title: Hyperthyroidism following primary hypothyroidism in association with polyendocrine autoimmunity.
abstract: A 37 year old male with a strong family history of autoimmune disease presented with typical symptoms of hyperthyroidism. He had exophthalmos but no goitre. Hyperthyroidism was confirmed by failure of 131I neck uptake to suppress after 7 days treatment with triiodothyronine. Six years previously a diagnosis of primary hypothyroidism has been made. At diagnosis of hyperthyroidism, thyroglobulin antibodies, thyroidal microsomal antibodies and thyroid stimulating immunoglobulins were detected. The absence of thyroid growth stimulating immunoglobulins and presence of immunoglobulins blocking TSH-induced growth may account for the absence of goitre throughout. HLA -B8, -B, -DR3 and -DR4 genotypes, low C4 complement concentrations and islet cell autoantibodies were detected at the time of diagnosis and 1 year later diabetes mellitus developed.
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology* / Q000235:genetics / Q000276:immunology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology* / Q000235:genetics / Q000276:immunology; D007037:Hypothyroidism / Q000150:complications* / Q000235:genetics / Q000276:immunology; D007328:Insulin / Q000097:blood; D008297:Male; D013954:Thyroglobulin / Q000276:immunology
chemical_list: D007328:Insulin; D013954:Thyroglobulin