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This article has been cited by other articles in PMC. Methods We report the clinical history, laboratory data, and results of imaging studies, along with the pathophysiological mechanism and the subsequent treatment in a patient with fluctuating thyroid functional status.
Results A year-old female was treated for hypothyroidism for more than two decades. She started having symptoms of hyperthyroidism along with a suppressed thyroid-stimulating hormone TSH. She continued to have persistent symptoms despite stopping her levothyroxine. Her free T3 and T4 were elevated along with an increased radioactive uptake scan.
Subsequently, her TSH began to rise beyond expected level, her hypothyroid symptoms reappeared, and methimazole was discontinued. Following this, she again developed symptoms of hyperthyroidism and thyroid values revealed an undetectable TSH.
She had at least two such documented cycles of hyperthyroidism alternating with hypothyroidism.
She was eventually treated with radioactive iodine ablation followed by levothyroxine replacement. Swinging dominance of TSH-blocking autoantibodies TBAb and thyroid-stimulating autoantibodies TSAb triggered by methimazole and levothyroxine, respectively, is likely the underlying mechanism.
Conclusions Physicians should be vigilant to the phenomenon of spontaneous conversion of hypothyroidism to hyperthyroidism, or vice versa, in a subset of patients with autoimmune thyroid disease. Repeated assessment of thyroid function along with measurement of TBAb and TSAb are invaluable in identifying this rare clinical entity.
Here we report an immune-mediated case with two decades history of hypothyroidism that spontaneously developed hyperthyroidism, which was followed by oscillating thyroid function between hypo- and hyperthyroidism.
We discuss recent developments of mechanistic insights and treatment options for this unique disorder. She started to have typical symptoms of hyperthyroidism with palpitations, loose stools, insomnia, poor concentration, fatigue, cold intolerance, and weight loss over a period of 3 months.
Her levothyroxine was therefore stopped but she remained symptomatic. On physical examination, her vital signs were normal; she had intact memory, normal judgment and insight.
She had lid lag and stare and a fine resting tremor. Her thyroid was palpable with no bruit or tenderness. The gland measured 30 g. Her TSH was 0. She again developed symptoms of hyperthyroidism and thyroid values revealed an undetectable TSH.
At this point, she was placed on propylthiouracil 25 mg daily. Four months later her TSH increased and her propylthiouracil was stopped.
Her levothyroxine was restarted. She had documented cycles of hypothyroidism alternating with hyperthyroidism. A complete evaluation of the hypothalamic-pituitary axis was done which was unremarkable.Hesi case studies thyroid disorders quizlet.
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Thyroid Case Study. Pharmacology HESI Review. Cystic Fibrosis. Hesi Hints. HESI TEST. Exam5. Lab work plays a vital role in the diagnosis and management of thyroid disorders.
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Thyroid cancer accounts for only % of evolve case studies thyroid disorders all cancer deaths, with an incidence of 11 cases and about deaths per , population in the United.