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A patient with Graves' disease showing only psychiatric symptoms and negativity for both TSH receptor autoantibody and thyroid stimulating antibody.

Hamasaki H, Yoshimi T, Yanai H - Thyroid Res (2012)

Bottom Line: She was treated by using methimazole, and hyperthyroidism and her psychiatric symptoms were promptly ameliorated.We experienced a patient with GD who did not show characteristic symptoms except for psychiatric symptoms, and also showed negativity for both TRAb1 and TSAb.Thyroid scintigraphy was useful to diagnose such a patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan. dyanai@hospk.ncgm.go.jp.

ABSTRACT

Background: Both thyroid stimulating hormone (TSH) and thyroid stimulating antibody (TSAb) negative Graves's disease (GD) is extremely rare. Here we present such a patient.

Case presentation: The patient was a 76-year-old woman who was diagnosed as having schizophrenia forty years ago. She did not show characteristic symptoms for hyperthyroidism, such as swelling of thyroid, exophthalmos, tachycardia and tremor, however, she showed only psychomotor agitation. Serum free triiodothyronine and free thyroxine levels were elevated and TSH level was suppressed, suggesting the existence of hyperthyroidism. However, both the first generation TSH receptor autoantibody (TRAb1) and the thyroid stimulating autoantibody (TSAb) were negative. Slightly increased blood flow and swelling was detected by thyroid echography. Thyroid scintigraphy demonstrated diffuse and remarkably elevated uptake of 123I uptake. Finally, we diagnosed her as having GD. She was treated by using methimazole, and hyperthyroidism and her psychiatric symptoms were promptly ameliorated.

Discussion: We experienced a patient with GD who did not show characteristic symptoms except for psychiatric symptoms, and also showed negativity for both TRAb1 and TSAb. Thyroid autoantibody-negative GD is extremely rare. Thyroid scintigraphy was useful to diagnose such a patient.

No MeSH data available.


Related in: MedlinePlus

Changes of free triiodothyronine (FT3) and free thyroxine (FT4).
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Figure 1: Changes of free triiodothyronine (FT3) and free thyroxine (FT4).

Mentions: Her body temperature was 35.7°C, blood pressure was 158/86 mmHg, and heart rate was 89 per minute and regular. Her thyroid was not swelled. She did not have tremor and exophthalmos. The serum TSH level was suppressed to < 0.03 μIU/mL (normal: 0.54-4.26 μIU/mL), free triiodothyronine (T3) and free thyroxine (T4) levels were elevated to 11.70 pg/mL (normal: 2.39-4.06 pg/mL) and 3.07 ng/dL (normal: 0.71-1.52 ng/dL), respectively (Figure1). Plasma glucose level was 116 mg/dL (normal: 80–112 mg/dL), and HbA1c level was 6.6% (normal: 4.7-6.2%). Her liver and renal functions were normal, and leukocyte counts and C-reactive protein (CRP) level were not elevated.


A patient with Graves' disease showing only psychiatric symptoms and negativity for both TSH receptor autoantibody and thyroid stimulating antibody.

Hamasaki H, Yoshimi T, Yanai H - Thyroid Res (2012)

Changes of free triiodothyronine (FT3) and free thyroxine (FT4).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3526500&req=5

Figure 1: Changes of free triiodothyronine (FT3) and free thyroxine (FT4).
Mentions: Her body temperature was 35.7°C, blood pressure was 158/86 mmHg, and heart rate was 89 per minute and regular. Her thyroid was not swelled. She did not have tremor and exophthalmos. The serum TSH level was suppressed to < 0.03 μIU/mL (normal: 0.54-4.26 μIU/mL), free triiodothyronine (T3) and free thyroxine (T4) levels were elevated to 11.70 pg/mL (normal: 2.39-4.06 pg/mL) and 3.07 ng/dL (normal: 0.71-1.52 ng/dL), respectively (Figure1). Plasma glucose level was 116 mg/dL (normal: 80–112 mg/dL), and HbA1c level was 6.6% (normal: 4.7-6.2%). Her liver and renal functions were normal, and leukocyte counts and C-reactive protein (CRP) level were not elevated.

Bottom Line: She was treated by using methimazole, and hyperthyroidism and her psychiatric symptoms were promptly ameliorated.We experienced a patient with GD who did not show characteristic symptoms except for psychiatric symptoms, and also showed negativity for both TRAb1 and TSAb.Thyroid scintigraphy was useful to diagnose such a patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan. dyanai@hospk.ncgm.go.jp.

ABSTRACT

Background: Both thyroid stimulating hormone (TSH) and thyroid stimulating antibody (TSAb) negative Graves's disease (GD) is extremely rare. Here we present such a patient.

Case presentation: The patient was a 76-year-old woman who was diagnosed as having schizophrenia forty years ago. She did not show characteristic symptoms for hyperthyroidism, such as swelling of thyroid, exophthalmos, tachycardia and tremor, however, she showed only psychomotor agitation. Serum free triiodothyronine and free thyroxine levels were elevated and TSH level was suppressed, suggesting the existence of hyperthyroidism. However, both the first generation TSH receptor autoantibody (TRAb1) and the thyroid stimulating autoantibody (TSAb) were negative. Slightly increased blood flow and swelling was detected by thyroid echography. Thyroid scintigraphy demonstrated diffuse and remarkably elevated uptake of 123I uptake. Finally, we diagnosed her as having GD. She was treated by using methimazole, and hyperthyroidism and her psychiatric symptoms were promptly ameliorated.

Discussion: We experienced a patient with GD who did not show characteristic symptoms except for psychiatric symptoms, and also showed negativity for both TRAb1 and TSAb. Thyroid autoantibody-negative GD is extremely rare. Thyroid scintigraphy was useful to diagnose such a patient.

No MeSH data available.


Related in: MedlinePlus