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Transient Graves disease developing after surgery for Cushing disease
Hiroyuki Morita1, Mako Isaji, Tomoatsu Mune
1Department of General Medicine, Gifu University School of Medicine, Japan. hmorita@cc.gifu-u.ac.jp
The American Journal of the Medical Sciences
|March 23, 2002
Summary
This study reports the first case of Graves disease developing after successful Cushing disease surgery. High cortisol levels may suppress underlying thyroid autoimmunity, which can emerge after treatment.
Area of Science:
- Endocrinology
- Immunology
- Neurosurgery
Background:
- Cushing disease, a condition caused by excess cortisol, can mask other endocrine disorders.
- Successful surgical treatment of Cushing disease involves normalizing cortisol levels, which may unmask latent conditions.
Observation:
- A patient with Cushing disease developed Graves disease post-surgery.
- Thyroid stimulating hormone (TSH) was suppressed initially, but later, anti-TSH receptor antibodies (TRAb) and thyroid stimulating antibodies (TSAb) increased.
Findings:
- The patient presented with thyrotoxicosis and elevated TSAb and TRAb levels, confirming Graves disease.
- Thyroid hormone levels and TRAb spontaneously normalized over time, suggesting a self-limiting process.
Implications:
- Hypercortisolism may suppress latent autoimmune thyroid disease.
- Abrupt reduction of glucocorticoids post-surgery can trigger the development of overt Graves disease.
- This case highlights the complex interplay between the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes.