title: Concurrence of Graves' disease and dysplastic cerebral blood vessels of the moyamoya variety.
abstract: We describe two Caucasian women with the concurrence of Graves' disease and the moyamoya phenomenon (radiological evidence of collateral cerebral blood vessels like "puffs of smoke" due to cerebrovascular occlusive disease). One patient presented with acute cerebrovascular ischemia due to Moyamoya disease shortly after radioactive iodine therapy for Graves' disease and the second presented with Graves' disease 10 years after being diagnosed with moyamoya dysplastic cerebral vessels. The optimal treatment of hyperthyroidism in these patients is unknown; however, careful control of the hyperthyroidism by any modality seems reasonable. Our limited experience suggests that antithyroid drugs and radioactive iodine therapy are rational options. Thyroidectomy appears to be a safe therapeutic alternative, although long-term efficacy may be difficult to assure. Both of our patients had to be treated twice for hyperthyroidism. Whether Graves' disease and Moyamoya coexist because of an aggressive autoimmune mechanism is a concept that remains to be settled.
authors.affiliation: Division of Endocrinology, University of Connecticut Health Center, Farmington, USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Tendler
authors.forename: K
authors.initials: K
authors.lastname: Shoukri
authors.forename: C
authors.initials: C
authors.lastname: Malchoff
authors.forename: D
authors.initials: D
authors.lastname: MacGillivray
authors.forename: R
authors.initials: R
authors.lastname: Duckrow
authors.forename: T
authors.initials: T
authors.lastname: Talmadge
authors.forename: G R
authors.initials: GR
authors.lastname: Ramsby
mesh_terms: D000328:Adult; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006111:Graves Disease / Q000150:complications* / Q000628:therapy; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications* / Q000175:diagnosis; D009503:Neutropenia / Q000139:chemically induced / Q000628:therapy; D011441:Propylthiouracil / Q000009:adverse effects / Q000627:therapeutic use; D013965:Thyroidectomy; D014284:Triiodothyronine / Q000097:blood
chemical_list: D007457:Iodine Radioisotopes; D014284:Triiodothyronine; D016179:Granulocyte Colony-Stimulating Factor; D011441:Propylthiouracil