Development of Graves' Disease Nine Years After Total Thyroidectomy Due to Follicular Carcinoma of the Thyroid

Abstract

We report a 49-year-old woman with Marfan syndrome who underwent total thyroidectomy for follicular carcinoma. The patient was given 100 mCi of radioactive iodine (131I) followed by levothyroxine (LT4) 0.2 mg/day after surgery. The subsequent five total body scans were negative and thyroglobulin (TG) measurements ranged between undetectable levels to 12 ng/mL. Nine years after thyroidectomy the patient developed bilateral exophthalmos with markedly positive thyroid-stimulating immunoglobulins (TSI), indicating the presence of Graves' disease. TG levels increased and concurrently pulmonary metastases that did not concentrate radioiodine at tracer doses, were diagnosed. Due to these metastatic lesions, the patient received a therapeutic dose of 150 mCi of 131I 1 month after LT4 withdrawal, and a total body scan was made 10 days later. Slight uptake of 131I was found in the right side of the neck, whereas predominant uptake occurred in the right lung base. We suggest that the elevated TSI played a role in the growth of metastases.

A case of metastatic follicular thyroid carcinoma complicated with Graves’ disease after total thyroidectomy

“…Previous studies reported that thyroid cancer occurs concomitantly with Graves' disease [2][3][4][5][6][7]. The incidence of thyroid carcinoma in patients with Graves' disease is between 1.7 and 2.5%, which is higher than dL) under the administration of L-T4.…”

“…Limited information is currently available on metastatic differentiated thyroid cancer leading to thyrotoxicosis after total thyroidectomy. There have been six cases that showed hyperthyroidism and were diagnosed as Graves' disease after total thyroidectomy for thyroid carcinoma (Table 1) [2][3][4][5][6][7]. All six cases had follicular carcinoma with large metastatic tumors.…”

“…The second proposed mechanism involves TSH receptors in progressive MMI therapy was not necessary. In previously reported cases, two patients were given 150 mCi RAI therapy [4,7], three 100 mCi [2,3,5], and one additional RAI therapy (total 200 mCi) [3]. In most reported cases, thyroid function was controlled [2][3][4][5]7], and metastases responded to therapy [2,4,5,7].…”

Four Cases of Graves' Disease which Developed after Painful Hashimoto's Thyroiditis

“…, subacute thyroiditis (5)(6)(7)(8)(9)(10)(11)(12), external head and neck irradiation (13), surgical treatment for thyroid nodules (14), and parathyroidectomy (15). Thyroid destruction releases autoantigens from the thyroid gland, and subsequently some cases undergo autoantibody production.…”

“…This is a form of the destructive thyroiditis. Therefore destruction of the thyroid follicular structure due to painful Hashimoto (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) and the destructive condition of the thyroid follicular structure, for example, surgical treatment for thyroid nodules (14), radioiodine therapy for a toxic nodular goiter (30)(31)(32), and external irradiation (13) (5-9, 10, 11 …”