Ayşe ARDUÇ, Mazhar Müslüm TUNA, Berçem AYÇİÇEK DOĞAN, Gülhan AKBABA, DİLEK BERKER, Serdar GÜLER

Thyroid Gland Hemiagenesis with Multinodular Graves' Disease: A Case Report

Tiroid hemiagenezisi (THA) nadir bir konjenital anomalidir. Tiroid sol lobunda ve kadınlarda daha sık görülür. Vakaların çoğu asemptomatiktir. THA'ye en sık eşlik eden tiroid patolojileri nontoksik noduler guatr ve Hashimoto's tiroiditidir, Graves' hastalığı ile birlikteliği ise çok nadirdir. Biz THA ile birlikte multinodüler Graves' hastalığı olan erkek olguyu sunuyoruz. Çarpıntı, ellerde titreme ve kilo kaybı nedeniyle başvuran 47 yaşındaki erkek hastanın laboratuar incelemesinde aşikar tirotoksikoz ve TSH reseptör antikor (TRAB) pozitifliği saptandı (TSH=0.04 µIU/ml serbest T4=1.3 ng/dl serbest T3=4.5 pg/ml TRAB=35 IU/l ). Tiroid ultrasonografisinde sağ lobda en büyüğü 6x11x17 mm olan nodüller izlendi, sol lob görüntülenemedi. Tc-99m tiroid sintigrafisinde sağ lobda aktivite tutulumu artmış, sol lobda aktivite tutulumu yoktu. Multinodüler Graves' hastalığı ve tiroid hemiagenezisi tanısı konulan hastaya metimazol tedavisi başlandı. Hemiagenezik tiroid bezinde Graves' hastalığı çok nadir de olsa gelişebilmektedir ve hipertiroidi ile başvuran hastalarda ayırıcı tanıda akılda tutulmalıdır

[Multinodüler Graves' Hastaliğinin Eşlik Ettiği Tiroid Hemiagenezili Olgu]

Thyroid hemiagenesis (THA) is a rare congenital anomaly. It occurs more frequently in the left lobe and predominantly in women. Most of the cases are asymptomatic. The most frequent associated thyroid disorders with THA are nontoxic nodular goiter and Hashimoto's thyroiditis whereas association of Graves' disease with THA is very rare. We present a man patient with THA and multinodular Graves' disease. A 47-year-old male was admitted with palpitation, hand tremor, and weight loss, and was found to have overt thyrotoxicosis and high TSH receptor antibody (TRAB) levels in laboratory analysis (TSH=0.04 µIU/ml sT4=1.3 ng/dl sT3=4.5 pg/ml TRAB=35 IU/l ). Thyroid ultrasonography revealed multiple thyroid nodules (largest one 6x11x17 mm in diameter) in the right lobe; the left lobe was not visualized. Tc-99m thyroid scan showed increased uptake of radioisotope in the right lobe, and there was no uptake in the left lobe. Based on these findings, the patient was diagnosed with THA and multinodular Graves' disease, and started on metimazole treatment. Although very rare, Graves' disease may occur in patients with THA, and it should be considered in the differential diagnosis of patients presenting with hyperthyroidism

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