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March 1989

Graves' Disease and Thyroxine-Binding Globulin Excess

Author Affiliations

Bethesda, Md

Arch Intern Med. 1989;149(3):705. doi:10.1001/archinte.1989.00390030149031

Tb the Editor.—We have read with interest the article in the June issue of the Archives by Dall' Aglio et al1 on incorrect treatment following the lack of recognition of the association of Graves' disease with thyroxine-binding globulin (TBG) deficiency (TBG-d).

The Table summarizes the relevant data of a case of Graves' disease (in a 57-year-old man) associated with the opposite TBG variation, ie, TBG excess (TBG-e), an association not recognized until our observation.

Such an association is more frequent than the association with TBG-d. In fact, no thyroid disease was found in 30 subjects with inherited TBG-d,2 and only five cases of TBG-d were isolated in a series of 250 thyrotoxic patients (2%)3; on the contrary, four patients with Graves' disease were found among 56 subjects (7%) with inherited TBG-e2 and 11 cases of inherited TBG-e were found among 155 patients (7%) with Graves'

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