For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
31
views
10
references
 Top references
cited by
0
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
2 collections
    0
    shares
      714
      similar
       All similar

          The flagship journal of the Society for Endocrinology. Learn more

      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Persistent hyperthyroidism and de novo Graves’ ophthalmopathy after total thyroidectomy

      research-article
      Author(s): 1 , , 2 , 3 , 1
      Publication date (Electronic):
      Journal: Endocrinology, Diabetes & Metabolism Case Reports
      Publisher: Bioscientifica Ltd
      Keywords: Adult, Female, Asian – Chinese, Singapore, Thyroid, Thyroid, Thyroxine (T4), Triiodothyronine (T3), TSH, Hyperthyroidism, Graves’ ophthalmopathy, Graves’ disease, Struma ovarii, Thyrotoxicosis, Goitre (multinodular), Thyroiditis, Ovarian tumour, Hyperthyroidism, Thyrotoxicosis, Fatigue, Myasthaenia, Palpitations, Menstrual disorder, Tremulousness, Weight loss, Heat intolerance, Goitre, Dysphagia, Bowel movements ȃ bleeding, Diplopia, Proptosis, FT3, FT4, TSH, TSH receptor antibodies, CT scan, Thyroid antibodies, MRI, Histopathology, Thyroidectomy, Salpingo-oophorectomy, Hysterectomy, Resection of tumour, Bilateral salpingo-oophorectomy, Carbimazole, Levothyroxine, Prednisolone, Glucocorticoids, Unique/unexpected symptoms or presentations of a disease, October, 2017

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          We report a patient with Graves’ disease who remained persistently hyperthyroid after a total thyroidectomy and also developed de novo Graves’ ophthalmopathy 5 months after surgery. She was subsequently found to have a mature cystic teratoma containing struma ovarii after undergoing a total hysterectomy and salpingo-oophorectomy for an incidental ovarian lesion.

          Learning points:

          • It is important to investigate for other causes of primary hyperthyroidism when thyrotoxicosis persists after total thyroidectomy.

          • TSH receptor antibody may persist after total thyroidectomy and may potentially contribute to the development of de novo Graves’ ophthalmopathy.

          Related collections

          Most cited references10

          • Record: found
          • Abstract: found
          • Article: not found

          Epidemiology and prevention of Graves' ophthalmopathy.

          W. Wiersinga, Luigi Bartalena (2002)
          Graves' ophthalmopathy is clinically relevant in approximately 50% of patients with Graves' disease, severe forms affecting 3%-5% of patients. Two age peaks of incidence are observed in the fifth and seventh decades of life, with slight differences between women and men. The disease is more frequent in women than in men, although the female-to-male ratio is only 1:4 in severe forms of eye disease. The natural history of Graves' ophthalmopathy is incompletely defined, but in many instances, especially in mild forms, the disease may remit or improve spontaneously. The onset of the ophthalmopathy is in most cases concomitant with the onset of hyperthyroidism, but eye disease may precede or follow hyperthyroidism. Cigarette smoking plays an important role in the occurrence of the ophthalmopathy, and is also associated with a higher degree of disease severity and a lower effectiveness of its medical treatment. Primary prevention (i.e., avoidance of the occurrence of the ophthalmopathy) is presently not feasible, but smoking withdrawal in relatives of patients with Graves' disease might be important. In terms of secondary prevention (i.e., avoidance of progression of subclinical eye disease into overt and severe ophthalmopathy) in addition to refraining from smoking, early and accurate control of thyroid dysfunction (both hyperthyroidism and hypothyroidism), as well as early diagnosis and treatment of mild eye disease are important. As to the role that management of hyperthyroidism may play in the course of Graves' ophthalmopathy, while antithyroid drugs and thyroidectomy are not disease-modifying treatments, radioiodine therapy causes a progression of the ophthalmopathy in approximately 15% of patients, especially high-risk patients, who smoke, have severe hyperthyroidism or uncontrolled hypothyroidism, high levels of thyrotropin (TSH)-receptor antibody, or preexisting eye disease. However, the risk of radioiodine-associated progression of the opthalmopathy can be eliminated by concomitant treatment with middle-dose glucocorticoids. In terms of tertiary prevention (i.e., avoidance of deterioration and complications of overt disease) early immunosuppressive treatment or orbital decompression, as appropriate, are essential tools. Smoking withdrawal may increase the effectiveness of immunosuppressive treatment.
          Article 0 comments Cited 105 times – based on 0 reviews     Review now
          Article has an altmetric score of 20
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Clinical characteristics of struma ovarii.

            Ki Jung Chang, Byong Chul Yoo, Mi-Ae Lyu … (2008)
            To evaluate the clinical characteristics of struma ovarii. Twenty-five cases of struma ovarii were reviewed retrospectively from June 1994 to April 2007. The presenting clinical, radiologic, and pathologic features of the patients were reviewed. The mean age of the patients in this study was 45.3 years. The majority was of premenopausal status. Sixteen patients had clinical symptoms such as low abdominal pain, palpable abdominal mass and vaginal bleeding. Although one patient had an abnormal thyroid function test, the laboratory findings normalized after operative treatment. CA-125 levels were elevated in 6 cases. Diagnosis by preoperative imaging studies were 8 dermoid cysts, while only 3 cases were diagnosed as struma ovarii. There were 4 cases of malignant struma ovarii, and no patients with recurrent disease. Struma ovarii is a rare tumor. The presented clinical, laboratory and radiological findings of patients are very diverse. The diagnosis was confirmed by pathologic findings. The treatment of benign struma ovarii is surgical resection only. The cases of malignant struma ovarii may need adjuvant treatment, but recurrence is uncommon.
            Article 0 comments Cited 52 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Immunopathogenesis of Graves' ophthalmopathy: the role of the TSH receptor.

              Seethalakshmi Iyer, Rebecca Bahn (2012)
              Graves' ophthalmopathy is an inflammatory autoimmune disorder of the orbit. The close clinical and temporal relationships between Graves' hyperthyroidism and ophthalmopathy have long suggested that both conditions derive from a single systemic process and share the thyrotropin receptor as a common autoantigen. This receptor is expressed not only in thyroid follicular cells, but also in orbital fibroblasts with higher levels measured in orbital cells from ophthalmopathy patients than in cells from normal individuals. Recent studies from several laboratories have shown that thyrotropin receptor activation in orbital fibroblasts enhances hyaluronic acid synthesis and adipogenesis, both cellular functions that appear to be upregulated in the diseased orbit. The phosphoinositide 3-kinase/Akt signaling cascade, along with other effector pathways including adenylyl cyclase/cAMP, appears to mediate these processes. Future therapies for this condition may involve inhibition of thyrotropin receptor signaling in orbital fibroblasts.
              Article 0 comments Cited 43 times – based on 0 reviews     Review now
              Article has an altmetric score of 3
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): Endocrinol Diabetes Metab Case Rep
                Journal ID (iso-abbrev): Endocrinol Diabetes Metab Case Rep
                Journal ID (hwp): EDM
                Title: Endocrinology, Diabetes & Metabolism Case Reports
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2052-0573
                Publication date (Electronic): 13 October 2017
                Publication date Collection: 2017
                Volume: 2017
                Electronic Location Identifier: 17-0109
                Affiliations
                [1 ]Department of Endocrinology , Singapore General Hospital, Singapore, Singapore
                [2 ]Department of Endocrinology , Changi General Hospital, Singapore, Singapore
                [3 ]Department of Pathology , Sengkang Health, Singapore, Singapore
                Author notes
                Correspondence should be addressed to W L Tay Email: weilin.tay@ 123456mohh.com.sg
                Article
                Publisher ID: EDM170109
                DOI: 10.1530/EDM-17-0109
                PMC ID: 5640566
                SO-VID: 4e192615-5706-45c3-8a8d-a4171d5baa67
                Copyright © © 2017 The authors
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

                History
                Date received : 11 August 2017
                Date accepted : 25 September 2017
                Categories
                Subject: Unique/Unexpected Symptoms or Presentations of a Disease

                Keywords: adult,female,asian – chinese,singapore,thyroid,thyroxine (t4),triiodothyronine (t3),tsh,hyperthyroidism,graves’ ophthalmopathy,graves’ disease,struma ovarii,thyrotoxicosis,goitre (multinodular),thyroiditis,ovarian tumour,fatigue,myasthaenia,palpitations,menstrual disorder,tremulousness,weight loss,heat intolerance,goitre,dysphagia,bowel movements ȃ bleeding,diplopia,proptosis,ft3,ft4,tsh receptor antibodies,ct scan,thyroid antibodies,mri,histopathology,thyroidectomy,salpingo-oophorectomy,hysterectomy,resection of tumour,bilateral salpingo-oophorectomy,carbimazole,levothyroxine,prednisolone,glucocorticoids,unique/unexpected symptoms or presentations of a disease,october,2017
                Data availability:
                Keywords: adult, female, asian – chinese, singapore, thyroid, thyroxine (t4), triiodothyronine (t3), tsh, hyperthyroidism, graves’ ophthalmopathy, graves’ disease, struma ovarii, thyrotoxicosis, goitre (multinodular), thyroiditis, ovarian tumour, fatigue, myasthaenia, palpitations, menstrual disorder, tremulousness, weight loss, heat intolerance, goitre, dysphagia, bowel movements ȃ bleeding, diplopia, proptosis, ft3, ft4, tsh receptor antibodies, ct scan, thyroid antibodies, mri, histopathology, thyroidectomy, salpingo-oophorectomy, hysterectomy, resection of tumour, bilateral salpingo-oophorectomy, carbimazole, levothyroxine, prednisolone, glucocorticoids, unique/unexpected symptoms or presentations of a disease, october, 2017

                Comments

                Comment on this article

                scite_
                2
                0
                0
                0
                Smart Citations
                2
                0
                0
                0
                Citing PublicationsSupportingMentioningContrasting
                View Citations

                See how this article has been cited at scite.ai

                scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

                Similar content714

                See all similar

                Most referenced authors92

                See all reference authors