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Thyroid autoimmune disease: between hypothyroidism and hyperthyroidism

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We aim at introducing a series of cases regarding autoimmune thyroid conditions in adult non-pregnant women with a particular pattern: hypothyroidism and thyrotoxicosis in the same patient at different moments. A 61-year old non-smoking woman was diagnosed at age of 58 with Basedow’s disease and treated for 3 months with thiamazole. She presented asymmetrical eye involvement and negative TRAB (TSH Receptor Antibodies). TSH (Thyroid Stimulating Hormone) rapidly increased under therapy but further on spontaneously when the drug was stopped thus levothyroxine was necessary. This aspect was unchanged for 3 more years. The second case is a 42-year old woman with autoimmune thyroiditis with inaugural episode of flare-up at age of 37 and remission within 6 months. Spontaneous euthyroidism continued for two years until thyrotoxicosis relapsed.
High Iodine 131 uptake and elevated TRAB confirmed Basedow’s disease.Thiamazole was started and controlled thyroid function. Radioiodine therapy was offered to the patient (15 mCi). Two months later, severe hypothyroidism required substitution therapy. A 65-year old woman had a two decades history of chronic thyroiditis with treated hypothyroidism. 12 years ago she was diagnosed with hepatitis C and treated with interferon, without remission. She continued thyroid substitution until recently when daily oral dose of levothyroxine was no longer necessary due to suppressed TSH. The patient refused any medication for thyroid during 2 years. Currently, primary hyperthyroidism is confirmed by thyroid scintigram, thus a short course of thyroid blocker drugs as propylthiouracil was started, to introduce a dose of radioiodine therapy. Multiple levels of interactions are found in patients with positive reaction for thyroid antibodies or chronic hepatic viral infections requiring a long-term follow-up and continuing adjustment of therapeutically approach.

Abbreviations: mm = millimetres, TSH = Thyroid Stimulating Hormone, TPO = Thyreoperoxidase Antibodies, TgAb = Thyreoglobulin Antibodies, TRAB = TSH Receptor Antibodies

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Simona Elena Albu, Mara Carsote, Dana Terzea, Adina Ghemigian, Ana Valea, Eugenia Petrova and Cristina Vasiliu

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