Unilateral graves' disease: The lesser known

Manthri, Ranadheer Gupta; Ajit, Nimmagadda; Vaikakkara, Suresh; Devi, B Vijayalakshmi; Kalawat, Tekchand

doi:10.4103/ijnm.ijnm_11_19

Cited by 9 publications

(5 citation statements)

References 3 publications

(3 reference statements)

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“…This finding appeared analogous to unilateral Graves' disease, an extremely rare condition in which an “ a priori ” clonal heterogeneity is believed to explain the greater sensitivity to TSH stimulation by one of the two lobes. [ 4 ] In our patient, the difference of uptake between normal thyroid gland and thyroglossal duct remnant was only related to the anatomy of the neck and, consequently, to the different distance of the radiation sources from the plane of the detect.…”

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confidence: 77%

Usefulness of hybrid single.photon emission computed tomography/computed tomography in a case of ectopic thyroid tissue in the thyroglossal duct remnant

et al. 2021

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Here, we report a case of a 54-year-old woman affected by thyrotoxicosis, with scintigraphic evidence of a diffuse hyperfunctioning goiter and a large ectopic thyroid tissue in the thyroglossal duct remnant. The latter was apparently more active than the two lobes at 99m Tc-pertechnetate scintigraphy, mimicking a condition of preexisting increased sensitivity to thyroid-stimulating hormone stimulation. On the other hand, single-photon emission computed tomography/computed tomography has proven to be a very useful tool in demonstrating this activity to be similar to the thyroid lobes and in defining extension and anatomical relationships of the mass.

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confidence: 77%

Usefulness of hybrid single.photon emission computed tomography/computed tomography in a case of ectopic thyroid tissue in the thyroglossal duct remnant

et al. 2021

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“…Given the potential occurrence of temporary HT, which appears to be prevalent in our patient, we must regularly observe the patient for any indications or manifestations of hypothyroidism. The possible shift from Hashimoto's to Graves' suggested a need for vigilant follow-up for potential hypothyroid reversion and antibody activity changes affecting thyroid function [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

The Thyroid Swing: A Patient's Journey From Hypothyroidism to Hyperthyroidism

Alnahdi

2024

Cureus

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The flip from hyperthyroidism (HT), as observed in Graves' disease (GD) cases, to hypothyroidism associated with Hashimoto's disease (HD) has been widely recognized and documented. However, the converse is infrequently observed. The observed phenomenon is likely attributed to the major role played by thyroid-stimulating hormone receptor antibodies (TRAbs) in this alternating disease pattern and a substantial reduction in thyroid tissue mass that could be stimulated by these antibodies. Therefore, here we present a case of one middle-aged individual experiencing this transitional switch from hypothyroidism to GD. A 42-year-old male patient diagnosed with HD-related hypothyroidism for two years has remained stable with levothyroxine medication since diagnosis. However, his symptoms of thyrotoxicosis, such as anxiety, weight loss, and palpitations, had appeared during his follow-up time at the clinic. Physical examination revealed mild exophthalmos, which confirmed HT by thyroid function test results. The possibility of levothyroxine-induced HT was initially considered, although the observed symptoms failed to ameliorate despite the reduction and discontinuation of levothyroxine. The diagnosis of GD was confirmed after subsequent examination, and a follow-up was carried out. This particular case study underscores a distinctive correlation that carries substantial implications for the diagnosis and treatment of GD. The consideration of this shift is warranted in cases where HT continues to exist despite the reduction or cessation of levothyroxine treatment. The diagnosis is established through antibody titers and a radioiodine uptake scan. Treatment choice is based on the illness's stage and the patient's and care provider's preferences. In the initial phase, anti-thyroid medications may be employed. It is imperative to conduct regular follow-ups on these patients due to the potential transient nature of this clinical condition.

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“…The prevalence of hyperthyroidism is approximately 1.3% of the population, and Graves disease is the most common etiology [ 1 ]. Unilateral Graves disease is a rare presentation with approximately 20 cases reported worldwide [ 2–7 ]. Previously identified cases of unilateral Graves disease revealed both females and males being affected equally, despite Graves disease's preponderance for females in the general population [ 1 , 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Unilateral Graves disease is a rare presentation with approximately 20 cases reported worldwide [ 2–7 ]. Previously identified cases of unilateral Graves disease revealed both females and males being affected equally, despite Graves disease's preponderance for females in the general population [ 1 , 2 ]. The majority of the unilateral Graves disease cases in the literature involve right-sided uptake [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…The underlying pathophysiology of unilateral Graves disease is unclear. Hypotheses include differences in the amino acid structure of the thyroid antigens in each lobe that may result in asymmetrical B-cell infiltration in the thyroid, differences in TSH receptors, and differences in the sodium-iodine symporter expression between the thyroid lobes [ 2 ]. The presence of residual thyroid tissue (thyroglobulin level > 0.5 ng/dL) and Graves ophthalmopathy are strong predictors for persistently elevated autoantibody levels after surgery and may indicate a potential risk for relapse [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Unilateral Thyroid Lobe Involvement of Graves Disease

Alzedaneen

Chelsea²,

Reddy

et al. 2023

JCEM Case Reports

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A 30-year-old man presented with 3-year history of Graves disease. He was initially diagnosed after he developed unilateral proptosis and was initiated on methimazole 5 mg, on which he was currently euthyroid. Visible right-sided thyromegaly and trouble swallowing developed 2 months after presentation to our practice. Biochemical evaluation revealed suppressed TSH, normal free T4 and total T3, and elevated thyroid stimulating immunoglobulin with normal thyroid receptor antibody. An ultrasound of the thyroid demonstrated left-sided small nodules with right-sided thyromegaly. A nuclear medicine uptake scan revealed significantly greater uptake in the right thyroid lobe, with overall minimal uptake in the left lobe. The need for definitive therapy that would not exacerbate orbitopathy was discussed, and the patient elected for a right-sided hemithyroidectomy. Postoperative biochemical evaluation demonstrated biochemical euthyroidism despite continued elevation in thyroid stimulating immunoglobulin and newly elevated thyroid receptor antibody while remaining off methimazole. Graves disease can rarely involve a single thyroid lobe. Given the rarity, further investigation is needed to determine the natural course of this form of Graves disease.

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Unilateral graves' disease: The lesser known

Cited by 9 publications

References 3 publications

Usefulness of hybrid single.photon emission computed tomography/computed tomography in a case of ectopic thyroid tissue in the thyroglossal duct remnant

Usefulness of hybrid single.photon emission computed tomography/computed tomography in a case of ectopic thyroid tissue in the thyroglossal duct remnant

The Thyroid Swing: A Patient's Journey From Hypothyroidism to Hyperthyroidism

Unilateral Thyroid Lobe Involvement of Graves Disease

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