August 1977

Unusual Events Preceding Hyperthyroidism With Diffuse Goiter

Author Affiliations

From the Departments of Medicine (Drs Bendezu, Wieland, and Levine) and Pathology (Dr Tang), Case Western Reserve University and St Luke's Hospital, Cleveland.

Arch Intern Med. 1977;137(8):1023-1025. doi:10.1001/archinte.1977.03630200031011

Two unique patients with hyperthyroidism are presented here. A 48-year-old woman with a family history of Graves' disease was first evaluated and treated for a toxic adenoma with radioactive iodine. Three months later, she was again hyperthyroid, was found to have a diffuse thyromegaly, and was treated with radioactive iodine for the second time. This patient represents, to our knowledge, the first reported case of two sequential forms of endogenous hyperthyroidism. The second patient, a 64-year-old woman, had well-documented hypothyroidism that was presumably primary. She was admitted in thyroid storm and subsequently died. The autopsy disclosed characteristic changes in the thyroid of hyperthyroidism and a normal pituitary gland. The timing of the onset of Graves' disease with hyperthyroidism cannot be accurately determined.

(Arch Intern Med 137:1023-1025, 1977)