title: Hyperthyroid Graves' disease after hemithyroidectomy for papillary carcinoma: report of three cases.
abstract: Here we report three cases of hyperthyroid Graves' disease that occurred after partial thyroidectomy for papillary carcinoma. In Case 1, the patient first developed hyperthyroidism 2 years after resection of left thyroid lobe, was treated for 2 years with antithyroid drug which was then discontinued, and relapsed with periodic paralysis after 8 years of remission. In Case 2, a hyperfunctioning remnant thyroid was noted 22 years after right hemithyroidectomy. In Case 3, where thyrotoxic symptoms became evident 7 weeks after right hemithyroidectomy, autoantibodies to thyroglobulin and thyroid microsome were positive in preoperative serum, in line with a report by others detecting these antibodies in 2 out of 3 such cases examined. Later bioassay revealed activity of thyroid stimulating antibodies in that serum, with further increase in titer in the sample taken at the clinical manifestation. Hence in Case 3, surgical stress may have altered immunological homeostasis, promoting a preclinical Graves' disease to full-blown hyperthyroidism.
authors.affiliation: Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University Graduate School of Medicine, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Misaki
authors.forename: M
authors.initials: M
authors.lastname: Iwata
authors.forename: K
authors.initials: K
authors.lastname: Kasagi
authors.forename: Y
authors.initials: Y
authors.lastname: Iida
authors.forename: T
authors.initials: T
authors.lastname: Akamizu
authors.forename: S
authors.initials: S
authors.lastname: Kosugi
authors.forename: J
authors.initials: J
authors.lastname: Konishi
mesh_terms: D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood; D002291:Carcinoma, Papillary / Q000150:complications / Q000601:surgery*; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating; D008297:Male; D008713:Methimazole / Q000627:therapeutic use; D008875:Middle Aged; D011989:Receptors, Thyrotropin / Q000097:blood; D012008:Recurrence; D013670:Sodium Pertechnetate Tc 99m; D013964:Thyroid Neoplasms / Q000150:complications / Q000601:surgery*; D013965:Thyroidectomy; D013972:Thyrotropin / Q000097:blood
chemical_list: D013956:Antithyroid Agents; D001323:Autoantibodies; D018828:Immunoglobulins, Thyroid-Stimulating; D011989:Receptors, Thyrotropin; C094372:thyrotropin-binding inhibitory immunoglobulin; D008713:Methimazole; D013972:Thyrotropin; D013670:Sodium Pertechnetate Tc 99m