Transformation of hashimoto thyroiditis to Graves’ disease

Pak, Stella; Valencia, Damian; Fershko, Adam

doi:10.15761/rri.1000117

Cited by 6 publications

(6 citation statements)

References 6 publications

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“…Ultrasound examination after the relapse of Basedow's disease revealed that the thyroid gland was not very hypervascular compared to that at the onset of the disease Hashimoto's disease rather than Basedow's disease [9,10]. There are a few reports showing the transformation of Hashimoto's thyroiditis to Basedow's disease [11][12][13][14][15], but in many of these reports such arguments are based on clinical and laboratory features.…”

Section: Discussionmentioning

confidence: 99%

Basedow’s disease with associated features of Hashimoto’s thyroiditis based on histopathological findings

et al. 2020

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Background: Basedow's disease and Hashimoto's thyroiditis are autoimmune thyroid disorders and usually diagnosed with elevation of serum autoimmune antibodies. Thyrotropin receptor antibodies (TRAb) and/or thyroidstimulating antibody (TSAb) are usually used for diagnosis of Basedow's disease, and thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb) are for diagnosis of Hashimoto's thyroiditis. However, it is difficult to diagnose a subject as Basedow's disease with associated features of Hashimoto's thyroiditis only with elevation of such autoimmune antibodies. Case presentation: A 44-year-old woman with 5-year history of Basedow's disease underwent a total thyroidectomy. She did not have a goiter. TRAb, TSAb, TPOAg and TgAb were all positive before a total thyroidectomy. In histopathological macroscopic examination, diffuse hyperplasia of the thyroid gland was observed. Furthermore, in histopathological microscopic examination, both characteristics of Basedow's disease and Hashimoto's thyroiditis were observed. After a total thyroidectomy, titers of all thyroid-associated autoimmune antibodies were markedly reduced. Conclusion: Herein, we report a subject with Basedow's disease without a goiter whose TPOAb and TgAb were relatively high at the onset of Basedow's disease. In addition, interestingly, the histopathological findings of this subject showed direct signs of Basedow's disease and Hashimoto's thyroiditis in the same thyroid gland. Considering from such findings, she seemed to have Basedow's disease with associated features of Hashimoto's thyroiditis. In conclusion, we should bear in mind the possibility of Basedow's disease with associated features of Hashimoto's thyroiditis in subjects with Basedow's disease, particularly when TPOAb and TgAb as well as TRAb and TSAb are positive.

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Section: Discussionmentioning

confidence: 99%

Basedow’s disease with associated features of Hashimoto’s thyroiditis based on histopathological findings

et al. 2020

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“…On the other hand, the progression of the thyroid immune diseases is similar to a pendulum clock dance, where they can develop from one form to another in the same patient and in both directions (11). HT and GD are the two main forms of a spectrum of thyroid immunological diseases (12). Although the conversion of HT to GD is a rare phenomenon and its mechanism is still unclear, a few cases were reported in the medical literature.…”

Section: Discussionmentioning

confidence: 99%

“…Although the conversion of HT to GD is a rare phenomenon and its mechanism is still unclear, a few cases were reported in the medical literature. Table 1 provides a summary of some cases (2,4,(12)(13)(14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Switching of Hashimoto Thyroiditis Into Graves’ Disease: A Case Report and Literature Review

Maksoud

Wannous

et al. 2021

Dis Diagn

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Background: Hashimoto thyroiditis (HT) and Graves’ disease (GD) are autoimmune inflammatory thyroid disorders. The evolution from GD into HT is the most common scenario while the conversion from HT into GD seems to be less common. Case Presentation: A 20-year-old female patient referred to the endocrinology clinic with a three-month history of fatigue, lethargy, lack of appetite, constipation, menorrhagia, cold intolerance, and 5 kg weight gain in the last two months. Clinical examination showed dry skin, scalp hair loss, and painless hard goiter whereas thyroid ultrasound revealed generalized homogeneous hypoechoic thyroid hypertrophy. Laboratory tests demonstrated increased serum thyroid-stimulating hormone (TSH) 210 µIU/L (normal: 0.25-4.50), decreased free thyroxine (FT4) 0.37 ng/L (normal: 0.8-1.8) and free triiodothyronine (FT3) 1.94 pg/mL (normal: 1.8-4.6), and finally, increased thyroid peroxidase antibodies (anti-TPO) 462 IU/mL (normal: up to 34). Based on observations, HT was diagnosed and thus daily treatment with levothyroxine 75 mcg was started for the patient. Two months later, she referred with symptoms suggestive of hyperthyroidism with reduced TSH levels, which did not improve after levothyroxine cessation, thus more laboratory tests were conducted and revealed decreased TSH levels, increased T3 and T4, and TSH receptor stimulating antibody (TSAb)levels, and increased radioactive iodine uptake at 24 hours. Therefore, the diagnosis of GD was made. Five weeks after treatment, she was in full remission. Conclusion: Although the switch from HT into GD is rare, it can occur at any time during the disease. Nonetheless, early diagnosis and treatment would improve the quality of care.

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“…This may indicate that the pathogenesis of hyperthyroidism in these patients is similar to HT, and it could be named autoimmune hyperthyroidism rather than classical GD. What is more, recently some reports suggest a conversion of GD to HT [22, 23] and vice versa [24].…”

Section: Discussionmentioning

confidence: 99%

Graves’ disease in children in the two decades following implementation of an iodine prophylaxis programme

Borowiec

Labochka

Milczarek

et al. 2018

cejoi

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Grave’s disease (GD) is a form of thyroid autoimmune disease characterised by hyperthyroidism. It is a rare clinical problem in paediatrics. Development of disease is the result of genetic susceptibility and some environmental factors. One of the best-documented environmental factors involved in thyroid autoimmunity is iodine excess. The aim of our study was to analyse the clinical course and response to pharmacological treatment in children diagnosed with Graves’ disease in first two decades after mandatory salt iodination. Records of 94 children diagnosed with GD in the years 1998-2017 were analysed. Medical data of patients was compared between two decades following implementation of iodine prophylaxis: 1998-2007 (first-decade group – FDG) and 2008-2017 (second-decade group – SDG); 34 and 60 patients, respectively. Medical data of FDG was obtained from archival records and previous analysis performed in 2006. Data of 60 patients from SDG were obtained from currently available medical records. Results were statistically analysed using Microsoft Excel and Statistica 11 software. Results: In our study, after mandatory salt iodination, the tendency of an increase in newly diagnosed GD in children without family susceptibility was observed. The antibody profile indicates the significant contribution of the autoimmune process involving all thyroid antigens; therefore, the term “autoimmune hyperthyroidism” seems to be more appropriate than classical GD in this group of patients. The first-choice treatment with methimazole rarely causes adverse events during the therapy, and they have benign character.

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Transformation of hashimoto thyroiditis to Graves’ disease

Cited by 6 publications

References 6 publications

Basedow’s disease with associated features of Hashimoto’s thyroiditis based on histopathological findings

Basedow’s disease with associated features of Hashimoto’s thyroiditis based on histopathological findings

Switching of Hashimoto Thyroiditis Into Graves’ Disease: A Case Report and Literature Review

Graves’ disease in children in the two decades following implementation of an iodine prophylaxis programme

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