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Hyperthyroidism after primary hypothyroidism. Follow-up with serial thyroid biopsies.

N Wakakuri, T Kubo, M Kitagawa

Archives of Internal Medicine

|August 1, 1985

Summary

Primary hypothyroidism can evolve into hyperthyroidism in adults with chronic lymphocytic thyroiditis. This condition may see spontaneous resolution of thyroiditis and antibody levels, indicating non-permanent histologic changes.

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Area of Science:

Endocrinology
Immunology
Pathology

Background:

Chronic lymphocytic thyroiditis (CLT), also known as Hashimoto's thyroiditis, is a common cause of primary hypothyroidism.
The natural history of CLT, particularly its potential for spontaneous remission or evolution into other thyroid states, is not fully understood.

Observation:

A 46-year-old male patient initially presented with primary hypothyroidism.
The patient was diagnosed with serologically and histologically confirmed chronic lymphocytic thyroiditis.
Follow-up thyroid biopsies demonstrated a resolution of the histologic features of CLT.

Findings:

The patient's hypothyroidism spontaneously evolved into a hyperthyroid state.
Circulating antithyroid antibody titers decreased in parallel with the histologic improvement of the thyroid.

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Histologic abnormalities associated with chronic lymphocytic thyroiditis were found to be potentially reversible.

Implications:

This case suggests that primary hypothyroidism in adults can spontaneously transition to hyperthyroidism.
The findings challenge the notion that the histologic changes in chronic lymphocytic thyroiditis are always irreversible.
Further research into the dynamic nature of autoimmune thyroid diseases is warranted.