Transient thyrotoxicosis occurred after cessation of steroid therapy in a patient with autoimmune thyroiditis and rheumatoid arthritis.

Maruyama, Hiroshi; Kato, Masakazu; Mizuno, Osamu; Kataoka, Kensuke; Matsuki, Shun

doi:10.1507/endocrj1954.29.583

Cited by 32 publications

(19 citation statements)

References 16 publications

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“…Thyrotoxicosis after adrenalectomy in a patient with Cushing's syndrome has been reported [1,2], as well as after discontinuation of steroid therapy in a patient with rheumatoid arthritis [3]. In these reports, it was suggested that the acute reduction in glucocorticoid may have exacerbated a subclinical thyroiditis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 1997

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Abstract. We report a 47-year-old Japanese man who presented with visual disturbance due to a pituitary tumor with suprasellar extension. The patient had mild secondary hypothyroidism preoperatively, and was started on administration of levothyroxine sodium immediately before transsphenoidal surgery. After the operation, levothyroxine sodium was continued for several months. Pathological examination of the surgical specimen, together with endocrinological investigation revealed that the suprasellar tumor was a FSH-producing pituitary adenoma. Since 3 months after the operation, he has developed muscle weakness and finger tremor. He was found to be thyrotoxicosis, and levothyroxine sodium was discontinued.Seven weeks after levothyroxine sodium was discontinued, thyrotoxicosis continued, with a positive thyrotropin binding inhibitory immunoglobulin (TBII) and a high diffuse 123I-uptake by the thyroid. He was started on thiamazole 30 mg/day. Although his thyroid dysfunction improved within 2 months, hyperthyroidism worsened repeatedly on attempts to discontinue thiamazole, and he required continuous treatment at 2.5 mg/day.Patients with occult autoimmune thyroiditis rarely progress to thyrotoxicosis after operations on other endocrine organs such as the adrenal or parathyroid gland. In patients with pituitary adenoma, thyroid function and thyroid-associated autoantibodies should be investigated pre-and post-operatively.

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Section: Discussionmentioning

confidence: 99%

“…PREVIOUS reports have noted thyroid dysfunction attributable to autoimmune thyroiditis arising after surgery on other endocrine organs, such as adrenal or parathyroid [1][2][3].…”

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confidence: 99%

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

et al. 1997

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“…Painless thyroiditis may occur after an acute cessation of steroid therapy in patients with rheumatoid arthritis [43] or allergic rhinitis [44], after an adrenalectomy in patients with Cushing's syndrome [45], or after hypopituitarism following pituitary apoplexy [46]. Moreover, there are reports of the ACTH DEFICIENCY AND PAINLESS THYROIDITIS [47].…”

Section: Discussionmentioning

confidence: 99%

Isolated Adrenocorticotropin Deficiency Associated with Painless Thyroiditis: A Case Report and Review of the Literature

et al. 2012

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INTRODUCTIONAlthough isolated adrenocorticotropin (ACTH) deficiency (IAD) is a heterogeneous disorder with several etiologies, the majority of acquired cases are most likely due to an autoimmune process [1][2][3]. Painless thyroiditis, which is considered a variant form of Hashimoto's thyroiditis, is characterized by transient thyrotoxicosis that is sometimes followed by transient hypothyroidism and then recovery [4]. Although acquired IAD is not uncommonly associated with other autoimmune endocrine disorders, especially Hashimoto's thyroiditis [5,6], reported cases of IAD associated with painless thyroiditis are scarce. Herein, we report a case of IAD associated with painless thyroiditis and briefly review the literature. CASE REPORTA 53-year-old Japanese man was admitted to hospital with a 3-month history of transient headache followed by general fatigue, weight loss of 4 kg and myalgia. He had a history of ocular myasthenia gravis which had been in remission following thymectomy 30 years prior to admission. He had no family history of endocrine or autoimmune disorders. On admission, he was 157 cm in height and weighed 47 kg. His blood pressure was 108/68 mmHg, pulse was regular at 92 beats/min, and his temperature was 37.1℃. Ophthalmologic examinations, including visual acuity, visual field and ocular fundus revealed no abnormalities. A small diffuse goiter was palpable without tenderness. The heart, lungs and abdomen were not remarkable. The relaxation phase of the Achilles ten- Kurume Medical Journal, 59, 71-77, 2012 Summary: A 53-year-old Japanese man was admitted with a 3-month history of transient headache followed by general fatigue and weight loss. He had a history of ocular myasthenia gravis which had been in remission following thymectomy 30 years ago. He had a small diffuse goiter without tenderness, and was diagnosed as having painless thyroiditis with mild thyrotoxicosis on admission. Endocrinological studies showed he had isolated adrenocorticotropin deficiency. Magnetic resonance imaging of the pituitary gland revealed no abnormalities. His symptoms improved soon after replacement of glucocorticoid. After an episode of hypothyroidism, he spontaneously became euthyroid. It is likely that thyrotoxicosis uncovered adrenal insufficiency that had developed insidiously, and hypoadrenocorticism-induced immunological changes may have triggered the development of painless thyroiditis. Moreover, thymectomy might have facilitated the development of pituitary and thyroid autoimmunity.

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“…Thus, it is suggested that iodine intake and various cytokines can initiate silent thyroiditis [3]. In addition, silent thyroiditis can also develop in patients after the cessation of steroid treatment for rheumatoid arthritis [4], after adrenalectomy in patients with Cushing's syndrome [5,6], after the administration of gonadotropin-releasing hormone analogues [7], and after viral infections [8][9][10]. However, the outbreak of silent thyroiditis (or atypical thyroiditis) has been indicated in few reports [11,12] Here, we report the cases of two brothers and their mother who developed silent thyroiditis in spring.…”

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Familial Occurrence of Silent Thyroiditis

2005

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Abstract. Two brothers and their mother, who had allergic rhinitis caused by Japanese cedar pollen, developed silent thyroiditis in spring. In addition, these three patients had the same HLA haplotype. Another brother, the father, and the paternal grandmother, who did not have allergic rhinitis caused by Japanese cedar pollen, did not show symptoms of silent thyroiditis. The present study indicates that genetic and/or environmental factors are important in the development of this familial type of silent thyroiditis.

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Transient thyrotoxicosis occurred after cessation of steroid therapy in a patient with autoimmune thyroiditis and rheumatoid arthritis.

Cited by 32 publications

References 16 publications

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

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

Isolated Adrenocorticotropin Deficiency Associated with Painless Thyroiditis: A Case Report and Review of the Literature

Familial Occurrence of Silent Thyroiditis

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