Recurrent Thyrotoxicosis due to Both Graves’ Disease and Hashimoto’s Thyroiditis in the Same Three Patients

Abstract

Hashimoto's thyroiditis (HT) and Graves' disease (GD) are the 2 most common autoimmune disease processes affecting the thyroid gland. The relationship between the two is complex and not clearly understood. It has been theorized that HT and GD are 2 separate disease processes due to unique genetic differences demonstrated by genome studies. On the other hand, based on occurrence of both HT and GD in monozygotic twins and within the same family, they have been regarded to represent 2 ends of the same spectrum. This case report describes 3 patients who presented with thyrotoxicosis due to both GD and HT. The initial presentation was thyrotoxicosis due to GD treated with antithyroid medication followed by temporary resolution. They all subsequently experienced recurrence of thyrotoxicosis in the form of Hashitoxicosis due to HT, and then eventually all developed thyrotoxicosis due to GD, requiring radioablation therapy.

Alternating Hypothyroidism and Hyperthyroidism in an Adolescent Boy – Do We Always Understand What Drives the Switch?

“…However, it is highly unusual for patients with Hashimoto's thyroiditis who already developed hypothyroidism, to switch to hyperthyroidism thereafter. To our knowledge, in all the published cases with such clinical course, children and adolescents were TRAb positive 1,2,6 . As previously pointed out, this was not the case in our patient.…”

“…Three therapeutic options should be considered, i.e., pharmacological treatment, I-131 ablation, and thyroidectomy. To our knowledge, in all pediatric TRAb positive cases described so far, definitve treatment with either thyroidectomy or I-131 ablation was selected or considered as a suitable option 1,2,6 . However, a mild clinical course in a TRAb negative adolescent boy led us to opt for a conservative therapeutic approach.…”

Reversible Orolingual Dyskinesia: An Unknown Presentation of Hashimoto’s Toxic Encephalopathy

“…HT and Grave's Disease (GD) are considered as the parts of two ends of the same spectrum of autoimmune pathogenesis process [5]. On the other hand, genomic scanning studies in humans suggest that these belong to two different and unique disease processes related to thyroid gland [6] which is further supported by the case reports in which the occurrence of HT and GD in the same family and GD followed by HT in the same patient are studied [7][8][9]. In addition, there is no sensitive biochemical parameters to differentiate each other; the diagnosis principally is made according to both clinical and laboratory investigations.…”