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

Abstract

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.

Association of Hashimoto’s Thyroiditis and Graves’ Disease: A Case Report and Review of the Literature

“…In this sense, a study reported an observation in which Graves' disease was associated with both specific antibodies and anti-TPO antibodies. Furthermore, in this observation, histology of the gland after thyroidectomy showed features Case Reports in Clinical Medicine of both Graves' disease and Hashimoto's thyroiditis [3].…”

“…Graves' disease and Hashimoto's thyroiditis are two organ-specific autoimmune diseases. Graves' disease is the most common cause of hyperthyroidism [3]. A recent study in our country shows that hyperthyroidism accounts for about 18% of outpatient visits and 72% of these cases were related to Graves' disease [4].…”

“…Thus, autoimmune thyroiditis can be associated with other autoimmune diseases [5]. However, the association between autoimmune thyroid diseases is rarely described [3].…”

A Rare and Unusual Evolution of Hypothyroidism in Hashimoto's Thyroiditis to Graves' Disease: A Case Report and Literature Review

“…Furthermore, the histopathological examination revealed both characteristics of Graves' disease and Hashimoto's thyroiditis at the same time. Based on these results, she was diagnosed with both diseases at the same time (Graves' disease and Hashimoto's thyroiditis) [ 19 ].…”