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BMJ Case Rep. 2014 May 21;2014. pii: bcr2013010432. doi: 10.1136/bcr-2013-010432.

Hot and cold: coexistent Graves' disease and Hashimoto's thyroiditis in a patient with Schmidt's syndrome.

Author information

1
Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India.
2
Department of Cardiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.

Abstract

A 37-year-old housewife presented with generalised fatigue, palpitations and weight loss over the past 3 months. Physical examination revealed signs of hyperthyroidism. Thyroid function tests confirmed the presence of thyrotoxicosis. Pertechnetate radionuclide imaging of the thyroid showed diffusely increased radiotracer uptake consistent with Graves' disease and a cold nodule in the right lobe. Needle aspiration from the nodule yielded evidence of Hashimoto's thyroiditis. The patient also tested strongly positive for antithyroid peroxidase antibodies. Simultaneous laboratory evaluation revealed primary adrenal failure and probable pernicious anaemia, thus producing a diagnosis of Schmidt's syndrome. The patient was initiated on appropriate medical therapy for endocrinopathy. Graves' disease was treated with radioablation.

PMID:
24850545
PMCID:
PMC4039812
DOI:
10.1136/bcr-2013-010432
[Indexed for MEDLINE]
Free PMC Article

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