Not a Grave Finding: Thymic Hyperplasia in the Setting of Graves’ Disease

Abstract

A 30-year-old Caucasian male with no previous medical history presented to the emergency department with sudden onset chest pain brought on by exertion at work. He had never experienced similar episodes before, and chest pain was described as severe, mid-sternal, non-radiating, and was associated with palpitations, dyspnea, and near-syncope. Patient also reported unintentional weight loss of 40 pounds over the 3 months leading up to presentation. Review of systems was positive for diaphoresis, increased anxiety, heat intolerance, and a mild hand tremor for several weeks. He denied cough, changes in vision or voice, nausea, vomiting, diarrhea, constipation, or abdominal pain. He reported no history of tobacco or illicit drug use and no family history of thyroid disease or autoimmune conditions. Assessment On examination, the patient was hypertensive (167/94 mm Hg), tachycardic (107 beats per minute), tachypneic (22 breaths per minute) with normal oxygen saturation (98%) on room air, and afebrile. Salient examination features included mild thyromegaly, resting fine tremor in outstretched hands, and symmetric hyperreflexia. No proptosis, cardiac, or pulmonary abnormalities were noted.

Graves' Disease with Thymic Hyperplasia: The Response of the Thyroid Function, Thyrotropin Receptor Autoantibody, and Thymic Size to Thiamazole Treatment

“…Normalization of the thyroid function in Graves' disease reportedly reduces the thymic size ( 3 ), suggesting that thymic resection may be unnecessary in Graves' disease with thymic hyperplasia ( 4 ). Although there are some reports documenting changes in the thymic size and thyroid function ( 5 , 6 ), differences following thiamazole treatment compared with pre-treatment are mainly described.…”