Graves’ disease in monozygotic twins – a case report

Abstract

BackgroundAutoimmune thyroid diseases including Graves’ disease and Hashimoto’s thyroiditis are caused by immune response to self-thyroid antigens. The rare situation of hyperthyroidism with Graves’ disease in twins has been reported in a very few case reports in literature.Case presentationWe present monozygotic female twins developing consecutively Graves’ disease within five years. One year before the diagnosis of Graves’ disease was established in the first twin, the mother developed a toxic thyroid nodule with hyperthyroidism leading to hemi thyroidectomy. Both the mother and the twins were cigarette smokers. The twins were treated with carbamizole and this therapy led to normalization of thyroid stimulating hormone and thyroxine.ConclusionThis case report supports the hypothesis that a genetic factor as well as an environmental factor (cigarette smoking) might be of great importance in the aetiology of Graves’ disease.

Autoantibodies - enemies, and/or potential allies?

“…Graves’ disease (GD) is caused by thyroid-stimulating autoantibodies (TSAbs) that activate the thyrotropin receptor on the thyroid cell membrane, leading to the over-production of thyroid hormones. GD affects approximately 2-3% of the world’s population ( 32 ). While thyroid hormones play a crucial role in control of metabolism, high levels hyper-stimulate the body’s activities, resulting in nervousness, a fast heartbeat, heat intolerance, and weight loss.…”

Graves' disease: pathophysiological aspects and considerations about using the chemometric analysis in the study of the disease

“…The increased incidence of Graves' disease among members of the same family signifies that genetic factors may have a significant role in determining the likelihood of developing Graves' disease. 3 Studies involving twins show a high degree of incidence in both twins, pointing to a major genetics contribution. However, there is a racial variation between major histocompatibility complex (MHC) haplotypes and the greater susceptibility towards Graves' disease.…”

Identical Twin Sisters with Close Onset of Graves’ Disease and with Multiple HLA Susceptibility Alleles for Graves’ Disease

“…The number of case reports of identical twins developing GD is small (4)(5)(6)(7). In these cases, the interval between the development of GD in the two twins ranged from less than one year (6) to 5 years (7), although the twins shared comparable environmental circumstances and had similar laboratory results, including anti-thyroid antibodies.…”

“…The number of case reports of identical twins developing GD is small (4)(5)(6)(7). In these cases, the interval between the development of GD in the two twins ranged from less than one year (6) to 5 years (7), although the twins shared comparable environmental circumstances and had similar laboratory results, including anti-thyroid antibodies. To the best of our knowledge, there are no case reports of identical twins who developed GD with similar timing of onset and who possessed multiple HLA susceptibility alleles for developing GD.…”