Thymic Hyperplasia and Graves Disease: Management of Anterior Mediastinal Masses in Patients with Graves Disease

Yacoub, Ator; Gaitonde, David Y; Wood, Jo

doi:10.4158/ep09025.orr

Cited by 21 publications

(16 citation statements)

References 21 publications

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“…There is no systematic, formal evaluation of how best to manage AMM in the setting of GD [3]. There is substantial variability in the rate of thymic involution as well as thymic size, shape and density even between individuals of the same age [6].…”

Section: Discussionmentioning

confidence: 99%

Mediastinal neoplasms in patients with Graves disease: a possible link between sustained hyperthyroidism and thymic neoplasia?

Boyd

Juskevicius

2012

Thyroid Res

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BackgroundAnterior mediastinal masses are a rare but well documented finding in Graves disease. The vast majority of these lesions represents benign thymic hypertrophy and regress after treatment of the hyperthyroidism. A small percentage of these cases however represent neoplastic/malignant diseases which require further treatment.Cases12 year old boy with one year history of refractory Graves disease was found to have an anterior mediastinal mass and underwent curative thyroidectomy for sustained hyperthyroidism. Cervical lymphadenopathy was detected during the procedure and biopsy was obtained. A 23 year old woman who presented with a one month history of hyperthyroid symptoms, was diagnosed with Graves disease and also was found to have an anterior mediastinal mass on imaging. Biopsy of the anterior mediastinal mass was obtained and subsequently the patient underwent robotic thymectomy. Histologic examination and immunophenotyping of the cervical lymph node in a 12 year old boy revealed neoplastic proliferation of T lymphoblasts diagnostic of T lymphoblastic leukemia/lymphoma. Examination of the anterior mediastinal mass biopsy in the 23 year old woman revealed type B1 thymoma which was confirmed after examination of the subsequent robotic thymectomy specimen.ConclusionThis is the first reported case of T cell lymphoblastic lymphoma and the third reported case of thymoma associated with sustained hyperthyroidism due to Graves disease. These cases indicate that an anterior mediastinal mass in a patient with active Graves disease may be due to a neoplastic cause, which may require definitive treatment. Caution should be exercised when dismissing a mediastinal mass as benign thymic hyperplasia in patients with active Graves disease.

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Section: Discussionmentioning

confidence: 99%

Mediastinal neoplasms in patients with Graves disease: a possible link between sustained hyperthyroidism and thymic neoplasia?

Boyd

Juskevicius

2012

Thyroid Res

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“…Some of the cases underwent thymic biopsy, while in others, the diagnosis relied on clinical findings, radiologic appearance consistent with a benign anterior mediastinal mass, laboratory evidence of hyperthyroidism, and regression or resolution of the mass with antithyroid therapy. At least one group reports a complication associated with thymectomy [14].…”

Section: Discussionmentioning

confidence: 99%

A case report of hyperthyroid-associated thymic hypertrophy in a child, presenting as an anterior mediastinal mass

2011

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We present the case of an 8-year-old boy with an anterior mediastinal mass and signs of hyperthyroidism. The anterior mediastinal mass had radiologic characteristics suggestive of thymic hypertrophy and regressed with antithyroid therapy. Though thymic hypertrophy is a known manifestation of hyperthyroidism, this is the youngest reported case. In selected cases, the diagnosis may be made based on the clinical picture, radiologic appearance, and response to antithyroid therapy without the need of a thymic biopsy or thymectomy.

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“…A diminuição da hiperplasia tímica pode levar até 2 anos, sendo que a diminuição mais óbvia parece ocorrer, em média, nos primeiros 6 meses 24 .…”

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“…O tratamento da DG, o seguimento clínico e a repetição do exame de imagem após 4 a 6 meses, é a prática mais consensual nestes casos 12,24,25 .…”

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Doença de Graves e hiperplasia do timo: caso clínico e revisão da literatura

2015

Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo

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A doença de graves (DG) é uma doença auto-imune sistémica e o atingimento de outros órgãos que não a tiróide é bem conhecido, nomeadamente sob a forma de oftalmopatia e dermopatia. A sua associação com hiperplasia do timo encontra-se estabelecida na literatura, sendo no entanto raramente notada na prática clínica já que, na maioria dos casos, o aumento de volume não atinge proporções significativas. Os autores apresentam o caso de uma doente de 34 anos enviada à consulta com quadro de emagrecimento e uma massa mediastínica anterior com 2,4×1,8 cm de etiologia a esclarecer. Após avaliação clínica e laboratorial o diagnóstico foi de doença de Graves. Relativamente à massa mediastínica, como as caracteristicas eram sugestivas de benignidade, postulou-se como hipótese mais provável tratar-se de uma doença de Graves com uma hiperplasia tímica associada. Procedeu-se ao controlo da função tiroideia com anti-tiroideus de síntese e adoptou-se uma atitude expectante relativamente à massa. Aos seis meses o diagnóstico foi confirmado pelo desaparecimento imagiológico da massa no exame de controle. Com este caso, realça-se a importância do reconhecimento da existência desta associação, de forma a evitar procedimentos invasivos desnecessários e não isentos dos riscos. A B S T R A C TGraves' disease (GD) is a systemic autoimmune disease and it's effects on other organs rather than thyroid is well known, particularly it's association to ophthalmopathy and dermopathy. It's association with thymic hyperplasia is now well established in the literature, however rarely noted in clinical practice. This is in part due to the fact that in most cases the increase in volume does not reach significant proportions. The authors present the case of a patient of 34 years sent to the department with a history of weight lost and an anterior mediastinal mass with 2.4×1,8 cm of unknown etiology. After clinical and laboratory evaluation, the diagnosis was GD. The mediastinal mass was postulated to be a thymic hyperplasia as it had imagiologic characteristics suggestive of benignity. The control of thyroid function with antithyroid drugs was the treatment of choice along with an expectant attitude with respect to the mass. After six months of treatment, the diagnosis was confirmed by the disappearance of the mass in the imagiologic controle examination. This case highlights the importance of recognizing the existence of this association, in order to avoid unnecessary invasive procedures which are not free from risks.

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Thymic Hyperplasia and Graves Disease: Management of Anterior Mediastinal Masses in Patients with Graves Disease

Cited by 21 publications

References 21 publications

Mediastinal neoplasms in patients with Graves disease: a possible link between sustained hyperthyroidism and thymic neoplasia?

Mediastinal neoplasms in patients with Graves disease: a possible link between sustained hyperthyroidism and thymic neoplasia?

A case report of hyperthyroid-associated thymic hypertrophy in a child, presenting as an anterior mediastinal mass

Doença de Graves e hiperplasia do timo: caso clínico e revisão da literatura

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