Marine Lenhart syndrome: Case reports of an unusual hyperthyroidism presentation
XHTML (Español (España))
PDF (Español (España))

Keywords

hyperthyroidism
Graves’ disease
thyrotoxicosis
thyroid nodules

How to Cite

Álvarez, A., Jaramillo , D. ., Valencia , A. I. ., Orozco, E., Zuluaga Gil, A., & Aristizabal, N. (2023). Marine Lenhart syndrome: Case reports of an unusual hyperthyroidism presentation. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 10(1). https://doi.org/10.53853/encr.10.1.747

Abstract

Introduction: Marine Lenhart syndrome is a rare form of presentation of Graves’ disease or diffuse hypercapting goiter, which is associated with autonomously functioning thyroid nodules. It has a prevalence between 0.8-2.7% among patients with Graves’ disease. This pathology is suspected in patients who require high doses of antithyroid drugs, its diagnosis is based on the finding of an enlarged hyperfunctioning gland, associated with one or more thyrotropin (TSH) dependent and histologically benign nodules. Treatment consists of high doses of antithyroid or radioactive iodine, and in selected cases, thyroidectomy.

Objective: The objective of this case study is to determine the sociodemographic, clinical, and therapeutic profile of patients with Marine Lenhart syndrome treated at a third level center in Medellín.

Case presentation: Therefore, we present the cases of two patients who consulted due to a clinical presentation compatible with thyrotoxicosis, who underwent a scintigraphy associated with ultrasound, and whose results established the diagnosis. Management with antithyroids was performed until euthyroidism was achieved prior to definitive therapy with surgery.

Discussion and conclusion: This article discusses the definition, clinical presentation, diagnosis and treatment of Marine Lenhart syndrome. In addition, this paper presents two clinical cases of patients with the disease, diagnostic imaging, paraclinical findings and clinical approach.

https://doi.org/10.53853/encr.10.1.747
XHTML (Español (España))
PDF (Español (España))

References

Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: Management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid: official journal of the American Thyroid Association. 2011;21(6):593-646. https://doi.org/10.1089/thy.2010.0417

Smith TJ, Hegedüs L. Graves’ Disease. N Engl J Med. 2016;375(16):1552–65. https://doi.org/10.1056/NEJMra1510030

Neuman D, Kuker R, Vendrame F. Marine-Lenhart Syndrome: Case report, diagnosis, and Management. Case Reports in Endocrinology. 2018:1–4. https://doi.org/10.1155/2018/3268010

ND C. Graves' disease with functioning nodules (Marine-Lenhart syndrome). J Nucl Med. 1972;13(12):885-92.

Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G. High incidence of multinodular toxic goiter in the elderly population in a low iodine intake area vs. high incidence of graves' disease in the young in a high iodine intake area: Comparative surveys of thyrotoxicosis epidemiology in east-Jutland Denmark and Iceland. J. Intern. Med. 1991;229(5):415–20. https://doi.org/10.1111/j.1365-2796.1991.tb00368.x

Jacobson DL, Gange SJ, Rose NR, Graham NMH. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. J. Clin. Immunol. 1997;84(3):223–43. https://doi.org/10.1006/clin.1997.4412

Tanda ML, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L, et al. Prevalence and natural history of graves' orbitopathy in a large series of patients with newly diagnosed Graves' hyperthyroidism seen at a single center. J. Clin. Endocr. . 2013;98(4):1443–9. https://doi.org/10.1210/jc.2012-3873

Wémeau J-louis, Klein M, Sadoul J-L, Briet C, Vélayoudom-Céphise F-L. Graves’ disease: Introduction, epidemiology, endogenous and environmental pathogenic factors. Ann. Endocrinol.. 2018;79(6):599–607. https://doi.org/10.1016/j.ando.2018.09.002

Eckstein AK, Plicht M, Lax H, Neuhäuser. M, Mann K, Lederbogen S, et al. Thyrotropin receptor autoantibodies are independent risk factors for graves’ ophthalmopathy and help to predict severity and outcome of the disease. J. Clin. Endocr.. 2006;91(9):3464–70. https://doi.org/10.1210/jc.2005-2813

Cantalamessa L, Baldini M, Orsatti A, Meroni L, Amodei V, Castagnone D. Thyroid nodules in graves’ disease and the risk of thyroid carcinoma. Arch. Inern. Med. 1999;159(15):1705. https://doi.org/10.1001/archinte.159.15.1705

Takei M, Ishii H, Sato Y, Komatsu M. 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;2014:1–4. https://doi.org/10.1155/2014/423563

El-Kaissi S, Kotowicz MA, Goodear M, Wall JR. An unusual case of Marine-Lenhart syndrome. Thyroid Off J Am Thyroid Assoc. 2003;13(10):993–4. https://doi.org/10.1089/105072503322511427

Chatzopoulos D, Iakovou I, Moralidis E. Marine-Lenhart syndrome and radioiodine-131 treatment. Thyroid Off J Am Thyroid Assoc. 2007;17(4):373–4. https://doi.org/10.1089/thy.2006.0150

Jameson Jl, Fauci AS, Kasper DL, Hauser AL, Longo DL, Loscalzo. Harrison Principios de Medicina Interna. 20th ed. AccessMedicina: McGraw Hill Medical

Carnell NE, Valente WA. Thyroid nodules in Graves’ disease: classification, characterization, and response to treatment. Thyroid Off J Am Thyroid Assoc. 1998;8(8):647–52. https://doi.org/10.1089/thy.1998.8.647

Harisankar CNB, Preethi GR, Chungath BB. Hybrid SPECT/CT evaluation of Marine-Lenhart syndrome. Clin Nucl Med. 2013;38(2):e89-90. https://doi.org/10.1097/RLU.0b013e31825ae860

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright (c) 2023 Revista Colombiana de Endocrinología, Diabetes & Metabolismo

Dimensions


PlumX


Downloads

Download data is not yet available.