Management Consideration for Anterior Mediastinal Mass in a Patient With Grave's Disease

A 36-year-old active duty female presented to an outside hospital emergency department for the evaluation of chest pain and weakness. Per report, comprehensive evaluation ruled out acute cardiopulmonary conditions. A computerized tomography scan revealed a large homogeneous anterior mediastinal mass. The patient was referred to a cardiothoracic surgeon who discussed treatment options, including surgery. She was subsequently referred to an interventional radiologist, who performed a biopsy. Findings were consistent with thymic hyperplasia without evidence of malignant cells. Follow-up with her primary care physician revealed an undetectable thyroid-stimulating hormone (TSH) level, and she was subsequently diagnosed with Graves' disease (GD). The primary care physician referred her to an endocrinologist who initiated treatment with methimazole. The patient's GD responded well to medication therapy; the thymic mass size decreased and her exercise tolerance increased. Notably, testing for TSH levels upon initial presentation could have avoided the need for biopsy.