RARE PRESENTATION OF MARINE-LENHART SYNDROME

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 449-497-Thyroid Neoplasia & Case Reports
Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-482
Ramesh Prajapati*1, Puja Shrestha1, Alan Scott Sacerdote1, Gul Bahtiyar2 and Natalie Montemayor3
1Woodhull Med & Mental Hlth Ctr, Brooklyn, NY, 2Woodhull Medical Center, Brooklyn, NY, 3woodhull medical center
The combination of Graves’ disease with a solitary hot thyroid nodule suppressing the remainder of the thyroid gland is rare. We report a case of Graves’ disease  associated with a single hyperfunctioning nodule with suppression of the remaining gland.

A 45 year old male patient with past medical history of Graves’ disease with severe ophthalmopathy was referred to endocrine clinic. His symptoms started with dry eyes several years ago without associated hypermetabolic symptoms. Further investigation revealed hyperthyroidism; he was started on methimazole. Thyroid stimulating immunoglobulin was 484 %( reference: <140%, Method: immunoassay). Thyroid scan with I-123 sodium iodide showed uptake of 28.3 percent at 24 hours, and showed large area of intense activity mid and lower left thyroid lobe with suppression of uptake in rest of the thyroid gland. Thyroid ultrasound showed heterogeneous well-defined 1.3x1.0x1.0 cm left mid lower pole nodule. These findings are suggestive of a rare variant of Marine-Lenhart syndrome.

Graves’ disease is thought to be caused by autoantibodies stimulating the TSH receptors. Thyroid nodules associated with Graves’ disease have been reported with the incidence between 25 to 30%, most of which are cold nodules. The incidence of Graves’ disease accompanied by hot nodules ranges from 2.7 to 4.1%.These rare cases with Graves’ disease with accompanying functioning thyroid nodules are known Marine-Lenhart syndrome.  Most reported cases of Marine-Lenhart syndrome are Graves’ disease with multiple hyperfunctioning nodules. Our case represents an unusual variety in which Graves’ disease with a hyperfunctioning solitary nodule was associated with suppression of the remaining gland. Acquired mutations resulting in constitutively activated TSH receptors and presence of anti TSH receptor autoantibodies might be responsible for the development of Marine-Lenhart syndrome. Cases have been published suggesting possible development of hyperfunctioning nodules in Graves’ disease after ablative treatment with Iodine 131.  Marine-Lenhart syndrome with a hot nodule containing papillary thyroid microcarcinoma has also been described, which upon total thyroidectomy revealed multifocal involvement.

Nothing to Disclose: RP, PS, ASS, GB, NM

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