Persistent hyperthyroidism and de novo Graves’ ophthalmopathy after total thyroidectomy

摘要

We report a patient with Graves’ disease who remained persistently hyperthyroid after a total thyroidectomy and also developed de novo Graves’ ophthalmopathy 5 months after surgery. She was subsequently found to have a mature cystic teratoma containing struma ovarii after undergoing a total hysterectomy and salpingo-oophorectomy for an incidental ovarian lesion.Learning points: class="unordered" style="list-style-type:disc">It is important to investigate for other causes of primary hyperthyroidism when thyrotoxicosis persists after total thyroidectomy.TSH receptor antibody may persist after total thyroidectomy and may potentially contribute to the development of de novo Graves’ ophthalmopathy. class="kwd-title">Patient demographics: Adult, Female, Asian – Chinese, Singapore class="kwd-title">Clinical overview: Thyroid, Thyroid, Thyroxine (T4), Triiodothyronine (T3), TSH, Hyperthyroidism, Graves’ ophthalmopathy, Graves’ disease, Struma ovarii, Thyrotoxicosis, Goitre (multinodular), Thyroiditis, Ovarian tumour class="kwd-title">Diagnosis & treatment: Hyperthyroidism, Thyrotoxicosis, Fatigue, Myasthaenia, Palpitations, Menstrual disorder, Tremulousness, Weight loss, Heat intolerance, Goitre, Dysphagia, Bowel movements ȃ bleeding, Diplopia, Proptosis, FT3, FT4, TSH, TSH receptor antibodies, CT scan, Thyroid antibodies, MRI, Histopathology, Thyroidectomy, Salpingo-oophorectomy, Hysterectomy, Resection of tumour, Bilateral salpingo-oophorectomy, Carbimazole, Levothyroxine, Prednisolone, Glucocorticoids class="kwd-title">Publication details: Unique/unexpected symptoms or presentations of a disease, October, 2017 class="head no_bottom_margin" id="__sec2title">BackgroundThe coexistence of Graves’ disease and struma ovarii is uncommon, resulting in delayed diagnosis. While de novo Graves’ ophthalmopathy has been seen after definitive treatment of Graves’ disease with radioactive iodine, it is uncommon after total thyroidectomy. Our patient had persistent thyrotoxicosis as well as the development of de novo Graves’ ophthalmopathy after total thyroidectomy, both mediated by the presence of functioning struma ovarii in a mature cystic teratoma.