The Marine-Lenhart syndrome revisited

Abstract

The coexistence of thyroid autonomy (Plummer's disease) and Graves' disease has been termed "Marine-Lenhart syndrome". During the last years, several papers have been published on the development of Graves' disease shortly after radioiodine therapy of Plummer's disease (autonomy). Especially in patients with elevated thyroid antibodies, the incidence of this event is significantly higher after radioiodine therapy of autonomy. A review of the literature dating back to 1911 is discussed in this paper. The original paper published by Marine and Lenhart comes to the conclusion that the two diseases are different expressions of one disease. Looking at the literature, we have to state now that the Marine-Lenhart syndrome has never existed: With Plummer we know now that Plummer's and Graves' disease are different diseases. They may develop in the same patient but independent from each other.

A Case of Marine-Lenhart Syndrome with a Negative TSH Receptor Antibody Titer Successfully Treated with a Fixed, Low Dose of I131

“…There is a previous case report of Marine-Lenhart syndrome associated with a negative TRAb titer, positive TPO antibody titer, and positive TG antibody titer [3]. However, in that report, the ultrasonographic study showed no nodularity, as pointed out in a review by Biersack and Biermann [2]. In addition, Chatzopoulos et al previously reported a case of Marine-Lenhart syndrome associated with a negative TRAb titer [4].…”

“…Hyperthyroidism also results from autonomic functioning adenomas (solitary toxic adenoma or Plummer disease) [1]. Marine-Lenhart syndrome is a rare disorder consisting of both Graves' disease and Plummer disease [2]. There have been various case reports describing Marine-Lenhart syndrome; however, to the best of our knowledge, all previously reported cases except two cases involved a positive TRAb titer [2–4].…”

An uncommon case of Marine-Lenhart syndrome

“…In a unifying pathogenetic hypothesis, it has also been proposed that autoimmunity, such as presence, intrinsic function and concentration of TRAb may influence the preferential development of diffuse or nodular follicular hyperplasia (19), and further enhance nodules activity (20). But several authors believe that Marine-Lenhart syndrome may be due to different pathological mechanisms that occur independently of each other in the same patients, without any relationship between TRAb positivity, and nodular growth and/or function (21). Therefore, the diagnosis of Marine-Lenhart syndrome remains difficult to be determined, and the simultaneous occurrence of the two diseases is still matter of debate (21,22).…”

“…But several authors believe that Marine-Lenhart syndrome may be due to different pathological mechanisms that occur independently of each other in the same patients, without any relationship between TRAb positivity, and nodular growth and/or function (21). Therefore, the diagnosis of Marine-Lenhart syndrome remains difficult to be determined, and the simultaneous occurrence of the two diseases is still matter of debate (21,22). As it occurred in some case reports (7,8,22), there has been also controversy regarding how to diagnose Marine-Lenhart syndrome, depending on which imaging techniques have been used to identify the thyroid nodule.…”

“…Besides the coexistence of thyroid autonomy (Plummer's disease) and Graves' disease, which is sometimes questionable (21,22), it is also possible that the two diseases may occur in the same patient years apart. There is literature on the risk that Graves-like hyperthyroidism may develop after radioiodine treatment in patients with elevated serum TPO-Ab levels at baseline (15,16), as well as in TPOAb-negative patients at baseline who became TPOAb-positive after treatment (17,18).…”