Conversion of Primary Hypothyroidism to Hyperthyroidism: A Case Report

Authors

Keywords:

hypothyroidism, Graves’ disease, antithyroid drugs, Carbimazole, agranulocytosis

Abstract

A 51-year-old male developed Graves’ thyrotoxicosis following long-standing treatment for hypothyroidism. After a short period of treatment with Carbimazole, he developed agranulocytosis and he required total thyroidectomy. In this relevant case report, we review several pathogenetic mechanisms that explain the transformation of auto-immune hypothyroidism into Graves’ disease and the possible approaches to the management of agranulocytosis secondary to antithyroid medications.

Further studies are required to determine the best way to manage severe thyrotoxicosis when agranulocytosis develops due to antithyroid medications.

 

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Author Biographies

Liam Clifford, Wyong Hospital, New South Sales

Resident Medical officer

Ammar Wakil, Wyong Hospital, New South Wales

Department of Endocrinology

References

Walsh JP. Managing thyroid disease in general practice. Med J Aust. 2016; 205(4):179-84. PMID: 27510349.

Chaudhry LA, Mazen KF, Ba-Essa E, Robert AA. Antithyroid drug induced agranulocytosis: What we still need to learn? Pan Afr Med J. 2016;23:27. PMID: 27200132. PMCID: PMC4856502. https://doi.org/10.11604/pamj.2016.23.27.8365.

Lamberg BA, Salmi J, Wägar G, Mäkinen T. Spontaneous hypothyroidism after antithyroid treatment of hyperthyroid Graves' disease. Journal Endocrinol Invest. 1981; 4(4):399-402. PMID: 6801105. https://doi.org/10.1007/BF03348302.

Fischli S, Lucchini B, Müller W, Slahor L, Henzen C. Rapid preoperative blockage of thyroid hormone production/secretion in patients with Graves' disease. Swiss Med Wkly. 2016;146:w14243. PMID: 26765838. https://doi.org/10.4414/smw.2016.14243.

McLachlan SM, Rapoport B. Thyrotropin-blocking autoantibodies and thyroid-stimulating autoantibodies: Potential mechanisms involved in the pendulum swinging from hypothyroidism to hyperthyroidism or vice versa. Thyroid. 2013;23(1):14-24. PMID: 23025526. PMCID: PMC3539254. https://doi.org/10.1089/thy.2012.0374.

Ohye H, Nishihara E, Sasaki I, et al. Four cases of Graves' disease which developed after painful Hashimoto's thyroiditis. Intern Med. 2006;45(6):385-9. PMID: 16617190.

Umena S, Takano T, Iijima T, et al. A case of repeated painless thyroiditis followed by Graves' disease. Endocr J. 1995;42(6):821-6. PMID: 8822326.

Chung YH, Ou HY, Wu TJ. Development of hyperthyroidism following primary hypothyroidism: A case report. Kaohsiung J Med Sci. 2004;20(4):188-91. PMID: 15191221. https://doi.org/10.1016/S1607-551X(09)70105-6.

Yamasaki H, Takeda K, Nakauchi Y, Suehiro T, Hashimoto K. Hypothyroidism preceding hyperthyroidism in a patient with continuously positive thyroid stimulating antibody. Intern Med. 1995;34(4):247-50. PMID: 7606091.

Watanabe N, Narimatsu H, Noh J, et al. Antithyroid drug-induced haematopoietic damage: A retrospective cohort study of agranulocytosis and pancytopaenia involving 50,385 patients with Graves' disease. J Clin Endocrinol Metab. 2012; 97(1):E49-53. PMID: 22049174. https://doi.org/10.1210/jc.2011-2221.

Hallberg P, Eriksson N, Ibañez L, et al. Genetic variants associated with antithyroid drug-induced agranulocytosis: A genome-wide association study in a European population. Lancet Diabetes Endocrinol. 2016;4(6):507-16. PMID: 27157822. https://doi.org/10.1016/S2213-8587(16)00113-3.

Chen PL, Shih SR, Wang PW, et al. Genetic determinants of antithyroid drug-induced agranuloyctosis by human leukocyte anitgen genotyping and genome-wide association study. Nat Commun. 2015;6:7633. PMID: 26151496. PMCID: PMC4506516. https://doi.org/ 10.1038/ncomms8633.

Cheung CL, Sing CW, Tang CS, et al. HLA-B*38:02:01 predicts carbimazole/methimazole-induced agranulocytosis. Clin Pharmacol Ther. 2016; 99(5):555-61. PMID: 26599303. https://doi.org/10.1002/cpt.309.

Cooper DS. Antithyroid drugs. New Engl J Med. 2005;352(9):905-17. PMID: 15745981. https://doi.org/10.1056/NEJMra042972.

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Published

2018-10-01

How to Cite

Clifford, L., & Wakil, A. (2018). Conversion of Primary Hypothyroidism to Hyperthyroidism: A Case Report. Journal of the ASEAN Federation of Endocrine Societies, 33(2), 190. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/463

Issue

Vol. 33 No. 2 (2018): November Issue

Section

Case Reports

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