Recently viewed 0 Save Search. EDM Case Reports. Open access. Get Citation Alerts Get Permissions. Download PDF. Check for updates. Learning points Autoimmune alternating hypo- and hyper-thyroidism is a highly uncommon condition in the pediatric age.
Case presentation A previously healthy year-old girl, referred for evaluation, presented in the clinic with a slightly increased thyroid volume, and a subclinical hyperthyroidism observed in June , with no signs or symptoms table 1. Discussion In this clinical case, there is an alternation between hyper- and hypothyroidism associated with elevated levels of antithyroglobulin, antithyroid peroxidase and TRAbs, with ultrasonographic and scintigraphic findings compatible both with thyroiditis and Graves' disease, respectively.
Conclusion Autoimmune alternating hypo- and hyper-thyroidism is a highly uncommon challenging condition, particularly in the pediatric age, and is due to the simultaneous presence of both TSAbs and TBAbs. Declaration of interest The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector. Patient consent A written informed consent was obtained from the patients' guardians for publication of the submitted article. Autoimmune disorders. Country of Treatment. Signs and Symptoms. Thyroid antibodies. Thyroid function.
Thyroid scintigraphy. Total T3. Total T4. Ultrasound scan. Case Report Type. Insight into disease pathogenesis or mechanism of therapy. Your current browser may not support copying via this button. Online ISSN: Related Articles. Export References. Follow us on: Share Share.
Having an underactive thyroid can decrease or slow down your bodily functions. With hyperthyroidism, you may find yourself with more energy, as opposed to less. You may experience weight loss as opposed to weight gain. And you may feel anxious as opposed to depressed. The most common difference between the two diseases relates to hormone levels.
Hypothyroidism leads to a decrease in hormones. Hyperthyroidism leads to an increase in hormone production. In the United States, hypothyroidism is more common than hyperthyroidism.
Finding a skilled doctor who specializes in the thyroid, typically an endocrinologist, is an important part of your treatment plan. Hyperthyroidism in men can cause complications like erectile dysfunction and low testosterone. However, treatment is available and will likely restore…. Subclinical hyperthyroidism is when your thyroid stimulating hormone TSH is low but your T3 and T4 levels are normal.
In some cases, it needs to be…. Thyroid storm is a result of untreated hyperthyroidism. An individual's heart rate, blood pressure, and body temperature can reach dangerously high…. In some patients, the eyes may be affected. Patients may notice the eyes become more prominent, the eyelids do not close properly, a gritty sensation and general irritation of the eyes, increased tear production, or double vision.
Like other autoimmune diseases, this condition may occur in other family members and is much more common in women than in men.
Sub-acute thyroiditis - This type of hyperthyroidism can follow a viral infection which causes inflammation of the thyroid gland. This inflammation causes the thyroid to release excess amounts of thyroid hormone into the blood stream which leads to hyperthyroidism. Over time the thyroid usually returns to its normal state.
Because the stored thyroid hormone has been released, patients may become hypothyroid where their thyroid gland produces too little thyroid hormone for a period of time until the thyroid gland can build up new stores of thyroid hormone. Postpartum thyroiditis - Some women develop mild to moderate hyperthyroidism within several months of giving birth, which usually lasts 1 to 2 months.
This is often followed by several months of hypothyroidism. Most women recover and have normal thyroid function. Excessive Iodine ingestion - Some food sources with high concentrations of iodine, such as over the counter supplements, kelp tablets, some expectorants, amiodarone a medication used to treat certain heart rhythm problems and x-ray dyes, may occasionally cause hyperthyroidism in some patients.
In most cases, the hyperthyroidism usually resolves when the supplement is discontinued. Overmedication with thyroid hormone - Patients who take too much thyroid hormone replacement can also develop hyperthyroidism. She is now clinically euthyroid. In this case report, we describe a middle-aged lady who was initially diagnosed with hypothyroidism approximately 30 years ago.
Primary hypothyroidism once diagnosed usually requires lifelong thyroid hormone replacement. Although similar cases have been described in literature, none has been reported after such a long period of almost 30 years. The first similar case was described by Joplin and Fraser in 4 and was followed by several others in the later 60s and 70s 5 , 6 , 7. In Takasu et al. What causes this conversion is not well understood, but there are different theories postulated.
In this case, it happened after an upper respiratory tract infection, and this could implicate an environmental trigger in a genetically susceptible individual as a possible mechanism.
One early study 6 , as well as Takasu et al. More recently, Moriarty et al. They believe that a variable behaviour of the TRAB with the TSH receptor is responsible for the conversion from hypothyroidism to hyperthyroidism and vice versa. Furgan et al. They also suggested that this conversion from hypothyroidism to hyperthyroidism may not be as rare as previously thought.
One of the largest recent studies was done by Takasu and Matsushita 9. They concluded that hypothyroidism due to blocking antibodies and hyperthyroidism with stimulating antibodies may be two aspects of the same condition or disease.
This phenomenon may not be as rare as previously thought and the physicians should be aware of this possibility if someone with a previously well-established hypothyroidism is now requiring less or no thyroid hormone replacement, and the TFTs keep demonstrating an overactive picture with no obvious reason, even many years after the diagnosis of hypothyroidism as in this case.
Further research, however, is needed to establish the exact pathogenesis of this phenomenon. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this case report. This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector. Written informed consent has been obtained from the patient for publication of the submitted article and accompanying images.
The authors are especially thankful to our endocrine nurse Jimboy Isuga who made sure that all investigations were carried out as requested on time and he updated us accordingly. National Center for Biotechnology Information , U.
Endocrinol Diabetes Metab Case Rep. Published online Aug 3. Author information Article notes Copyright and License information Disclaimer. Correspondence should be addressed to E Ahmad Email ten. Received Jun 17; Accepted Jul This article has been cited by other articles in PMC. Case presentation We describe the case of a year-old lady diagnosed with primary hypothyroidism back in , based on tiredness, fatigue and a high thyroid-stimulating hormone TSH of 7.
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