Graves’ disease

Background: Marine-Lenhart syndrome (MLS) is a rare thyroid disorder characterized by the coexistence of Graves' disease (GD) with autonomously functioning thyroid nodules. This overlap presents diagnostic and therapeutic challenges due to the dual hyperthyroid mechanisms involved. Case Presentation: A 32-year-old female presented with weight loss, palpitations, heat intolerance, and nervousness. Physical examination revealed a slightly enlarged thyroid without palpable nodules. Laboratory results confirmed hyperthyroidism with suppressed thyroid-stimulating hormone (TSH) and elevated free thyroxine (FT4) and free tri-iodothyronine (FT3). Thyroid scintigraphy identified a hyperfunctioning nodule in the right lobe, and ultrasonography confirmed a 2.5 × 2.0 cm hypoechoic nodule with increased vascularity. Fine needle aspiration cytology (FNAC) categorized the lesion as Bethesda category 2 (benign). Elevated TSH receptor antibody (TRAb) levels confirmed concurrent GD. The patient was diagnosed with MLS and initiated on carbimazole, achieving biochemical euthyroidism within three months. Given her personal circumstances, radioiodine therapy was deferred. Discussion: MLS remains underrecognized due to its variable presentation and resemblance to Plummer’s disease and classical GD. Accurate differentiation is critical, as the management strategy differs from isolated GD or toxic nodular goiter. While antithyroid drugs provide symptomatic control, definitive treatment often requires radioiodine therapy or surgery. The presence of thyroid nodules in GD also raises concerns about potential malignancy, necessitating close monitoring. Conclusion: This case highlights the importance of considering MLS in patients with Graves’ disease and coexisting thyroid nodules. A tailored approach integrating clinical, biochemical, and imaging findings is essential for optimal management.

Introduction: Treatment of Graves' disease (GD) is based on the triad of antithyroid drugs (ATD), radioactive iodine and surgery (total or subtotal thyroidectomy). ATD remains the first-line treatment. Aim: To determine predictors of GD remission after treatment with ATD. Methods: Cross-sectional study for analytical purposes including 105 patients followed for GD treated with ATD for 12 to 18 months. The collection of clinical and biological data was done through the consultation of medical records. Patients were divided to two groups according to their outcome. The "Remission" group included patients with durable euthyroidism after treatment withdrawal. The "Failure" group included patients who did not achieve euthyroidism at the end of treatment or who had relapsed after treatment withdrawal. Results were compared using Chi-Square test and t-test and logistic regression model with significance at p Results: Patients in the "Remission" group were 43 (40.95%) and patients in the "Failure" group were 62 (59.05%). Factors that were significantly associated with remission at univariate analysis were: a shorter duration of symptom progression, a shorter duration of treatment, a lower initial anti-TSH receptor antibodies level, methimazole use compared to Benzylthiouracil use and better therapeutic adherence. Multivariate analysis showed that only shorter treatment duration (p = 0.01, OR = 0.90, IC95% [0.87 0.97]), lower initial anti-TSH receptor antibodies level (p = 0.016; = 0.93, IC95% [0.87-0.98]) and methimazole use (p = 0.048, OR = 2.4, IC95% [1.00-5.74]) were significant predictors of remission. Conclusion: A lower initial level of anti-TSH receptor antibodies, the use of methimazole compared to Benzylthiouracil as well as a shorter duration of treatment are factors of better prognosis in the outcome of Graves’ disease after Antithyroid drug treatment.