Graves' disease in a renal transplant

The occurrence of hyperthyroidism and/or Graves' disease (GD) in transplant recipients receiving immunosuppressive therapy is extremely rare. A 47-year-old man developed GD after renal transplantation while he was under adequate immunosuppressive therapy. To our knowledge, the case presented here is the second case report of GD developed in a renal transplant recipient under adequate immunosuppressive therapy. The patient had undergone a renal transplantation 2 years before, and since then, he had been receiving continuous immunosuppressive therapy with cyclosporine A and prednisone. He presented with 3 months' history of palpitation, excessive sweating, weakness, heat intolerance and weight loss. Thyroid ultrasonography and scan revealed diffusely enlarged thyroid gland without nodules. The finding of elevated serum levels of thyroid hormones and suppressed TSH level subsequently confirmed hyperthyroidism. A diagnosis of GD was made after the demonstration of elevated thyroid autoantibodies. Although the mechanisms involved in transplant rejection and human autoimmunity are thought to be similar, the development of GD in a patient receiving therapeutic immunosupression suggests that different immunologic processes may be involved in GD. Further studies seem to be needed since the pathogenetic mechanisms suggested in the literature so far are not satisfactory to explain the development of GD in transplant patients under adequate immunosuppressive therapy.