A new case of Marine‐Lenhart syndrome with a papillary thyroid carcinoma

Lombardi, Martina; Tonacchera, Massimo; Macchia, Enrico

doi:10.1002/ccr3.1769

Cited by 7 publications

(13 citation statements)

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“…However, Lombardi et al have reported symptoms of hyperthyroidism wherein physical and clinical signs and biochemical results (thyroid hormones and autoantibodies) were consistent with GD (autoimmune hyperthyroidism) associated with an autonomously hyperactive nodule, suggesting an MLS diagnosis. Likewise, our patient presented with symptoms of hyperthyroidism associated with marked exophthalmia [1].…”

Section: Discussionmentioning

confidence: 99%

“…Of great significance, relief of autoimmune response is especially helpful to overcome thyroid eye disease due to severe exophthalmia. Malignancies such as papillary cancer have also been reported in patients with MLS [1,[9][10]. Generally, total thyroidectomy is the recommended procedure for surgical management of MLS [1][2][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with GD, thyroid glands may harbor solid nodules, of which, the great majority are hypofunctioning. In general, thyroid nodules occur in 10% to 35% of GD cases [1-3]. Uncommonly, these nodules are hyperfunctioning adenomas that are estimated to occur in 0.8% to 2.7% of GD cases.…”

Section: Introductionmentioning

confidence: 99%

“…Marine-Lenhart syndrome (MLS) is described as the coexistence of Graves' disease (GD) and autonomously functioning thyroid nodule(s), both of which cause hyperthyroidism by different physiopathology [1][2]. In toxic adenoma and toxic multinodular cases, solitary or multiple hyperactive nodules may create thyrotoxicosis, while in GD, hyperthyroidism arises from autoimmune diffuse hyperplasia of the thyroid gland.…”

Section: Introductionmentioning

confidence: 99%

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Recurrent Goiter Presented with Marine-Lenhart Syndrome 27 Years After Initial Surgery

Gürleyik

2019

Cureus

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Marine-Lenhart syndrome (MLS), a rare form of hyperthyroidism, is the coexistence of Graves’ disease (GD) and autonomously functioning thyroid nodule(s). Herein, we report a case of recurrent goiter presented with MLS. A 52-year-old man presented at our department with recurrent goiter, exophthalmia, and symptoms of hyperthyroidism. In addition to clinical signs and thyroid eye disease, suppressed thyroid-stimulating hormone (TSH) and high free thyroxine (FT4) and autoantibody levels lead to the diagnosis of GD. Thyroid ultrasound and nuclear scan showed the presence of a large, solid, and functioning “hot” nodule in the right lobe. Thus, in recurrent goiter cases, the diagnosis was MLS, wherein autoimmune hyperthyroidism was associated with the functioning nodule. Following medical control with methimazole, the patient underwent total excision of recurrent goiter. Levothyroxine (LT4) therapy was prescribed to maintain normal serum hormone levels. At follow-up, the gradual decrease in serum levels of autoantibody was detected. This patient is a very rare example of MLS that occurs in recurrent goiter case. Clinical signs, serum hormone and autoantibody levels, thyroid ultrasound, and nuclear scan establish the correct diagnosis of this specific and rare disorder. Thyroid surgery and total removal of glandular tissue provides definitive control of hyperthyroidism and obviates autoimmune reaction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recurrent Goiter Presented with Marine-Lenhart Syndrome 27 Years After Initial Surgery

Gürleyik

2019

Cureus

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“…DTCs found in or out of AFTN in MLS are really rare events (Valenti et al 1999, Scherer et al 2013, Sharma 2017, Lombardi et al 2018. The DTC happened in MLS may be related to the stimulation of TRAb or gene mutation such as BRAF V600E (Scherer et al 2013).…”

Section: Mechanismmentioning

confidence: 99%

Thyrotoxicosis with concomitant thyroid cancer

Cheng

Jin

et al. 2019

Endocrine-Related Cancer

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Thyrotoxicosis with concomitant thyroid cancer is rare and poorly recognized, which may result in delayed diagnosis, inappropriate treatment and even poor prognosis. To provide a comprehensive guidance for clinicians, the etiology, pathogenesis, diagnosis and treatment of this challenging setting were systematically reviewed. According to literatures available, the etiologies of thyrotoxicosis with concomitant thyroid cancer were categorized into Graves’ disease with concurrent differentiated thyroid cancer (DTC) or medullary thyroid cancer, Marine–Lenhart Syndrome with coexisting DTC, Plummer’s disease with concomitant DTC, amiodarone-induced thyrotoxicosis with concomitant DTC, central hyperthyroidism with coexisting DTC, hyperfunctioning metastases of DTC and others. The underlying causal mechanisms linking thyrotoxicosis and thyroid cancer were elucidated. Medical history, biochemical assessments, radioiodine uptake, anatomic and metabolic imaging and ultrasonography-guided fine-needle aspiration combined with pathological examinations were found to be critical for precise diagnosis. Surgery remains a mainstay in both tumor elimination and control of thyrotoxicosis, while anti-thyroid drugs, beta-blockers, 131I, glucocorticoids, plasmapheresis, somatostatin analogs, dopamine agonists, radiation therapy, chemotherapy and tyrosine kinase inhibitors should also be appropriately utilized as needed.

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