Endocrine Abstracts

Introduction: Graves disease is a frequent etiology of hyperthyroidism. It is defined as a diffuse hyperfunctioning of the thyroid gland caused by an autoimmune disorder. We herein present a rare case of unilateral Graves disease involving the right lobe of the thyroid.

Observation: A 44-year-old woman was referred for investigation of subclinical hyperthyroidism revealed by a routine check-up. On physical examination, she had tremor, eyelid retraction, tachycardia and the thyroid gland was no palpable. She complained of heat intolerance and nervousness for 1 year. On biological investigations, she had a serum TSH level of 0.001 mUI/l (normal range:0.35-4.94) and a serum free thyroxin (FT4) level of 1.48 ng/dl(normal range:0.7-1.48) : confirmed persistent grade 2 subclinical hyperthyroidism. She also had a serum glucose level of 0.96 g/l, a serum total cholesterol level of 1.51 g/l, a serum triglycerides level of 0.86 g/l, HDL-cholesterol level of 0.53 g/l and LDL- cholesterol level of 0.80 g/l. She had a white blood cells of 6680 elements/mm3, neutrophils of 3360/mm3 and lymphocytes of 2290/mm3. The liver and kidney function tests and c-reactive protein (CRP) were normal. The serum TSH receptor antibody level was high 17.54 UI/ml (normal range<2 UI/l) and the level of antithyroperoxidase antibody was within normal range. The bone mineral density was normal. The cervical ultrasonography showed a normal thyroid volume, normovascular gland and a nodule in the lower pole of the right lobe with a long-axis diameter of 14 mm EU-TIRADS 5. The thyroid scintigraphy revealed an increased uptake in the right thyroid lobe with an accompanying suppression in the left lobe. The fine needle aspiration biopsy of the nodule revealed benign appearance on cytological examination. The patient received antithyroid drug: methimazole and propranolol and recovered well.

Conclusion: Graves’ disease usually presents with frank clinical signs of hyperthyroidism, bilateral exophthalmos, and a diffuse goiter. This case illustrates a rare case of unilateral involvement of the thyroid and a subclinical hyperthyroidism in a patient with confirmed diagnosis of graves’ disease. Clinicians should be aware of this rare presentation of the disease as it affects treatment.