Case Author(s): Bart Rydzewski M.D., Ph.D. and Keith Fischer M.D. , . Rating: #D2, #Q3

Diagnosis: Graves Disease

Brief history:

23 year old male with tachycardia, heat intolerance and diarrhea.

Images:

Standard and magnification images of the neck

View main image(tr) in a separate image viewer

Full history/Diagnosis is available below


Diagnosis: Graves Disease

Full history:

This is a 23 year old male with a 6-month history of tachycardia, palpitations, and extreme heat intolerance associated with excessive perspiration, and loose bowel movements. He has gained 15 lb. over the last 7 months due to increased appetite. Over the last several months he has noted enlargement of the lower portion of the neck associated with mild tenderness in this area. He had mild hypertension, which was successfully treated with medication.

Recent thyroid function tests revealed serum TSH level below 0.1 uU/ml. Ultrasonographic evaluation of the thyroid gland demonstrated a right lower pole thyroid nodule.

Radiopharmaceutical:

9.6 mCi Tc-99m pertechnetate I.V.

Findings:

The thyroid images demonstrate a marked, diffuse increase in radiopharmaceutical uptake throughout a moderately enlarged thyroid gland. There is mild radiopharmaceutical uptake in a structure which is located superior to and is separate from the isthmus of the thyroid gland. This most likely represents thyroglossal duct tissue. There is an approximately 8 mm ill-defined area of decreased radiopharmaceutical uptake within the lower pole of the right thyroid lobe which represents a hypofunctioning thyroid nodule. There is marked decrease in the normally present soft tissue uptake.

Discussion:

Gravesí disease or diffuse toxic goiter results from the presence of autoantibodies mimicking the function of Thyroid Stimulating Hormone and thus excessively stimulating thyroid hormone production. It classically presents with symptoms of hyperthyroidism such as tachycardia, hypertension, heat intolerance, nervousness, and diarrhea. It is often associated with a diffuse enlargement of the thyroid gland without nodularity.

Thyroid scintigraphy performed either with Tc-99m pertechnetate or I-123 demonstrates diffuse enlargement and increased uptake within the thyroid gland. It is manifested by relatively poor visualization of the surrounding soft tissues and salivary glands.

The treatment of the Gravesí disease can consist of treatment with antithyroid medications such as Propylthiouracil or Methimazole, surgical thyroidectomy or I-131 therapy. The last option is the most commonly used mode of definitive therapy due to its safety and efficacy.

ACR Codes and Keywords:

References and General Discussion of Thyroid Scintigraphy (Anatomic field:Face, Mastoids, and Neck, Category:Metabolic, endocrine, toxic)

Search for similar cases.

Edit this case

Add comments about this case

Read comments about this case

Return to the Teaching File home page.


Case number: tr010

Copyright by Wash U MO