking at the pertinent literature (15)(16)(17)(18), we present our case as a variant of classic Marine--Lenhart syndrome. When the "hot" nodule was discovered, there was no diffuse increase in radiotracer uptake by the gland and TRAb were negative, because hyperthyroidism due to Graves' disease -diagnosed three years before -was successfully cured by radioiodine.…”