Case Report of International Journal of Case Reports
Recurrence of Graves’ disease in thyroid remnant after total thyroidectomy
Óscar Moreno Domínguez1, Beatriz Barquiel Alcalá1, Alejandro Castro Calvo2, Lucrecia Herranz de la Morena1
1Department of Endocrinology and Nutrition, La Paz Hospital, Madrid, Spain. 2Department of Otorhinolaryngology, La Paz Hospital, Madrid, Spain
Recurrences of Graves’ disease (GD) after total thyroidectomy (TT) are uncommon, with few cases reported in literature. This article describes the case of a 58-year-old man who was treated with TT due to GD over 15 years ago. A progressive reduction of levothyroxine treatment was observed due to persistent subclinical hyperthyroidism. Thyroid-stimulating hormone receptor antibodies were detected in blood analysis and in the imaging test, a lesion was identified in the upper left anterolateral cervical region. A histopathological study of the lesion revealed colloid goiter. The patient was diagnosed with GD recurrence in a thyroid remnant and was remitted to an otorhinolaryngologist to remove the lesion. The histopathological study showed diffuse thyroid hyperplasia. The objective of this clinical case report is to highlight this unusual recurrence to better treat and improve long-term outcomes in patients treated with TT.
Keywords: Graves’ disease, recurrence, thyroid remnant, total thyroidectomy
How to cite this article:
Óscar Moreno Domínguez, Beatriz Barquiel Alcalá, Alejandro Castro Calvo, Lucrecia Herranz de la Morena. Recurrence of Graves’ disease in thyroid remnant after total thyroidectomy. International Journal of Case Reports, 2020 4:135. DOI: 10.28933/ijcr-2020-05-1605
1. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016; 26 (10): 1343-1421.
2. Snook KL, Stalberg PL, Sidhu SB, Sywak MS, Edhouse P, Delbridge L. Recurrence after total thyroidectomy for benign multinodular goiter. World J Surg. 2007; 31: 593-598.
3. Lin YS, Lin JD, Hsu CC, Yu MC. The long-term outcomes of thyroid function after subtotal thyroidectomy for Graves’ hyperthyroidism. J Surg Res. 2017; 220: 112-118.
4. Barczyński M, Konturek A, Hubalewska-Dydejczyk A, Gołkowski F, Nowak W. Randomized clinical trial of bilateral subtotal thyroidectomy versus total thyroidectomy for Graves’ disease with a 5-year follow-up. Br J Surg. 2012; 99 (4): 515-522.
5. Basili G, Andreini R, Romano N, Lorenzetti L, Monzani F, Naccarato G, Goletti O. Recurrence of Graves’ disease in thyroglossal duct remnants: relapse after total thyroidectomy. Thyroid. 2009; 19(12): 1427-1430
6. Sung TY, Lee YM, Yoon JH, Chung KW, Hong SJ. Long-Term Effect of Surgery in Graves’ Disease: 20 Years Experience in a Single Institution. Int J Endocrinol. 2015; 2015: 542641.
7. Guo Z, Yu P, Liu Z, Si Y, Jin M. Total thyroidectomy vs bilateral subtotal thyroidectomy in patients with Graves’ diseases: a meta-analysis of randomized clinical trials. Clin Endocrinol (Oxf). 2013; 79(5):739-46.
8. Jakibchuk K, Ali S, Samantray J. Recurrence of Graves’ disease in ectopic thyroid tissue. BMJ Case Rep. 2018; 2018. pii: bcr-2017-221566.
9. Winters R, Christian RC, Sofferman R. Thyrotoxicosis due to ectopic lateral thyroid tissue presenting 5 years after total thyroidectomy. Endocr Pract. 2011; 17(1): 70-73.
10. D’Andrea V, Cantisani V, Catania A, Di Matteo FM, Sorrenti S, Greco R, et al. Thyroid tissue remnants after “total thyroidectomy”. G Chir. 2009; 30(8/9): 339-344.