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Hashimoto's thyroiditis following Graves' disease.
Acta Med Indones. 2010 Jan; 42(1):31-5.AM

Abstract

Both Graves' disease and chronic thyroiditis (Hashimoto's thyroiditis) are autoimmune diseases of thyroid gland. Graves' disease is caused by stimulation of TSH receptor located on the thyroid gland by an antibody, which is known as TSH receptor antibody (TRAb). Furthermore, this may lead to hyperplasia and hyperfunction of the thyroid gland. On the contrary, the cause of Hashimoto's thyroiditis is thought due to a TSH stimulation-blocking antibody (TSBAb) which blocks the action of TSH hormone and subsequently brings damage and atrophy to thyroid gland. Approximately 15-20% of patients with Graves' disease had been reported to have spontaneous hypothyroidism resulting from the chronic thyroiditis (Hashimoto's disease). Pathogenesis for chronic thyroiditis following anti-thyroid drug treatment in patients with Graves' disease remains unclear. It has been estimated that chronic thyroiditis or Hashimoto's disease, which occurs following the Graves' disease episode is due to extended immune response in Graves' disease. It includes the immune response to endogenous thyroid antigens, i.e. thyroid peroxidase and thyroglobulin, which may enhance lymphocyte infiltration and finally causes Hashimoto's thyroiditis. We report four cases of chronic thyroiditis (Hashimoto's disease) in patients who have been previously diagnosed with Graves' hyperthyroidism. In three cases, Hashimoto's thyroiditis occurs in 7 to 25 years after the treatment of Grave's disease; while the other case has it only after few months of Grave's disease treatment. The diagnosis of Hashimoto's disease (chronic thyroiditis) was based on clinical manifestation, high TSHs level, positive thyroid peroxidase antibody and thyroglobulin antibody, and supported by positive results of fine needle aspiration biopsy. Moreover, the result of histopathological test has also confirmed the diagnosis in two cases. All cases have been successfully treated by levothyroxine treatment.

Authors+Show Affiliations

Department of Internal Medicine, Faculty of Medicine, University of Hasanuddin-Wahidin Sudirohusodo Hospital, Makassar 90245, Sulawesi Selatan, Indonesia. husani_umar65@yahoo.co.idNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

20305330

Citation

Umar, Husaini, et al. "Hashimoto's Thyroiditis Following Graves' Disease." Acta Medica Indonesiana, vol. 42, no. 1, 2010, pp. 31-5.
Umar H, Muallima N, Adam JM, et al. Hashimoto's thyroiditis following Graves' disease. Acta Med Indones. 2010;42(1):31-5.
Umar, H., Muallima, N., Adam, J. M., & Sanusi, H. (2010). Hashimoto's thyroiditis following Graves' disease. Acta Medica Indonesiana, 42(1), 31-5.
Umar H, et al. Hashimoto's Thyroiditis Following Graves' Disease. Acta Med Indones. 2010;42(1):31-5. PubMed PMID: 20305330.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hashimoto's thyroiditis following Graves' disease. AU - Umar,Husaini, AU - Muallima,Nur, AU - Adam,John M F, AU - Sanusi,Harsinen, PY - 2010/3/23/entrez PY - 2010/3/23/pubmed PY - 2010/9/30/medline SP - 31 EP - 5 JF - Acta medica Indonesiana JO - Acta Med Indones VL - 42 IS - 1 N2 - Both Graves' disease and chronic thyroiditis (Hashimoto's thyroiditis) are autoimmune diseases of thyroid gland. Graves' disease is caused by stimulation of TSH receptor located on the thyroid gland by an antibody, which is known as TSH receptor antibody (TRAb). Furthermore, this may lead to hyperplasia and hyperfunction of the thyroid gland. On the contrary, the cause of Hashimoto's thyroiditis is thought due to a TSH stimulation-blocking antibody (TSBAb) which blocks the action of TSH hormone and subsequently brings damage and atrophy to thyroid gland. Approximately 15-20% of patients with Graves' disease had been reported to have spontaneous hypothyroidism resulting from the chronic thyroiditis (Hashimoto's disease). Pathogenesis for chronic thyroiditis following anti-thyroid drug treatment in patients with Graves' disease remains unclear. It has been estimated that chronic thyroiditis or Hashimoto's disease, which occurs following the Graves' disease episode is due to extended immune response in Graves' disease. It includes the immune response to endogenous thyroid antigens, i.e. thyroid peroxidase and thyroglobulin, which may enhance lymphocyte infiltration and finally causes Hashimoto's thyroiditis. We report four cases of chronic thyroiditis (Hashimoto's disease) in patients who have been previously diagnosed with Graves' hyperthyroidism. In three cases, Hashimoto's thyroiditis occurs in 7 to 25 years after the treatment of Grave's disease; while the other case has it only after few months of Grave's disease treatment. The diagnosis of Hashimoto's disease (chronic thyroiditis) was based on clinical manifestation, high TSHs level, positive thyroid peroxidase antibody and thyroglobulin antibody, and supported by positive results of fine needle aspiration biopsy. Moreover, the result of histopathological test has also confirmed the diagnosis in two cases. All cases have been successfully treated by levothyroxine treatment. SN - 0125-9326 UR - https://www.unboundmedicine.com/medline/citation/20305330/Hashimoto's_thyroiditis_following_Graves'_disease_ L2 - http://www.inaactamedica.org/archives/2010/20305330.pdf DB - PRIME DP - Unbound Medicine ER -