Minor hyperthyroidism with normal levels of thyroid-stimulating hormone receptor antibodies: a case report

Abstract

The present report describes for the first time a case of diffuse hyperthyroidism in a 30-year-old female patient who had normal levels of thyroid-stimulating hormone receptor antibodies (TSHR-Ab), slightly elevated plasma levels of thyroid hormones, and slightly increased thyroid blood flow. Seven years before, after severe stress, she had Graves' disease with elevated plasma levels of TSHR-Ab. The patient's recent medical history included mental stress and autonomic dysfunction. This report describes a mild form of hyperthyroidism in terms of elevated plasma levels of thyroid hormones and Doppler ultrasonography data; this condition was first defined as 'minor hyperthyroidism'. The examination data suggest a probable secondary role of the immune system and primary role of the autonomic nervous system in the pathogenesis of Graves' disease.

Keywords: Doppler; Graves’ disease; PSV-STA; TSHR-Ab; autonomic nervous system; hyperthyroidism; thyroid ultrasound.

Figure 1

Doppler ultrasonography images of both lobes of the thyroid gland. A,B, Slightly increased blood flow intensity in both lobes (higher intensity is seen in the right lobe). C,D, PSV-STA is 42 cm/s and 35 cm/s in the right and left arteries, respectively (in contrast, the common carotid arteries showed a PSV of 67 cm/s and 42 cm/s in the right and left arteries, respectively, in which the complete arteries were measured at the same level).