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Builes Barrera CA, Castaño PA, Herrera Revollo P, Pérez Paternina ME, Rodriguez Arrieta LA. Type 2 Marine-Lenhart Syndrome: An Uncommon Cause of Thyrotoxicosis. Cureus 2021; 13:e20558. [PMID: 35103137 PMCID: PMC8776516 DOI: 10.7759/cureus.20558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
Marine-Lenhart syndrome (MLS) is an uncommon cause of primary hyperthyroidism, which can occur in the context of diffuse goiter due to Graves disease (GD) or autonomic nodular disease (Plummer disease (PD)). The coexistence of these two conditions is the hallmark of the MLS. Patients with MLS have a lower remission rate with oral antithyroid drugs, requiring definitive management therapies with radioactive iodine or surgery. We present the case of a 48-year-old female with a history of primary autoimmune hyperthyroidism (GD) since 2016, with biochemical control of hyperthyroidism with methimazole but without the possibility of stopping treatment. The scintigraphic uptake pattern showed heterogeneous uptake of the thyroid parenchyma with three hyper-uptake nodules without inhibition of the rest of the thyroid tissue, findings of an MLS condition with the indication for definitive therapy, for which he was referred to nuclear medicine for the administration of radioactive iodine.
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Danno H, Nishihara E, Kousaka K, Nakamura T, Kasahara T, Kudo T, Ito M, Fukata S, Nishikawa M, Miyauchi A. Prevalence and Treatment Outcomes of Marine-Lenhart Syndrome in Japan. Eur Thyroid J 2021; 10:461-467. [PMID: 34950599 PMCID: PMC8647058 DOI: 10.1159/000510312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/19/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Marine-Lenhart syndrome (MLS) is now understood to be a combination of Graves' disease and autonomously functioning thyroid nodule(s) (AFTNs). The prevalence of the syndrome and suitable treatments for those living in iodine-sufficient areas are uncertain. OBJECTIVES We aimed to investigate the prevalence, treatment, and prognosis of MLS in Japan, an iodine-sufficient area. METHODS This study involved patients who visited our hospital between February 2005 and August 2019. Among patients with both thyrotoxicosis and thyroid nodule(s) larger than 10 mm, MLS and isolated AFTNs were diagnosed based on serum thyroid-stimulating hormone receptor antibody levels and scintigraphy using radioiodine or technetium-99m and thyroid uptake. RESULTS Twenty-two patients were found to have MLS, compared to 372 with isolated AFTNs and 8,343 with Graves' disease, during the period. Therefore, the rate of MLS cases was 0.26% among all patients with Graves' disease (22/8,343). Treatments and outcomes were assessed for cases of MLS (n = 18) and isolated AFTNs (n = 269). Antithyroid drugs (ATDs) were withdrawn in 27.8% of cases in the MLS group and 10.3% in the isolated AFTN group. There was no significant difference in the clinical outcome after ATD withdrawal between the 2 groups. However, the rate of hypothyroidism after radioactive iodine (RAI) administration was significantly higher in the MLS group than in the isolated AFTN group (42.9 vs. 9.0%, p = 0.005) despite similar doses of RAI. CONCLUSIONS The prevalence of MLS among patients with Graves' disease was 0.26% in Japan. RAI therapy induces hypothyroidism more frequently than in those with AFTNs probably because RAI is taken up in the surrounding Graves' tissues.
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Affiliation(s)
- Hirosuke Danno
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
- *Hirosuke Danno, Center for Excellence in Thyroid Care, Kuma Hospital, 8-2-35, Shimoyamate-Dori, Chuo-Ku, Kobe-City Hyogo 650-0011 (Japan),
| | - Eijun Nishihara
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Kazuyoshi Kousaka
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Tomohiko Nakamura
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Toshihiko Kasahara
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Takumi Kudo
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Mitsuru Ito
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Shuji Fukata
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Mitsushige Nishikawa
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Akira Miyauchi
- Division of Surgery and Director, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
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Oka K, Yasuda M, Shien T, Otsuka F. A marked goiter involved in Marine-Lenhart syndrome. J Gen Fam Med 2019; 20:37-38. [PMID: 30631661 PMCID: PMC6321827 DOI: 10.1002/jgf2.220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 11/11/2022] Open
Abstract
Marine-Lenhart syndrome is rare disease defined as coexistence of Graves' disease and autonomously functioning thyroid nodule. We will introduce a case of Marine-Lenhart with a huge goiter.
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Affiliation(s)
- Kosuke Oka
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Miho Yasuda
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Tadahiko Shien
- Department of Breast and Endocrine SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Fumio Otsuka
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
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Ribeiro FCM, Ruas LA, J. AL, Sousa AAD, Araújo AF, Mwambire J, Jesus ALCD, Bussuan RM, Sá LBCD, Arbex AK. Graves’ Disease and Marine Lenhart Syndrome: A Rare Clinical Presentation. Health (London) 2019. [DOI: 10.4236/health.2019.119091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lombardi M, Tonacchera M, Macchia E. A new case of Marine-Lenhart syndrome with a papillary thyroid carcinoma. Clin Case Rep 2018; 6:2299-2302. [PMID: 30564316 PMCID: PMC6293153 DOI: 10.1002/ccr3.1769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/09/2018] [Accepted: 07/29/2018] [Indexed: 11/10/2022] Open
Abstract
We report the case of a patient with the coexistence of Graves' disease and autonomously functioning thyroid nodules. Because of the suspicious ultrasound pattern, he was submitted to fine-needle aspiration of the hot nodule and cytology revealed a papillary thyroid cancer. After total thyroidectomy a papillary thyroid cancer was found.
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Affiliation(s)
- Martina Lombardi
- Department of Clinical and Experimental MedicineEndocrine UnitUniversity of PisaPisaItaly
| | - Massimo Tonacchera
- Department of Clinical and Experimental MedicineEndocrine UnitUniversity of PisaPisaItaly
| | - Enrico Macchia
- Department of Clinical and Experimental MedicineEndocrine UnitUniversity of PisaPisaItaly
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Coexistent presentation of Graves' disease and an autonomous thyroid nodule following administration of an iodinated contrast load. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.jecr.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Giuffrida G, Giovinazzo S, Certo R, Vicchio TM, Baldari S, Campennì A, Ruggeri RM. An uncommon case of Marine-Lenhart syndrome. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2014; 58:398-401. [PMID: 24936736 DOI: 10.1590/0004-2730000003173] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/03/2014] [Indexed: 11/22/2022]
Abstract
The term Marine-Lenhart syndrome describes the association between Graves' disease and autonomously functioning thyroid nodules (AFTN), such as toxic adenoma or toxic multinodular goiter. The two diseases may coexist or may be present at different moments in the same patient. In the literature, there are many reports on the development of Graves' disease after radioiodine treatment for AFTN, but very little information may be found on the occurrence of AFTN after radioiodine therapy for Graves' disease. We describe here the case of a female patient with Graves' disease who was successfully treated with radioiodine for Graves' disease, returning to normal thyroid function. Three years later, biochemical analysis and ultrasound examination identified a thyroid nodule that progressively increased in size. The 99mTc-pertechnetate scintigraphy showed avid uptake in the right lobule, which corresponded to a nodular lesion consistent with AFTN.
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Affiliation(s)
- Giuseppe Giuffrida
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
| | - Salvatore Giovinazzo
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
| | - Rosaria Certo
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
| | - Teresa Manuela Vicchio
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
| | - Sergio Baldari
- Department of Biomedical Sciences and of Morphological and Functional Images, Unit of Nuclear Medicine, University of Messina, Italy
| | - Alfredo Campennì
- Department of Biomedical Sciences and of Morphological and Functional Images, Unit of Nuclear Medicine, University of Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
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A Case of Marine-Lenhart Syndrome with a Negative TSH Receptor Antibody Titer Successfully Treated with a Fixed, Low Dose of I 131. Case Rep Endocrinol 2014; 2014:423563. [PMID: 25161779 PMCID: PMC4137599 DOI: 10.1155/2014/423563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/17/2014] [Indexed: 11/17/2022] Open
Abstract
We herein describe a case of Marine-Lenhart syndrome with a negative TSH receptor antibody titer. A 75-year-old female presented to our hospital with malaise, palpitations, and mild fine tremors. She did not have any signs suggestive of Graves' ophthalmopathy, including conjunctival injection, periorbital edema, or proptosis. Her laboratory data were negative for thyroid autoantibodies, including anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and anti-TSH receptor antibodies (TRAb). Ultrasonography of the thyroid gland revealed a tumor in the right lobe. The remaining thyroid gland had an inhomogeneous and rough texture with a high color Doppler flow. I123 scintigraphy disclosed a hot nodule in the right thyroid gland corresponding to the tumor detected on ultrasonography, suggesting Plummer disease. Furthermore, there was an increased uptake of radionuclide in the rest of the thyroid gland, despite the suppressed level of TSH and negative titer of TRAb, suggesting underlying Graves' disease. The present findings suggested a diagnosis of Marine-Lenhart syndrome with a negative TRAb titer. Treatment with 10 mCi of radioiodine was highly effective in treating hyperthyroidism in this case. A negative TSH receptor antibody titer does not necessarily rule out the existence of Graves' disease in patients with Plummer disease.
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Scherer T, Wohlschlaeger-Krenn E, Bayerle-Eder M, Passler C, Reiner-Concin A, Krebs M, Gessl A. A Case of simultaneous occurrence of Marine - Lenhart syndrome and a papillary thyroid microcarcinoma. BMC Endocr Disord 2013; 13:16. [PMID: 23657056 PMCID: PMC3654942 DOI: 10.1186/1472-6823-13-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 04/23/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Marine-Lenhart syndrome is defined as the co-occurrence of Graves' disease and functional nodules. The vast majority of autonomous adenomas are benign, whereas functional thyroid carcinomas are considered to be rare. Here, we describe a case of simultaneous occurrence of Marine-Lenhart syndrome and a papillary microcarcinoma embedded in a functional nodule. CASE PRESENTATION A 55 year-old, caucasian man presented with overt hyperthyroidism (thyrotropin (TSH) <0.01 μIU/L; free thyroxine (FT4) 3.03 ng/dL), negative thyroid peroxidase and thyroglobulin autoantibodies, but elevated thyroid stimulating hormone receptor antibodies (TSH-RAb 2.6 IU/L). Ultrasound showed a highly vascularized hypoechoic nodule (1.1 × 0.9 × 2 cm) in the right lobe, which projected onto a hot area detected in the 99mtechnetium thyroid nuclear scan. Overall uptake was increased (4.29%), while the left lobe showed lower tracer uptake with no visible background-activity, supporting the notion that both Graves' disease and a toxic adenoma were present. After normal thyroid function was reinstalled with methimazole, the patient underwent thyroidectomy. Histological work up revealed a unifocal papillary microcarcinoma (9 mm, pT1a, R0), positively tested for the BRAF V600E mutation, embedded into the hyperfunctional nodular goiter. CONCLUSIONS Neither the finding of an autonomously functioning thyroid nodule nor the presence of Graves' disease rule out papillary thyroid carcinoma.
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Affiliation(s)
- Thomas Scherer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Evelyne Wohlschlaeger-Krenn
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Michaela Bayerle-Eder
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Christian Passler
- Department of Surgery, SMZ Floridsdorf, Hinaysgasse 1, Vienna, 1210, Austria
| | | | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Alois Gessl
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
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Zechmann CM, Haufe SE. [Radiologic and nuclear medicine diagnosis and therapy of thyroid disorders. Part 1: Benign thyroid diseases]. Radiologe 2012; 52:661-76; quiz 677. [PMID: 22801791 DOI: 10.1007/s00117-012-2359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The thyroid gland is one of the most important endocrine organs. It has multiple influences on physical and mental health. The most important benign diseases are goiter, thyroid adenomas and inflammation. The clinical, imaging and laboratory findings are often pathognomic. The therapy spectrum ranges from follow-up, to medication or definitive therapy by operation or radioiodine therapy.
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Affiliation(s)
- C M Zechmann
- Abteilung Nuklearmedizin, Universität Heidelberg, Im Neuenheimer Feld 400, 69120 , Heidelberg, Deutschland.
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