Publication:
Conversion to Graves disease from Hashimoto thyroiditis: a study of 24 patients.

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2018

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Gonzalez-Aguilera, Beatriz
Betea, Daniela
Lutteri, Laurence
Cavalier, Etienne
Geenen, Vincent
Beckers, Albert
Valdes-Socin, Hernan

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Abstract

The conversion of Hashimoto's thyroiditis (HT) to hyperthyroidism due to thyrotropin receptor antibodies is intriguing and considered rare. The contribution of TSH receptor blocking antibodies (TRAb), which may be stimulators (TSAb) or blockers (TBAb), is suspected. We describe clinical and biological variables in a series of patients switching from Hashimoto's thyroiditis to Grave's disease. Retrospective case study of 24 patients with Hashimoto's thyroiditis followed during 48 ± 36 months that developed later Graves' disease (GD). These variables were analysed in the hypo and hyperthyroid phase: age, sex, initial TSH, free triiodothyronine (fT3), free thyroxine (fT4), anti-TPO, TBII antibodies, parietal cell autoantibodies, time between hypo and hyperthyroidism, thyroid volume and levothyroxine doses (LT). In HT, mean TSH was 9.4 ± 26.1 UI/L and levothyroxine treatment was 66.2 ± 30.8 µg/day. The switch to GD was observed 38 ± 45 months after HT diagnosis. As expected, we found significant differences on TSH, FT3, FT4 and TBAb levels. Three out of 14 patients had parietal cell autoantibodies. In two of these three cases there was an Helicobacter pylori infection. There were no significant differences between HT and GD groups with respect to thyroid volume. To our knowledge, large series documenting the conversion of HT to GD are scarce. Although rare, this phenomenon should not be misdiagnosed. Suspicion should be raised whenever thyroxine posology must be tapered down during the follow-up of HT patients. Further immunological and genetic studies are needed to explain this unusual autoimmune change.

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Adult
Autoantibodies
Female
Graves Disease
Hashimoto Disease
Humans
Hypothyroidism
Immunoglobulins, Thyroid-Stimulating
Luminescent Measurements
Male
Middle Aged
Receptors, Thyrotropin
Retrospective Studies
Statistics, Nonparametric
Thyroid Function Tests
Thyrotropin
Thyroxine
Triiodothyronine
Young Adult

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