Postparathyroidectomy transient thyrotoxicosis.

Abstract

Three patients are described who had spontaneously resolving transient thyrotoxicosis after resection of a parathyroid adenoma without thyroidectomy or an apparent thyroid abnormality before or during surgery. All had documented thyrotoxicosis that developed within 2 weeks after surgery, which was clinically symptomatic in two of three patients. The thyrotoxicosis was associated with subnormal radioactive iodine thyroid uptake when performed in the two symptomatic patients and was consistent with a postsurgical inflammatory etiology secondary to thyroid gland trauma during parathyroidectomy. In all patients, the clinical and biochemical evidence of thyrotoxicosis resolved within 2 months. Antithyroglobulin and antimicrosomal antibodies were not detected in the two patients who had a complete recovery 3 months after surgery. However, in the patient who had autoimmune thyroiditis, hyperthyroidism due to Graves' disease subsequently developed 19 months after parathyroidectomy and was associated with increasing titers of antithyroglobulin and antimicrosomal thyroidal autoantibodies. From these observations, we conclude that 1) spontaneously resolving transient thyrotoxicosis of varying severity may occur in some patients after parathyroidectomy, which could be secondary to intraoperative thyroid gland manipulation, and 2) while the occurrence of subsequent Graves' hyperthyroidism in a patient with underlying autoimmune thyroiditis may have been a coincidence, this observation also raises the possibility that thyroidal autoantigen released during parathyroidectomy may trigger the reactivation of autoimmune thyroid disease in a predisposed subject.

Manifestation of Primary Hyperthyroidism after Pituitary Adenomectomy: A Case Report.

“…In these reports, it was suggested that the acute reduction in glucocorticoid may have exacerbated a subclinical thyroiditis. Postparathyroidectomy thyrotoxicosis was also reported, and thyroid autoantigen release during surgery was suggested as a cause of this case [4]. In our case, the surgery was for an FSH-producing pituitary adenoma.…”

A Case of Pulmonary Metastatic Thyroid Cancer Complicated with Graves' Disease.

“…1) TSAb may have stimulated the metastatic carcinoma to develop thyrotoxicosis in the patient. Development of Graves' disease has been described following parathyroidectomy [11], radioiodine therapy [12], acute and subacute thyroiditis [13] and in patients treated with a percutaneous ethanol injection (PEI) [14]. Before the remnant thyroidectomy at the previous hospital, TRAb was positive and remained stable after the operation.…”

Acute Spontaneous Hemorrhagic Degeneration of the Thyroid Nodule with Subacute Thyroiditis-Like Symptoms and Laboratory Findings.

“…The serum level of Tg is frequently increased after aspiration of the thyroid [20]. The serum level of thyroid hormones can also be transiently elevated either by aspiration of the thyroid [21], or by resection of a parathyroid adenoma without thyroidectomy [22]. The low thyroidal RAID might be explained by the destruction of the follicle around the nodule, the decreased serum level of TSH and/or increased iodine liberation from the thyroid.…”