Document Detail


Graves' disease and thymic hyperplasia: the relationship of thymic volume to thyroid function.
MedLine Citation:
PMID:  20718680     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Thymic hyperplasia is associated with Graves' disease, particularly in young patients. The degree of thymic transformation is minimal in most but not all patients. In the latter group radiological measurements of thyroid size and their change with treatment have rarely been reported. We present two patients with Graves' disease and relatively rapid resolution of thymic enlargement after successful treatment of their hyperthyroidism.
SUMMARY: Three patients with thyrotoxicosis secondary to Graves' disease and marked thymic enlargement were seen at our institution during a 2-year period. On computed tomography (CT) studies their volumes were 67, 81, and 54 cm(3). Thymic hyperplasia in the setting of Graves' disease was the diagnosis of exclusion. Two of the patients returned for follow-up after successful treatment of thyrotoxicosis as requested. On repeat CT their thymic volumes had decreased by 72% and 78%, respectively. Two types of histological modifications of the thymus have been described in association with Graves' disease, namely, thymic parenchyma hyperplasia and medullary lymphoid hyperplasia. The mechanisms underlying thymic transformation in patients with Graves' hyperthyroidism are not completely elucidated, but autoimmune processes underlying Graves' disease are presumed to play a role. The clinical course of our patients is consistent with earlier literature, indicating that thymic enlargement may occur in conjunction with Graves' hyperthyroidism, and that it usually resolves as hyperthyroidism is treated, but there is little quantitative pre- and posttreatment of hyperthyroidism data.
CONCLUSION: Although every patient must be individually considered, it appears that thymic hyperplasia can be diagnosed in most Graves' hyperthyroid patients by considering the clinical context and appropriate radiologic studies such as CT. Raising awareness of the association of thymic hyperplasia in patients with Graves' hyperthyroidism and its resolution with the reversibility of the hyperthyroid state should prevent unnecessary thymic evaluation and surgery with its attendant risks.
Authors:
Geanina Popoveniuc; Meeta Sharma; Madhuri Devdhar; Jason A Wexler; Nancy M Carroll; Leonard Wartofsky; Kenneth D Burman
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  20     ISSN:  1557-9077     ISO Abbreviation:  Thyroid     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-09     Completed Date:  2011-01-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1015-8     Citation Subset:  IM    
Affiliation:
Division of Endocrinology, Department of Medicine, Georgetown University Hospital, Washington, DC 20010, USA. geanina.popoveniuc@medstar.net
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use
Adult
Anti-Inflammatory Agents / therapeutic use
Antithyroid Agents / therapeutic use
Calcium Channel Blockers / therapeutic use
Diltiazem / therapeutic use
Female
Graves Disease / complications,  pathology*,  radiography
Humans
Male
Methimazole / therapeutic use
Middle Aged
Organ Size
Prednisone / therapeutic use
Propanolamines / therapeutic use
Propranolol / therapeutic use
Thymus Gland / pathology,  radiography
Thymus Hyperplasia / etiology,  pathology*,  radiography
Thyroidectomy
Thyrotoxicosis / etiology,  pathology*,  radiography
Thyrotropin / blood
Thyroxine / blood
Treatment Outcome
Triiodothyronine / blood
Young Adult
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Anti-Inflammatory Agents; 0/Antithyroid Agents; 0/Calcium Channel Blockers; 0/Propanolamines; 42399-41-7/Diltiazem; 525-66-6/Propranolol; 53-03-2/Prednisone; 60-56-0/Methimazole; 6893-02-3/Triiodothyronine; 7488-70-2/Thyroxine; 84057-94-3/esmolol; 9002-71-5/Thyrotropin

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