The Unusual Late-Onset Graves’ Disease following Hashimoto’s Related Hypothyroidism: A Case Report and Literature Review
Background. The shift of Graves’ disease (GD) to Hashimoto’s disease- (HD-) related hypothyroidism is well established. However, the opposite is rare. This is likely to the loss of critical thyroid mass available for stimulation by thyroid hormone receptor stimulating antibody, making this shift unu...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
|
| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2020/5647273 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832566076632727552 |
|---|---|
| author | Aseel Sukik Sara Mohamed Mhd-Baraa Habib Sundus Sardar Bashar Tanous Raad Tahtouh Mouhand F. H. Mohamed |
| author_facet | Aseel Sukik Sara Mohamed Mhd-Baraa Habib Sundus Sardar Bashar Tanous Raad Tahtouh Mouhand F. H. Mohamed |
| author_sort | Aseel Sukik |
| collection | DOAJ |
| description | Background. The shift of Graves’ disease (GD) to Hashimoto’s disease- (HD-) related hypothyroidism is well established. However, the opposite is rare. This is likely to the loss of critical thyroid mass available for stimulation by thyroid hormone receptor stimulating antibody, making this shift unusual. Herein, we report a young lady with a late shift from HD into GD and present a scoping literature review. Case presentation. We report a twenty-five-year-old lady with a sixteen-year-history of Hashimoto’s-related hypothyroidism stable on levothyroxine. While following in the clinic, she started developing thyrotoxic symptoms in the form of anxiety, weight loss, and palpitation. Physical examination was remarkable for mild exophthalmos. The thyroid function test confirmed hyperthyroidism. Levothyroxine-induced hyperthyroidism was initially suspected; however, the symptoms did not improve despite reducing and stopping levothyroxine. Subsequent workup confirmed the diagnosis of GD. Discussion and Conclusion. This case highlights a unique association that has significant diagnostic and management implications. This shift should be considered when hyperthyroidism persists despite reducing or stopping levothyroxine. The diagnosis is made utilizing antibody titers and radioiodine update scan. While the management depends on the disease’s stage and the treating physician preference, antithyroid agents can be used initially. Following up these patients is essential as the shift can be transient. |
| format | Article |
| id | doaj-art-7ca216acfb8242989313b065ec5de877 |
| institution | Kabale University |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-7ca216acfb8242989313b065ec5de8772025-02-03T01:05:15ZengWileyCase Reports in Endocrinology2090-65012090-651X2020-01-01202010.1155/2020/56472735647273The Unusual Late-Onset Graves’ Disease following Hashimoto’s Related Hypothyroidism: A Case Report and Literature ReviewAseel Sukik0Sara Mohamed1Mhd-Baraa Habib2Sundus Sardar3Bashar Tanous4Raad Tahtouh5Mouhand F. H. Mohamed6Internal Medicine Department, Hamad Medical Corporation, Doha, QatarInternal Medicine Department, Hamad Medical Corporation, Doha, QatarInternal Medicine Department, Hamad Medical Corporation, Doha, QatarInternal Medicine Department, Hamad Medical Corporation, Doha, QatarInternal Medicine Department, Hamad Medical Corporation, Doha, QatarInternal Medicine Department, Hamad Medical Corporation, Doha, QatarInternal Medicine Department, Hamad Medical Corporation, Doha, QatarBackground. The shift of Graves’ disease (GD) to Hashimoto’s disease- (HD-) related hypothyroidism is well established. However, the opposite is rare. This is likely to the loss of critical thyroid mass available for stimulation by thyroid hormone receptor stimulating antibody, making this shift unusual. Herein, we report a young lady with a late shift from HD into GD and present a scoping literature review. Case presentation. We report a twenty-five-year-old lady with a sixteen-year-history of Hashimoto’s-related hypothyroidism stable on levothyroxine. While following in the clinic, she started developing thyrotoxic symptoms in the form of anxiety, weight loss, and palpitation. Physical examination was remarkable for mild exophthalmos. The thyroid function test confirmed hyperthyroidism. Levothyroxine-induced hyperthyroidism was initially suspected; however, the symptoms did not improve despite reducing and stopping levothyroxine. Subsequent workup confirmed the diagnosis of GD. Discussion and Conclusion. This case highlights a unique association that has significant diagnostic and management implications. This shift should be considered when hyperthyroidism persists despite reducing or stopping levothyroxine. The diagnosis is made utilizing antibody titers and radioiodine update scan. While the management depends on the disease’s stage and the treating physician preference, antithyroid agents can be used initially. Following up these patients is essential as the shift can be transient.http://dx.doi.org/10.1155/2020/5647273 |
| spellingShingle | Aseel Sukik Sara Mohamed Mhd-Baraa Habib Sundus Sardar Bashar Tanous Raad Tahtouh Mouhand F. H. Mohamed The Unusual Late-Onset Graves’ Disease following Hashimoto’s Related Hypothyroidism: A Case Report and Literature Review Case Reports in Endocrinology |
| title | The Unusual Late-Onset Graves’ Disease following Hashimoto’s Related Hypothyroidism: A Case Report and Literature Review |
| title_full | The Unusual Late-Onset Graves’ Disease following Hashimoto’s Related Hypothyroidism: A Case Report and Literature Review |
| title_fullStr | The Unusual Late-Onset Graves’ Disease following Hashimoto’s Related Hypothyroidism: A Case Report and Literature Review |
| title_full_unstemmed | The Unusual Late-Onset Graves’ Disease following Hashimoto’s Related Hypothyroidism: A Case Report and Literature Review |
| title_short | The Unusual Late-Onset Graves’ Disease following Hashimoto’s Related Hypothyroidism: A Case Report and Literature Review |
| title_sort | unusual late onset graves disease following hashimoto s related hypothyroidism a case report and literature review |
| url | http://dx.doi.org/10.1155/2020/5647273 |
| work_keys_str_mv | AT aseelsukik theunusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT saramohamed theunusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT mhdbaraahabib theunusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT sundussardar theunusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT bashartanous theunusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT raadtahtouh theunusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT mouhandfhmohamed theunusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT aseelsukik unusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT saramohamed unusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT mhdbaraahabib unusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT sundussardar unusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT bashartanous unusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT raadtahtouh unusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview AT mouhandfhmohamed unusuallateonsetgravesdiseasefollowinghashimotosrelatedhypothyroidismacasereportandliteraturereview |