Pendulum swings from hypo- to hyperthyroidism: thyrotoxicosis after severe hypothyroidism following neck irradiation in a patient with a history of Hodgkin's lymphoma

Thyroid Research
Krzysztof C LewandowskiAndrzej Lewiński

Abstract

A change in a thyrometabolic state from severe hypothyroidism to thyrotoxicosis is very uncommon, but possible in some circumstances. A 27-year old female presented with clinical and biochemical thyrotoxicosis with a previous history chemo- and radiotherapy (including the neck region) for a Hodgkin's lymphoma (at the age of 18). At the age of 20 this was followed by severe hypothyrodism [TSH > 100 μIU/mL (reference range: 0.27-4.2)]. She was stated on L-thyroxine, but the dose was later reduced and subsequently discontinued. She had significantly elevated titres of both anti-thyroid peroxidase antibodies and anti-TSH-receptor antibodies throughout the course of disease. Thyroid scintigraphy revealed a normal and homogenous iodine uptake. We suspect that a gradual switch from thyroid-blocking to thyroid-stimulating antibodies resulted in development of an overt thyrotoxicosis, possibly with a contributory effect of neck irradiation on her autoimmune status.

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Citations

Aug 8, 2018·Endocrinology, Diabetes & Metabolism Case Reports·Ehtasham AhmadApostolos Vrettos
May 28, 2019·Expert Review of Endocrinology & Metabolism·Jonathan C Howell, Susan R Rose
Sep 27, 2019·International Journal of Molecular Sciences·Agnieszka PolakMaria Klatka
Sep 24, 2019·Case Reports in Oncology·Natalie MoraMohamed K M Shakir

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Methods Mentioned

BETA
hormone-replacement therapy

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