An uncommon case of Marine-Lenhart syndrome

Abstract

SUMMARYThe term Marine-Lenhart syndrome describes the association between Graves' disease and autonomously functioning thyroid nodules (AFTN), such as toxic adenoma or toxic multinodular goiter. The two diseases may coexist or may be present at different moments in the same patient. In the literature, there are many reports on the development of Graves' disease after radioiodine treatment for AFTN, but very little information may be found on the occurrence of AFTN after radioiodine therapy for Graves' disease. We describe here the case of a female patient with Graves' disease who was successfully treated with radioiodine for Graves' disease, returning to normal thyroid function. Three years later, biochemical analysis and ultrasound examination identified a thyroid nodule that progressively increased in size. The SUMÁRIOO termo "síndrome de Marine-Lenhart" descreve a associação da doença de Graves e nódulos tireoidianos de funcionamento autônomo (AFTN), como no adenoma tóxico ou bócio multinodular tóxico. As duas doenças podem coexistir ou podem estar presentes em diferentes momentos no mesmo paciente. Na literatura, existem muitos relatos sobre o desenvolvimento da doença de Graves após radioiodoterapia para AFTN, mas muito poucos dados podem ser encontrados em relação ao aparecimento de AFTN após radioiodoterapia para doença de Graves. Descrevemos o caso de uma paciente do sexo feminino com doença de Graves que realizou com sucesso o tratamento com iodo radioativo, com a normalização da função da tireoide. Três anos depois, uma análise bioquímica e um exame de ultrassonografia identificaram o aparecimento de um nódulo na tireoide que progressivamente aumentou de tamanho. A cintilografia com 99m Tc-pertecnetato revelou uma captação ávida no lóbulo direito, correspondente à lesão nodular, consistente com uma AFTN. Arq Bras Endocrinol Metab. 2014;58(4):398-401

Marine-Lenhart syndrome in two adolescents, including one with thyroid cancer: a case series and review of the literature

“…While early studies primarily reported on low-functioning thyroid nodules, there have recently been increasing numbers of reports of GD patients with 'increased' nodular functionality [6][7][8][9][10][11], similar to the patients examined in this case series. This phenomenon led to the hypothesis that this association could comprise either a different clinical entity from, or more likely, an extension of Marine-Lenhart syndrome.…”

Manifestation of Marine Lenhart Syndrome after failed Radioactive Iodine therapy

“…Recently documented cases of MLS include cases of coexisting Graves' disease and hyperfunctioning nodules at the time of diagnosis 7-10 , cases of Graves' disease with "cold" nodules at the time of diagnosis that then later were confirmed as hyperfunctioning 11 , and cases of development of toxic adenomas years after successful treatment of Graves' disease [12][13] . This highlights the need for a unified definition of MLS, which was proposed by Neuman et al in 2018 7 .…”

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

“…While Charkes has reported the prevalence of this disorder at approximately 2.7% based on a review of 375 GD cases, Carnell and Valente detected autonomous nodules in only four (0.85%) of 468 GD cases [4][5]. This condition is estimated to occur in 0.8% to 2.7% of patients with GD; also, thyroid nodules occur in 10% to 15% and functioning nodules occur in 1% of patients with GD [2,[4][5][6][7].…”