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Persistent hyperthyroidism and de novo Graves' ophthalmopathy after total thyroidectomy
Wei Lin Tay1, Wann Jia Loh2, Lianne Ai Ling Lee3
1Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
Endocrinology, Diabetes & Metabolism Case Reports
|October 25, 2017
Summary
Persistent hyperthyroidism after thyroid removal necessitates investigating other causes, such as struma ovarii. Thyroid-stimulating hormone receptor antibodies can persist post-thyroidectomy, potentially causing new Graves
Area of Science:
- Endocrinology
- Gynecology
- Ophthalmology
Background:
- Graves' disease is an autoimmune disorder causing hyperthyroidism.
- Persistent hyperthyroidism after total thyroidectomy is uncommon.
- Graves' ophthalmopathy is an extrathyroidal manifestation of Graves' disease.
Purpose of the Study:
- To report a case of persistent hyperthyroidism and new-onset Graves' ophthalmopathy after total thyroidectomy.
- To identify the underlying cause of persistent thyrotoxicosis in this patient.
- To highlight the potential role of struma ovarii in persistent Graves' disease.
Main Methods:
- Case report of a patient with Graves' disease.
- Review of clinical history, surgical findings, and histopathology.
- Hormonal assays and antibody testing.
Main Results:
- Patient remained hyperthyroid despite total thyroidectomy.
- Developed new-onset Graves' ophthalmopathy 5 months post-surgery.
- Mature cystic teratoma with struma ovarii identified in the ovary.
Conclusions:
- Persistent hyperthyroidism post-thyroidectomy requires investigation for alternative causes.
- Struma ovarii can present as a source of persistent thyrotoxicosis.
- Persistent TSH receptor antibodies may contribute to de novo Graves' ophthalmopathy.
Keywords:
2017AdultAsian – ChineseBilateral salpingo-oophorectomyBowel movements ȃ bleedingCT scanCarbimazoleDiplopiaDysphagiaFT3FT4FatigueFemaleGlucocorticoidsGoitreGoitre (multinodular)Graves’ diseaseGraves’ ophthalmopathyHeat intoleranceHistopathologyHyperthyroidismHysterectomyLevothyroxineMRIMenstrual disorderMyasthaeniaOctoberOvarian tumourPalpitationsPrednisoloneProptosisResection of tumourSalpingo-oophorectomySingaporeStruma ovariiTSHTSH receptor antibodiesThyroidThyroid antibodiesThyroidectomyThyroiditisThyrotoxicosisThyroxine (T4)TremulousnessTriiodothyronine (T3)Unique/unexpected symptoms or presentations of a diseaseWeight loss
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