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Case Reports
. 2020 Nov 3;13(11):e236465.
doi: 10.1136/bcr-2020-236465.

Autoimmune switch from hyperthyroidism to hypothyroidism in Graves' disease

Preethi Padmanaban  1 , Rohit Jain  2
Affiliations
Case Reports

Autoimmune switch from hyperthyroidism to hypothyroidism in Graves' disease

Preethi Padmanaban et al. BMJ Case Rep. .

Abstract

We report a case of a 21-year-old young woman who was initially diagnosed with hyperthyroidism secondary to Graves' disease and spontaneously switched to hypothyroidism in a year. While most autoimmune hypothyroidism is due to Hashimoto's disease, in her case, we suspect that her hypothyroidism is due to a switch of antibody dominance from thyroid stimulating hormone (TSH) receptor-stimulating antibody (TS Ab) to TSH receptor-blocking antibody (TB Ab). Switching from dominant TS Ab activity to dominant TB Ab activity is a rare phenomenon. Optimal management of this condition is not known. Loss of follow-up and medication non-adherence has made medical management in this young woman of reproductive age further challenging.

Keywords: endocrine system; endocrinology; thyroid disease; thyroiditis; thyrotoxicosis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Thyroid uptake scan showing diffuse uptake significant for Graves’ disease.
Figure 2
Figure 2
Thyroid-stimulating hormone (TSH) versus free T4: thyroid function tests over time.
See this image and copyright information in PMC

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Publication types

Supplementary concepts