Graves’ disease and recurrence in ectopic thyroid tissue after total thyroidectomy

We report a case of a 46-year-old woman who presented with a midline neck mass 2 years after total thyroidectomy for Graves’ disease. Despite levothyroxine treatment withdrawal, she remained biochemically with subclinical hyperthyroidism. Her thyroid stimulating hormone receptor antibodies were cons...

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Bibliographic Details
Published in:BMJ case reports 2021-07, Vol.14 (7), p.e243313
Main Authors: Cunha, Clara, Ferrinho, Catia, Saraiva, Catarina, Duarte, João Sequeira
Format: Article
Language:English
Subjects:
Asymptomatic
Case Report
Case reports
Female
Graves disease
Graves Disease - surgery
Humans
Hyperthyroidism
Hypotheses
Hypothyroidism
Iodine
Iodine Radioisotopes
Middle Aged
Morphogenesis
Neck
Neoplasm Recurrence, Local
Patients
Scintigraphy
Surgery
Thyroid Dysgenesis - diagnostic imaging
Thyroid Dysgenesis - surgery
Thyroid gland
Thyroid Neoplasms
Thyroidectomy
Ultrasonic imaging
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Summary:We report a case of a 46-year-old woman who presented with a midline neck mass 2 years after total thyroidectomy for Graves’ disease. Despite levothyroxine treatment withdrawal, she remained biochemically with subclinical hyperthyroidism. Her thyroid stimulating hormone receptor antibodies were consistently elevated. Neck ultrasonography revealed an infrahyoid solid nodule and pertechnetate scintigraphy confirmed an increased uptake at the same level, without any uptake in the thyroid bed. Treatment with methimazole 5 mg/day was initiated with clinical improvement and achievement of euthyroidism. After that, she received 10 mCi of radioactive iodine. Since then, she experienced regression of the neck mass and is doing well on a replacement dose of levothyroxine. Recurrence of Graves’ disease in ectopic thyroid following total thyroidectomy is extremely rare. This diagnose should be considered in patients who underwent total thyroidectomy and remained with thyrotoxicosis despite decreasing the levothyroxine dose.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-243313