Alternating hyperthyroidism and hypothyroidism in Graves’ disease

Wong, Mimi; Inder, Warrick J.

doi:10.1002/ccr3.1700

Cited by 22 publications

(19 citation statements)

References 13 publications

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“…Cases of hypothyroidism converting to hyperthyroidism in the setting of Graves have been reported in the literature (1,2). Additionally, cases of continuously alternating hypothyroidism and hyperthyroidism have been reported (3,4). The pathophysiology for this alternating state is not completely understood, however, research is emerging.…”

Section: Discussionmentioning

confidence: 99%

Conversion of Hypothyroidism to Hyperthyroidism: A Rare Clinical Phenomenon

Watari

Jassil

2020

AACE Clinical Case Reports

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Objective: We present a patient with long standing hypothyroidism that developed hyperthyroidism secondary to Graves’ disease. Recognition of this disease phenomenon is crucial to ensure prompt diagnosis and close follow-up. Methods: The patient was evaluated with thyroid function testing and thyroid antibody testing. Further evaluation included ophthalmologic examination and radioactive iodine uptake imaging. Results: A 56-year-old female with past medical history of human immunodeficiency virus (HIV), hepatitis C infection, and hypothyroidism presented for evaluation of thyroid disease. She had been off of levothyroxine for the last 8 months due to biochemical findings of thyrotoxicosis. Family history was significant for hyperthyroidism and hypothyroidism. Labs were consistent with hypothyroidism so levothyroxine was restarted. Exam showed lid lag and proptosis. Ophthalmologic evaluation found bilateral 23 mm proptosis. Additional lab testing was positive for thyroid peroxidase antibody and thyroid stimulating immunoglobulin. Following levothyroxine use, the patient developed subclinical hyperthyroidism and thyroid replacement was stopped. The patient remained euthyroid for one year off of levothyroxine. Following one year, she developed mild hyperthyroidism with increased radioactive iodine uptake. She was placed on propranolol for symptomatic relief. Months later, thyroid function testing normalized. Conclusion: In Graves’ disease, hypothyroidism and conversion of hypothyroidism to hyperthyroidism are rare, yet important to recognize, clinical phenomenon. The stimulatory and inhibitory properties of thyroid-stimulating hormone receptor antibodies are speculated to play a role in individuals with alternating hypothyroidism and hyperthyroidism. These individuals can present a diagnostic and therapeutic challenge. Clinicians must maintain a high clinical suspicion for this disease entity.

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Section: Discussionmentioning

confidence: 99%

Conversion of Hypothyroidism to Hyperthyroidism: A Rare Clinical Phenomenon

Watari

Jassil

2020

AACE Clinical Case Reports

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“…Indeed, circulating levels of TSH receptor inhibiting and stimulating antibodies have been reported in the same patient [12]. The clinical manifestation will be determined by which antibody predominates and this may vary with time with the same patient clinically manifesting as Hashimoto's thyroiditis or Graves' disease [13]. Alternating episodes of hypothyroidism and hyperthyroidism may be ultimately stopped with thyroidectomy or radioactive ablation of the thyroid [8, 12].…”

Section: Discussionmentioning

confidence: 99%

Graves� disease following hypothyroidism due to Hashimoto�s thyroiditis in a black South African lady: a case report

2019

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Graves' disease and Hashimoto's thyroiditis are autoimmune thyroid disorders with distinct pathological and histopathological features. The conversion from Hashimoto's thyroiditis to Graves' disease has been rarely reported throughout the world with no reports in the African race to our knowledge. We here report an African lady who was initially diagnosed with primary hypothyroidism following Hashimoto's disease but later became thyrotoxic due to Graves' disease.

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“…A block and replace regimen may improve stability over the short to intermediate term, but this is not a definitive therapy and requires long-term close monitoring. Definitive therapy includes both thyroidectomy and radioactive iodine, which has the disadvantage in that it can only be performed in the hyperthyroid phase [3].…”

Section: Discussionmentioning

confidence: 99%

“…The patient was specifically treated with methimazole. Without definitive treatment such as surgery or thyroid ablation, management can be challenging and close monitoring of the patient along with regular thyroid function test will be required for ongoing follow-up [3].…”

Section: Discussionmentioning

confidence: 99%

Oscillating Hypothyroidism and Hyperthyroidism: A Rare Autoimmune Syndrome

et al. 2019

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Graves' disease is an autoimmune thyroid disorder with overproduction of thyroid hormones secondary to the production of thyroid-stimulating hormone receptor (TSH-R) stimulating antibodies (TSAbs). It is very common for Graves' disease patients to convert to a hypothyroid state especially in end-stage Graves' disease or after iodine ablation. These patients require lifelong thyroxin replacement therapy. In this case report, we describe a rare phenomenon known as "oscillating hypo-and hyperthyroidism". In this rare entity of autoimmune endocrine disorder patients with hypothyroidism spontaneously convert to Graves' disease.

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Alternating hyperthyroidism and hypothyroidism in Graves’ disease

Cited by 22 publications

References 13 publications

Conversion of Hypothyroidism to Hyperthyroidism: A Rare Clinical Phenomenon

Conversion of Hypothyroidism to Hyperthyroidism: A Rare Clinical Phenomenon

Graves� disease following hypothyroidism due to Hashimoto�s thyroiditis in a black South African lady: a case report

Oscillating Hypothyroidism and Hyperthyroidism: A Rare Autoimmune Syndrome

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