Recurrent hyperthyroidism after radioiodine-induced hypothyroidism: report of two cases and literature review.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
G H Tan, H Gharib

Abstract

The practice at the Mayo Clinic in treating Graves' disease with radioiodine (131 I) is to achieve a hypothyroid state. Less than 10% of the patients need more than one dose. Although cases of transient hypothyroidism have been reported after treatment with 131 I, the recurrence of hyperthyroidism is unusual after hypothyroidism has been induced with 131 I. We studied two cases seen at our institution in the past year in which the circumstances behind the recurrence have never been reported previously. The first case illustrates a recurrence of hyperthyroidism after the patient had received 38.5 mCi of 131 I. The second patient had recurrence of hyperthyroidism after 22 years of replacement therapy with levothyroxine. Both patients had increased levels of thyroid-stimulating immunoglobulin. We believe that the recurrence of the hyperthyroid state in these two patients was due to incomplete ablation of the thyroid. Apparently 131 I caused hypothyroidism, but residual cells remained viable and under continuous stimulation of thyroid-stimulating immunoglobulin produced recurrent thyrotoxicosis.

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Citations

Nov 20, 2001·Scandinavian Journal of Clinical and Laboratory Investigation. Supplementum·B R Smith
Jan 16, 1998·Endocrinology and Metabolism Clinics of North America·G G Klee, I D Hay
Apr 16, 1998·Endocrinology and Metabolism Clinics of North America·M M KaplanH J Dworkin
Nov 18, 2009·Cases Journal·Arnaldo Moura NetoDenise Engelbrecht Zantut-Wittmann
Dec 25, 2007·Arquivos brasileiros de endocrinologia e metabologia·Viviane CanadasEnio Castellar
Sep 26, 2017·Therapeutic Advances in Endocrinology and Metabolism·Fariha SalmanEbenezer Nyenwe

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