[Particular evolution of the thyroid state in Grave's disease: two cases].
We report two cases of Grave's disease (GD) caracterized by the succession of hypothyroid and hyperthyroid states. Case 1: A 32 years old woman, has presented initially a typical GD with hyperthyroidism. Grave's ophtalmopathy and homogenous goiter. Four months later, she presented a spontaneous hypothyroidism necessiting treatment with thyroxine and a severe myasthenia gravis. More later (6 months), she experienced symptoms of hyperthyroidism after thymectomy. The level of anti-thyrotropin-receptor antibodies (TSab) was very high (141 UI/I, NV < 10). Case 2: A 29 years old woman has been treated by thyroxine (150 microg/day) for a primary hypothyroidism. Ten months later, she presented symptoms of hyperthyroidism even after stoppage of thyroxine. TSH value was decreased (TSH < 0.05 microU/ml) and FT4 level was raised (FT4 = 25.5 pmol/l). The thyroid antibodies were positive. We discuss, after review of the litterature, the physiopathological mecanisms of these changes in the thyroid state, particularly the role of the blocking and stimulating anti-thyrotropin-receptor antibodies.
Cherif
Lotfi
L
Service de Néphrologie et de Médecine Interne, Unité d'Endocrinologie, Hôpital Charles Nicolle, Tunis.
Ben Abdallah
Néjib
N
Khairi
Karima
K
Hadj Ali
Inçaf
I
Turki
Sami
S
Ben Maïz
Hédi
H
D000328:Adult; D001323:Autoantibodies / Q000097:blood; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000276:immunology; D006801:Humans; D007037:Hypothyroidism / Q000150:complications; D011989:Receptors, Thyrotropin / Q000276:immunology
D001323:Autoantibodies; D011989:Receptors, Thyrotropin