Presence of Thyroid-Stimulating Hormone Receptor Antibodies in a Patient with Subacute Thyroiditis followed by Hypothyroidism and Later Graves' Disease with Ophthalmopathy: A Case Report

Hallengren, Bengt; Planck, Tereza; Åsman, Peter; Lantz, Mikael

doi:10.1159/000435915

Cited by 10 publications

(13 citation statements)

References 15 publications

(23 reference statements)

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“…It is believed that SAT may trigger autoreactive B cells to produce TRAb, resulting-in some patients-in subsequent TRAb-associated thyroid dysfunction [4,13]. This hypothesis can be confirmed by the fact that there have been much more case reports of TRAb occurrence after SAT resolution than of the simultaneous presence of SAT and TRAb [14][15][16][17]. Perhaps this is mainly due to the lack of assessment and monitoring of TRAb levels during the course of SAT.…”

Section: Discussionmentioning

confidence: 99%

Strong Correlation between HLA and Clinical Course of Subacute Thyroiditis—A Report of the Three Siblings

Stasiak

Lewiński

2020

Genes

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Subacute thyroiditis (SAT) is a thyroid inflammatory disease with susceptibility associated with the presence of human leukocyte antigen (HLA)-B*35, -B*18:01, -DRB1*01 and -C*04:01. Previous viral infection is considered as a triggering factor in genetically predisposed individuals. The influence of HLA on the SAT course was previously suggested. We aim to present the three siblings—female twins and their brother—with very close onset but different clinical courses of SAT, which appeared to be HLA-dependent. The HLA profile in the reported three siblings is strongly correlated with both SAT and Graves’ disease (GD), however the coexistence of particular sets of high risk and protective alleles seems to be crucial for the GD development and the SAT course. The co-occurrence of HLA-DRB1*15:01 and/or -B*07:02, possibly together with the lack of HLA-A*01:01 and -B*41:01 seems to be key factors protecting against the development of GD with high TRAb levels, as well as against the recurrent SAT course and steroid dependence.

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Section: Discussionmentioning

confidence: 99%

Strong Correlation between HLA and Clinical Course of Subacute Thyroiditis—A Report of the Three Siblings

Stasiak

Lewiński

2020

Genes

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“… 4 , 5 , 6 Case reports have documented GD following subacute thyroiditis, a viral infection of the thyroid. 7 , 8 Severe acute respiratory syndrome coronavirus, the virus responsible for severe acute respiratory syndrome, was found to cause extensive damage to the thyroid glands. Furthermore, clinicians have linked subacute thyroiditis with SARS-CoV-2, the related novel coronavirus responsible for COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Graves’ Thyrotoxicosis Following SARS-CoV-2 Infection

Harris¹,

Mushref²

2021

AACE Clinical Case Reports

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“…The criteria for SAT, including tender goiter and either elevated ESR and/or low RAIU, were documented in 29 of 31 cases (93.5%) [2][3][4][5][6][7][8][9][10][11][12][13][14] ; histologic findings of SAT were reported in 4 of the 31 cases (13%). 4,10,15 GD diagnosis was supported by elevated RAIU in 26 of the 31 cases (84%), elevated TSI or TRAb level in 21 of the 31 cases (68%), and both in about 16 of the 31 cases (52%). 2,[5][6][7][8][9][10][11][12][13][14][15] Two cases documented a change in the TRAb or TSI level from being absent at the onset of SAT to being elevated when GD was diagnosed.…”

Section: Discussionmentioning

confidence: 92%

“…4,10,15 GD diagnosis was supported by elevated RAIU in 26 of the 31 cases (84%), elevated TSI or TRAb level in 21 of the 31 cases (68%), and both in about 16 of the 31 cases (52%). 2,[5][6][7][8][9][10][11][12][13][14][15] Two cases documented a change in the TRAb or TSI level from being absent at the onset of SAT to being elevated when GD was diagnosed. 8,12 Elevated TSI and/or TRAb levels after SAT, especially if prior levels are noted to be absent, as in our patient, provide support for thyroid damage and autoimmune activation, previously described as a cause of GD after SAT.…”

Section: Discussionmentioning

confidence: 92%

Graves Disease Following Subacute Thyroiditis in a Chinese Man

Al-Bacha¹,

Lahiri²

2022

AACE Clinical Case Reports

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Background/Objective: The development of Graves disease (GD) after subacute thyroiditis (SAT) is rare, with approximately 31 reported cases, of which only 5 occurred in men. We describe a case of GD diagnosed based on newly elevated thyroid-stimulating immunoglobulin (TSI) and thyroid-stimulating hormone (TSH) receptor autoantibody (TRAb) levels after SAT. Case Report: A 32-year-old Chinese man presented with right anterior neck pain, swelling, sore throat, cough, and fever. He had a diffuse tender goiter but no proptosis, lid lag, or stare. His TSH level was 0.03 mIU/mL (normal range [NR] 0.45-5.33 mIU/mL), serum free thyroxine (FT4) level was 2.40 ng/dL (NR 0.61-1.44 ng/dL), total triiodothyronine (TT3) level was 113 ng/dL (NR 87-178 ng/dL), TSI level was <0.10 IU/L (NR < 0.10 IU/L), and erythrocyte sedimentation rate was 21 mm/h (NR < 15 mm/h). After 7 weeks of prednisone, the symptoms resolved, FT4 level was 0.95 ng/dL, and TT3 level was 91 ng/dL. At 11 weeks after SAT onset, the TSH level was <0.01 mIU/mL, TT3 level was 257 ng/dL, FT4 level was 3.03 ng/dL, TSI level was 1.94 IU/L, then 3.42 IU/L 2 weeks later, TRAb level was 8.72 IU/L (NR < 2 IU/L), and erythrocyte sedimentation rate was 4 mm/h. After 1 month of methimazole, the FT4 level was 1.32 ng/dL and TT3 level was 110 ng/dL. Genetic testing revealed human leukocyte antigen-B35 and DRB1*15:01 positivity. Discussion: GD after SAT is thought to be due to the activation of thyroid autoimmunity induced by SAT in genetically susceptible individuals. Conclusions: This case illustrates the induction of thyroid autoimmunity after SAT, resulting in GD, supporting TSI and/or TRAb testing if hyperthyroidism recurs. The presence of HLA alleles associated with SAT and GD suggests a genetic contribution to the development of thyroid autoimmunity.

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Presence of Thyroid-Stimulating Hormone Receptor Antibodies in a Patient with Subacute Thyroiditis followed by Hypothyroidism and Later Graves' Disease with Ophthalmopathy: A Case Report

Cited by 10 publications

References 15 publications

Strong Correlation between HLA and Clinical Course of Subacute Thyroiditis—A Report of the Three Siblings

Strong Correlation between HLA and Clinical Course of Subacute Thyroiditis—A Report of the Three Siblings

Graves’ Thyrotoxicosis Following SARS-CoV-2 Infection

Graves Disease Following Subacute Thyroiditis in a Chinese Man

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