Thyrotrophin receptor antibody characteristics in a woman with long‐standing Hashimoto's who developed Graves' disease and pretibial myxoedema

Kamath, Chandan; Young, Stuart; Kabelis, Katarzyna; Sanders, Jane; Adlan, Mohamed; Furmaniak, Jadwiga; Smith, Bernard Rees; Premawardhana, Lakdasa

doi:10.1111/j.1365-2265.2012.04397.x

Cited by 40 publications

(31 citation statements)

References 27 publications

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“…This is not surprising considering that such a conversion is known to be detectable in the natural history of patients with HT (42,43,44,45,46) and has also been specifically described in children with either TS (29,30,31) or DS (38,47). Moreover, the shifting HT/GD has been, just recently, found to be more common in GD children with these chromosomal aberrations than in those without them (48).…”

Section: Discussionmentioning

confidence: 90%

Five-year prospective evaluation of thyroid function in girls with subclinical mild hypothyroidism of different etiology

Waśniewska

Aversa

Salerno

et al. 2015

European Journal of Endocrinology

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Aim: To follow-up for 5 years thyroid status evolution in 127 girls with mild (TSH 5-10 mU/l) subclinical hypothyroidism (SH) of different etiologies. Patients: The population was divided into two age-matched groups of 42 and 85 girls with either idiopathic (group A) or Hashimoto's thyroiditis (HT)-related SH (group B). Group B was in turn divided into three subgroups, according to whether SH was either isolated or associated with Turner syndrome (TS) or Down syndrome (DS). Results: At the end of follow-up the rate of girls who became euthyroid was higher in group A (61.9% vs 10.6%), whereas the rates of patients who remained SH (55.3% vs 26.2%), became overtly hypothyroid (30.6% vs 11.9%) or required levothyroxine (L-T 4 ) therapy (63.5% vs 23.8%) were higher in group B. Among the girls of group B, the risk of remaining SH or developing overt hypothyroidism was higher in the subgroups with TS or DS than in those with isolated HT. Conclusions: Long-term prognosis of mild and idiopathic SH is frequently benign, even though a L-T 4 treatment may be needed throughout follow-up in almost a quarter of cases; long-term prognosis is different in the girls with either idiopathic or HT-related SH; and the association with either TS or DS impairs the outcome of HT-related SH.

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Section: Discussionmentioning

confidence: 90%

Five-year prospective evaluation of thyroid function in girls with subclinical mild hypothyroidism of different etiology

Waśniewska

Aversa

Salerno

et al. 2015

European Journal of Endocrinology

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“…The most common scenario is the evolution from GD into HT, whereas the switch from HT into GD seems to be less common. This is probably due to the lack of a critical mass of functioning thyroid tissue able to react to thyrotropin (TSH) receptor autoantibodies (TRABs) in individuals with long-standing HT (5).…”

Section: Introductionmentioning

confidence: 99%

Conversion to Graves disease from Hashimoto thyroiditis: a study of 24 patients

Gonzalez-Aguilera¹,

Betea²,

Lutteri³

et al. 2018

Archives of Endocrinology and Metabolism

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Objective: The conversion of Hashimoto's thyroiditis (HT) to hyperthyroidism due to thyrotropin receptor antibodies is intriguing and considered rare. The contribution of TSH receptor blocking antibodies (TRAb), which may be stimulators (TSAb) or blockers (TBAb), is suspected. We describe clinical and biological variables in a series of patients switching from Hashimoto's thyroiditis to Grave's disease. Subjects and methods: Retrospective case study of 24 patients with Hashimoto's thyroiditis followed during 48 ± 36 months that developed later Graves' disease (GD). These variables were analysed in the hypo and hyperthyroid phase: age, sex, initial TSH, free triiodothyronine (fT3), free thyroxine (fT4), anti-TPO, TBII antibodies, parietal cell autoantibodies, time between hypo and hyperthyroidism, thyroid volume and levothyroxine doses (LT). Results: In HT, mean TSH was 9.4 ± 26.1 UI/L and levothyroxine treatment was 66.2 ± 30.8 µg/day. The switch to GD was observed 38 ± 45 months after HT diagnosis. As expected, we found significant differences on TSH, FT3, FT4 and TBAb levels. Three out of 14 patients had parietal cell autoantibodies. In two of these three cases there was an Helicobacter pylori infection. There were no significant differences between HT and GD groups with respect to thyroid volume. Conclusions: To our knowledge, large series documenting the conversion of HT to GD are scarce. Although rare, this phenomenon should not be misdiagnosed. Suspicion should be raised whenever thyroxine posology must be tapered down during the followup of HT patients. Further immunological and genetic studies are needed to explain this unusual autoimmune change. Arch Endocrinol Metab. 2018;62(6):609-14

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“…This is highly unlikely in our patient as she is not in elderly age group. Associated factors with the conversion process are pregnancy and the use of immunomodulatory drugs, such as Alemtuzumab [6].…”

Section: Discussionmentioning

confidence: 99%

Transformation of hashimoto thyroiditis to Graves’ disease

Pak¹,

Valencia²,

Fershko³

2017

Res Rev Insights

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Hashimoto's thyroiditis and Graves' disease are thyroid-specific autoimmune disorders with distinct pathological mechanism. Clinical presentation and histopathological features also vary greatly in these disorders. Sequential conversation from Hashimoto's thyroiditis (HT) to Graves' disease (GD) has been rarely reported throughout the world. Herein, we report a woman with history of HT, who then developed GD requiring total thyroidectomy. By reporting this case, we hope to raise awareness about this phenomenon among clinicians and illustrate the potential mechanisms behind such change. Improving recognition and identification of this potential conversation between HT and GD would allow clinicians to expeditiously implement appropriate treatment, increasing the quality of care.

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Thyrotrophin receptor antibody characteristics in a woman with long‐standing Hashimoto's who developed Graves' disease and pretibial myxoedema

Cited by 40 publications

References 27 publications

Five-year prospective evaluation of thyroid function in girls with subclinical mild hypothyroidism of different etiology

Five-year prospective evaluation of thyroid function in girls with subclinical mild hypothyroidism of different etiology

Conversion to Graves disease from Hashimoto thyroiditis: a study of 24 patients

Transformation of hashimoto thyroiditis to Graves’ disease

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