Hyperthyroidism of Graves’ disease: Evidence for only unilateral involvement of the thyroid gland in a 31-year-old female patient

Abstract

Hyperthyroidism of Graves' disease (Morbus Basedow) is known to involve the thyroid gland in toto, unlike Graves' ophthalmopathy which clinically may either be unilateral or bilateral. We report a 31-year-old Caucasian female patient who presented with unilateral goiter and clinical and laboratory evidence for hyperthyroidism. High-resolution ultrasonography of the thyroid gland revealed a morphology indicative of an autoimmune thyroid disease strictly limited only to the right lobe. 123I-scintiscanning showed a homogenous but several fold increased uptake of the radionuclide in the right lobe of the thyroid gland, whereas the uptake in the left lobe did not differ from the uptake in normal controls. Cytology of the fine needle aspirate of the right lobe revealed a remarkable inflammatory background mainly by presence of lymphocytes, a finding which was not seen in the cytology of the left lobe. Furthermore, both serum antibodies to TSH-receptors and thyroid peroxidase were significantly increased. Consequently, hyperthyroidism of Graves' disease with the involvement of only one lobe of the thyroid gland was diagnosed.

Graves' Disease Affecting one Thyroid lobe (Unilateral Graves' Disease): Case Report

“…Another reason might be the isolated lymphatic drainage of each lobe, which may lead to different autoreactivity against the key thyroid autoantigens and thyroid stimulating hormone receptors (TSH-R). This in part would also support the hypothesis of Dimai et al (9) who postulated that the side to side difference may be caused by bacterial or viral infection of the thyroid gland. In fact most thyroid infections are due to lymphatic seeding and may lead to inhomogenous alteration of thyroid tissue (10,11) .…”

“…In 1999, Dimai et al (9) reported unilateral Graves disease in a 31 years old female. This was reported again in a 33 years old woman in 2004 (10) and in 39 years old male by Bolognesi and Rossi in 2006 (6) .…”

First Reported Case of Unilateral Graves' Disease in the Left Lobe of a Bilobar Thyroid Gland

“…In 1999, Dimai et al described a 31-year-old female Caucasian patient who was thyrotoxic and had a unilateral goiter (2). Ultrasonography of the thyroid gland revealed changes consistent with autoimmune thyroid disease limited to the right lobe, and I-123 uptake was homogeneously concentrated in the right lobe.…”

“…There are only a handful of case reports of unilateral Graves' disease not caused by thyroid hemiagenesis available in the medical literature. Each case described involved a hyperfunctioning right thyroid lobe (1)(2)(3)(4). In this report we describe a case of unilateral Graves' disease involving the left thyroid lobe of a bilobar gland, summarize the cases in the medical literature to date, and discuss the possible pathophysiology behind unilateral Graves' disease.…”

Atypical Manifestations

“…To our knowledge only one case of 'single-lobe' autoimmune hyperthyroidism is known in the literature. Dimai et al [1] reported a 31-year-old Caucasian female patient who presented with clinical and laboratory evidence of hyperthyroidism and unilateral goitre. High-resolution ultrasonography of the thyroid gland revealed a morphology indicative of an autoimmune thyroid disease strictly limited only to the right lobe.…”