Ayse ARDUC, Mazhar Muslum TUNA, Bercem AYCİCEK DOGAN, Gulhan AKBABA, Dilek BERKER, Serdar GULER

Thyroid Gland Hemiagenesis with Multinodular Graves' Disease: A Case Report [Multinodüler Graves' Hastaliğinin Eşlik Ettiği Tiroid Hemiagenezili Olgu]

AbstractThyroid 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. Keywords: Thyroid hemiagenesis, Graves' disease, multinodular goiter

Anahtar Kelimeler:

Tiroid hemiagenezisi, Graves' hastalığı, multinodüler guatr

PDF

___

Kaynaklar
McHenry CR, Walfish PG, Rosen IB, Lawrence AM, Paloyan E. Congenital thyroid hemiagenesis. Am Surg. 1995;61(7):634-8.
Mikosch P, Gallowitsch HJ, Kresnik E, Molnar M, Gomez I, Lind P. Thyroid hemiagenesis in an endemic goiter area diagnosed by ultrasonography: report of sixteen patients. Thyroid. 1999;9(11):1075-84.
Berker D, Ozuguz U, Isik S, Aydin Y, Ates Tutuncu Y, Akbaba G, Guler S. A report of ten patients with thyroid hemiagenesis: ultrasound screening in patients with thyroid disease. Swiss Med Wkly. 2010;140(7-8):118-21
Shabana W, Delange F, Freson M, Osteaux M, De Schepper J. Prevalence of thyroid hemiagenesis: ultrasound screening in normal children. Eur J Pediatr. 2000;159:456-8.
Korpal-Szczyrska M, Kosiak W, Swieton D. Prevalence of thyroid hemiagenesis in an asymptomatic schoolchildren population. Thyroid. 2008;18(6):637-9.
Ruchala M, Szczepanek E, Szaflarski W, Moczko J, Czarnywojtek A, Pietz L, Nowicki M, Niedziela M, Zabel M, Köhrle J, Sowinski J. Increased risk of thyroid pathology in patients with thyroid hemiagenesis: results of a large cohort case-control study. Eur J Endocrinol. 2010;162(1):153-60.
Gursoy A, Anil C, Unal AD, Demirer AN, Tutuncu NB, Erdogan MF. Clinical and epidemiological characteristics of thyroid hemiagenesis: ultrasound screening in patients with thyroid disease and normal population. Endocrine. 2008;33(3):338-41.
Melnick JC, Stemkowski PE. Thyroid hemiagenesis (hockey stick sign): a review of the world literature and a report of four cases. J Clin Endocrinol Metab. 1981;52(2):247-51.
Polak M, Sura-Trueba S, Chauty A, Szinnai G, Carré A, Castanet M. Molecular mechanisms of thyroid dysgenesis. Horm Res. 2004;62 Suppl 3:14-21.
Castanet M, Leenhardt L, Léger J, Simon-Carré A, Lyonnet S, Pelet A, Czernichow P, Polak M. Thyroid hemiagenesis is a rare variant of thyroid dysgenesis with a familial component but without Pax8 mutations in a cohort of 22 cases. Pediatr Res. 2005;57(6):908-13.
Knobel M, Medeiros-Neto G. An outline of inherited disorders of the thyroid hormone generating system. Thyroid. 2003;13(8):771-801.
Karabay N, Comlekci A, Canda MS, Bayraktar F, Degirmenci B. Thyroid hemiagenesis with multinodular goiter: a case report and review of the literature. Endocr J. 2003;50(4):409-13.
Klein I, Becker DV, Levey GS. Treatment of hyperthyroid disease. Ann Intern Med. 1994;121(4):281-8.
Wartofsky L, Glinoer D, Solomon B, Nagataki S, Lagasse R, Nagayama Y, Izumi M. Differences and similarities in the diagnosis and treatment of Graves' disease in Europe, Japan, and the United States. Thyroid. 1991;1(2):129-35.
Mazza E, Carlini M, Flecchia D, Blatto A, Zuccarini O, Gamba S, Beninati S, Messina M. Long-term follow-up of patients with hyperthyroidism due to Graves' disease treated with methimazole. Comparison of usual treatment schedule with drug discontinuation vs continuous treatment with low methimazole doses: a retrospective study. J Endocrinol Invest. 2008;31(10):866-72.
Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN; American Thyroid Association; American Association of Clinical Endocrinologists. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593-646.