April - June 2007, Volume 3, Issue 2

Balmes E, Burcea A, Belgun M, Alexandrescu D, Badiu C

Marine-Lenhart syndrome. Case report and literature review

Acta Endo (Buc) 2007, 3 (2): 201-208
doi: 10.4183/aeb.2007.201

Graves’ disease and toxic nodular goiter both cause thyrotoxicosis by different pathophysiological mechanisms. Rare cases associates both etiologies are undertaken by the diagnosis of Marine-Lenhart syndrome. A woman aged 38, with Graves’ unilateral ophthalmopathy and a solitary, echo-dense thyroid nodule, developed thyrotoxicosis within the following 3 months. The diagnosis was certified by suppressed TSH (0.002 mIU/L), high fT4 (5.6 ng/mL) associated with elevated TRAb (3.5 IU/L), moderately elevated TPOAb (63.1 IU/mL) and ATGl (248 IU/mL). The thyroid radioiodine scan revealed a solitary hot nodule in the left lobe with an elevated radioiodine uptake. Methyl prednisolone was started by oral and pulse therapy, with stabilization of ophthalmopathy within 5 months. After four months with antithyroid drug therapy followed by radioiodine (25 mCi 131I), the thyroid scan revealed diffuse radioiodine uptake. Nine months after radioiodine therapy, the patient was in clinical and biochemical hypothyroidism and substitutive therapy was instituted. A broad literature review suggested that in such rare cases, underlying autoimmune mechanisms might be involved in the development of thyroid nodules with variable function and proliferation activity.

Keywords: Autonomous thyroid nodule, Graves ophthalmopathy, TRAb, Marine-Lenhart syndrome

Correspondence: Corin Badiu, MD, Department of Thyroid-Related Disorders, Institute of Endocrinology, Bucharest, 011863, Romania, badicrin@yahoo.co.uk