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| |  Unusual Combination of Graves' Disease and Subacute Thyroiditis in the Same Patient: Presented at AACE By Maggie Schwarz WASHINGTON, DC -- May 25, 2005 -- Although rare, physicians should be aware of the possible occurrence of Graves' disease and subacute thyroiditis in the same patient. The unusual case report of such a patient was presented here May 19th at the American Association of Clinical Endocrinologists (AACE) 14th Annual Meeting and Clinical Congress. "The transformation from hyperthyroidism to hypothyroidism in this patient serves as a reminder for primary care physicians to refer fluctuating Graves' disease cases to an endocrinologist early," said Sujata M. Wagh, MD, a research fellow in clinical endocrinology at the University of Massachusetts Medical Center in Worcester, Massachusetts, United States. A 33-year-old woman with an unremarkable medical history developed hyperthyroidism, and treatment was initiated with methimazole 10 mg daily. Eleven months later, while still taking methimazole, she exhibited hypothyroidism and had developed abrupt painful enlargement of the thyroid. She could not be contacted after thyroid test results became available. She returned 2 months later with an enlarging goiter, fatigue, weight gain, hoarseness, and depressed mood. An NSAID was prescribed for pain; methimazole was discontinued and levothyroxine begun at 100 mg/d. Eight months after levothyroxine therapy had been instituted, her serum thyroid-stimulating hormone level was still mildly elevated at 4.94 mIU/mL. Several cases of painful goiter followed by rapidly progressive thyroid failure in patients with hyperthyroid Graves' disease have been reported. Most of these patients were treated with glucocorticoids or anti-inflammatory drugs and experienced pain relief. In a few cases, these painful episodes have reportedly been recurrent, even during the hypothyroid phase, and have necessitated subtotal thyroidectomy for prevention of further episodes. In contrast to most cases of subacute thyroiditis, patients with Graves' disease in whom subacute thyroiditis develops usually have sustained thyroid failure. "Primary care physicians need to be aware of the phenomenon of Graves' disease spontaneously resolving on its own," concluded Dr. Wagh. "It usually results in sustained hypothyroidism."
[Presentation title: Painful Thyroiditis in a Patient With Graves' Disease.]
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