J Korean Thyroid Assoc.  2015 May;8(1):98-102. 10.11106/cet.2015.8.1.98.

Radioactive Iodine-Induced Graves' Disease in a Patient with Toxic Adenoma

• Yoon S
• Shin K
• Cho E
• Kim MJ

• KMID: 2149626
• DOI: http://doi.org/10.11106/cet.2015.8.1.98

Abstract

We report a rare case of radioactive iodine (RAI)-induced Graves' disease in a patient with toxic adenoma. A 42-year-old woman presented with neck masses. A hot nodule was detected on a thyroid scan, which suggested toxic adenoma. She was treated with RAI. Three months after the treatment, she complained of thyrotoxic symptoms such as weight loss, palpitation, diarrhea, and menstrual irregularity. A new thyroid scan showed diffuse increased uptake, while the toxic adenoma previously detected was now a cold nodule. Moreover, an increased level of antibodies against the thyroid-stimulating hormone receptor was detected. These findings indicated Graves' disease. Hence she was treated with anti-thyroid drug. This case serves as a reminder for physicians to consider RAI-induced Graves' disease if thyrotoxicosis is noted after RAI treatment.

Keyword

Graves' disease; Radioisotopes; Thyroid nodule; Thyrotoxicosis

MeSH Terms

Adenoma*
Adult
Antibodies
Diarrhea
Female
Graves Disease*
Humans
Iodine
Neck
Radioisotopes
Thyroid Gland
Thyroid Nodule
Thyrotoxicosis
Thyrotropin
Weight Loss
Antibodies
Iodine
Radioisotopes
Thyrotropin

Figure

• 

  Fig. 1. Change in the Tc-99m thyroid scan. (A) Before radioactive iodine therapy, a hot nodule was noted in the right upper part of the thyroid. (B) After radioactive iodine therapy, diffuse uptake in both thyroid lobes was observed, except in the region in which toxic adenoma was previously noted.

• 

  Fig. 2. Ultrasonography imaging and fine-needle aspiration cytology of the thyroid nodule. (A) Ultrasonography showed a 2.9 cm cystic heterogeneous nodule. (B) Fine-needle aspiration cytology of the thyroid nodule showed cystic goiter (magnification ×200).

• 

  Fig. 3. Change in thyroid function after radioactive iodine (RAI) treatment. fT4: free thyroxine, T3: triiodothyronine, TSH: thyroid stimulating hormone.

Reference

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