De Novo Extra-Thyroidal Manifestations of Graves’ Disease presenting 16 Years after Total Thyroidectomy for Thyroid Cancer

Ann Kwee; Kai-Ling  Yong; Lay Leng  Seah; Chiaw-Ling  Chng

doi:10.15605/jafes.036.02.08

Authors

Ann Kwee Department of Endocrinology, Singapore General Hospital https://orcid.org/0000-0002-5700-2731
Kai-Ling Yong Oculoplastics Department, Singapore National Eye Center https://orcid.org/0000-0002-8466-8870
Lay Leng Seah Oculoplastics Department, Singapore National Eye Center
Chiaw-Ling Chng Department of Endocrinology, Singapore General Hospital https://orcid.org/0000-0003-2232-5298

DOI:

https://doi.org/10.15605/jafes.036.02.08

Keywords:

Thyroid cancer, Graves' disease, thyroidectomy, radioactive iodine

Abstract

We present a 61-year-old Chinese female who had a history of angioinvasive follicular thyroid cancer (FTC) treated with total thyroidectomy 16 years ago, without radioactive iodine (RAI) treatment who now presents with de novo pretibial myxedema (PTM) followed by active severe Graves’ ophthalmopathy (GO) requiring pulse steroids and radiotherapy.

Downloads

Download data is not yet available.

References

Bartalena L, Baldeschi L, Boboridis K, et al. The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy Guidelines for the Management of Graves’ Orbitopathy. Eur Thyroid J. 2016;5(1):9-26. https://pubmed.ncbi.nlm.nih.gov/27099835. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836120. https://doi.org/10.1159/000443828.

Laurberg P, Wallin G, Tallstedt L, Abraham-Nordling M, Lundell G, Törring O. TSH-receptor autoimmunity in Graves’ disease after therapy with anti-thyroid drugs, surgery, or radioiodine: A 5-year prospective randomized study. Eur J Endocrinol. 2008;158(1):69-75. https://pubmed.ncbi.nlm.nih.gov/18166819. https://doi.org/10.1530/EJE-07-0450.

Bahn RS. Clinical review 157 - Pathophysiology of Graves’ ophthalmopathy: The cycle of disease. J Clin Endocrinol Metab. 2003;88(5):1939-46. PMID: 12727937. https://doi.org/10.1210/jc.2002-030010.

Folkestad L, Brandt F, Brix T, et al. Total Thyroidectomy for thyroid cancer followed by thyroid storm due to thyrotropin receptor antibody stimulation of metastatic thyroid tissue. Eur Thyroid J. 2017;6(5):276-80. https://pubmed.ncbi.nlm.nih.gov/29071241. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649237. https://doi.org/10.1159/000479061.

Filetti S, Belfiore A, Amir SM, et al. The role of thyroid-stimulating antibodies of Graves’ disease in differentiated thyroid cancer. N Engl J Med. 1988;318(12):753-9. https://pubmed.ncbi.nlm.nih.gov/3347223. https://doi.org/10.1056/NEJM198803243181206.

Dobyns B, Sheline G, Workman J, Tompkins E, McConahey W, Becker D. Malignant and benign neoplasms of the thyroid in patients treated for hyperthyroidism: A report of the cooperative thyrotoxicosis therapy follow-up study. J Clin Endocrinol Metab. 1974;38(6):978-98. https://pubmed.ncbi.nlm.nih.gov/4134013. https://doi.org/10.1210/jcem-38-6-976.

Chen YK, Lin CL, Chang YJ, et al. Cancer risk in patients with Graves’ disease: A nationwide cohort study. Thyroid. 2013;23(7):879-84. https://pubmed.ncbi.nlm.nih.gov/23421548. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704114. https://doi.org/10.1089/thy.2012.0568.

Pazaitou-Panayiotou K, Perros P, Boudina M, et al. Mortality from thyroid cancer in patients with hyperthyroidism: The Theagenion Cancer Hospital experience. Eur J Endocrinol. 2008;159(6):799-803. https://pubmed.ncbi.nlm.nih.gov/18819945. https://doi.org/10.1530/EJE-08-0468.

Belfiore A, Russo D, Vigneri R, Filetti S. Graves’ disease, thyroid nodules and thyroid cancer. Clin Endocrinol (Oxf). 2001;55(6):711-8. https://pubmed.ncbi.nlm.nih.gov/11895209. https://doi.org/10.1046/j.1365-2265.2001.01415.x.

Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-421. https://pubmed.ncbi.nlm.nih.gov/27521067. https://doi.org/10.1089/thy.2016.0229.

Jang SY, Lee KH, Oh JR, Kim BY, Yoon JS. Development of thyroid-associated ophthalmopathy in patients who underwent total thyroidectomy. Yonsei Med J. 2015;56(5):1389-94. https://pubmed.ncbi.nlm.nih.gov/26256985. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541672. https://doi.org/10.3349/ymj.2015.56.5.1389.

Yoon JS, Lew H, Park JS, Nam KH LS. Papillary thyroid carcinoma with thyroid-associated orbitopathy in a euthyroid state. Ophthalmic Plast Reconstr Surg. 2007;23(3):187-91. https://pubmed.ncbi.nlm.nih.gov/17519654. https://doi.org/10.1097/IOP.0b013e31803e1755.

Eckstein AK, Lösch C, Glowacka D, et al. Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetrical Graves ophthalmopathy. Br J Ophthalmol. 2009;93(8):1052-6. https://pubmed.ncbi.nlm.nih.gov/19221109. https://doi.org/10.1136/bjo.2007.137265.

Tamai H, Hirota Y, Matsuzuka F, Kuma K NS. Three cases developed Graves’ disease after surgical treatment for thyroid carcinomas. Horumon To Rinsho. 1982;30:124-5.

Yu HM, Park SH, Lee JM, Park KS. Graves’ disease that developed shortly after surgery for thyroid cancer. Endocrinol Metab (Seoul). 2013;28(3):226-30. https://pubmed.ncbi.nlm.nih.gov/24396683. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811703. https://doi.org/10.3803/enm.2013.28.3.226.

Misaki T, Iwata M, Kasagi K, et al. Hyperthyroid papillary graves ’ carcinoma : Report after of three hemithyroidectomy cases. Endocr J. 2000;47(2):191-5. https://pubmed.ncbi.nlm.nih.gov/10943744. https://doi.org/10.1507/endocrj.47.191.

Kasuga Y, Kobayashi S, Fujimori M, et al. Development of Graves’ disease after surgical treatment for thyroid nodules: Report of four cases. Endocr J. 1997;44(4):567-70. https://pubmed.ncbi.nlm.nih.gov/9447291. https://doi.org/10.1507/endocrj.44.567.

Marcocci C, Bruno-Bossio G, Manetti L, et al. The course of Graves’ ophthalmopathy is not influenced by near total thyroidectomy: A case-control study. Clin Endocrinol (Oxf). 1999;51(4):503-8. https://pubmed.ncbi.nlm.nih.gov/10583319. https://doi.org/10.1046/j.1365-2265.1999.00843.x.

De Bellis A, Conzo G, Cennamo G, et al. Time course of Graves’ ophthalmopathy after total thyroidectomy alone or followed by radioiodine therapy: A 2-year longitudinal study. Endocrine. 2012;41(2):320-6. https://pubmed.ncbi.nlm.nih.gov/22169963. https://doi.org/10.1007/s12020-011-9559-x.

Cho BY, Oh SK, Shong YK, et al. Changes in thyrotropin receptor antibody after subtotal thyroidectomy in Ggraves’ disease: Comparison with the degree of lymphocytic infiltration in the thyroid. Autoimmunity. 1990;8(2):143-7. https://pubmed.ncbi.nlm.nih.gov/1983330. https://doi.org/10.3109/08916939008995732.

De Bruin TWA, Patwardhan NA, Brown RS, Braverman LE. Graves’ disease: Changes in TSH receptor and anti-microsomal antibodies after thyroidectomy. Clin Exp Immunol. 1988;72(3):481-5. https://pubmed.ncbi.nlm.nih.gov/3168323. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1541569.

Garrity JA, Bahn RS. Pathogenesis of Graves ophthalmopathy: Implications for prediction, prevention, and treatment. Am J Ophthalmol. 2006;142(1):147-53. https://pubmed.ncbi.nlm.nih.gov/16815265. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960010. https://doi.org/10.1016/j.ajo.2006.02.047.

Fatourechi V. Pretibial myxedema pathophysiology and treatment options. Am J Clin Dermatol. 2005;6(5):295-309. https://pubmed.ncbi.nlm.nih.gov/16252929. https://doi.org/10.2165/00128071-200506050-00003.