Marine-lenhart syndrome: a rare cause of hyperthyroidism

Arous Mohamed Khairi; Mrabet Houcem Elomma; Fadia Boubaker; Mariem Souissi; Baha Zantour; Wafa Alaya; Sfar Mohamed Habib

doi:10.1530/endoabs.99.EP602

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Endocrine Abstracts (2024) 99 EP602 | DOI: 10.1530/endoabs.99.EP602

ECE2024 Eposter Presentations Thyroid (198 abstracts)

Marine-lenhart syndrome: a rare cause of hyperthyroidism

Mohamed Khairi Arous ¹ , Houcem Elomma Mrabet ¹ , Fadia Boubaker ¹ , Mariem Souissi ¹ , Baha Zantour ¹ , Wafa Alaya ¹ & Mohamed Habib Sfar ¹

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¹University Hospital Taher Sfar, Endocrinology and Internal medicine Department, Mahdia, Tunisia

Background: Marine-Lenhart syndrome (MLS) is defined by the coexistence of Graves’ disease and a hyperactive nodule or multinodular goiter. Although rare, its diagnosis by functional imaging coupled with ultrasound is necessary in order to propose a radical treatment. We report the case of a patient followed for hyperthyroidism related to a SML.

Case presentation: A 52-year-old patient consulted for a picture of thyrotoxicosis associating tremor, weight loss, polyphagia, irritability and thermophobia. Physical examination revealed a small goiter with a right lobar nodule and bilateral exophtalmia. Hormonal assessment showed a TSH at 0.002 mIU/l and FT4 at 47.1 pmol/l confirming peripheral hyperthyroidism. Anti-TSH receptor antibodies were positive at 40. The Graves’ disease was diagnosed confronted to the proptosis and the positivity of the antibodies. Neck ultrasound showed a hypervascularized goiter and two right lobar nodules classified EU-TIRADS III measuring 7.1 mm and 2.3 mm respectively. Scintigraphy showed an increased diffuse iodine uptake of the thyroid gland along with a partially extinctive thyroid nodule. The patient was put on 20 mg/d of thiamazol in preparation for a radical treatment by total thyroidectomy

Conclusions: The diagnosis of MLS is present in 2-4% of patients with MB; hence the inecessity of a neck ultrasound even in the presence of clinically or biologically obvious Graves’ disease, especially in the presence of a thyroid nodule. Scintigraphy is also required to characterize the nodule. The treatment of MLS is surgical, since resistance to synthetic antithyroid drugs is noted in these cases.