Abstract #1407308: Marine Lenhart Syndrome: Case Series of Autonomously Functioning Thyroid Nodule with Graves’ Disease

Abstract

Marine-Lenhart syndrome, first described in 1911 by Marine and Lenhart is the coincidence of Graves’ disease with autonomous functioning thyroid nodules. It is a very rare condition, but now considered a distinct sub entity of Graves’ disease. Here we represent case series of seven patients. This is a case series of seven patients presented with autonomous functioning thyroid nodules (AFTN) on background of Graves’ disease. All our patients were females with mean age of 44.5 years. Symptoms of hyperthyroidism were present in 5 of these patients, while other two were asymptomatic at time of presentation. Four of them had Grave’s opthalmopathy with predominant symptom of proptosis. Autoimmunity especially thyroid receptor antibodies were present in almost all of these patients. Thyroid function tests of five patients showed hyperthyroidism, one had subclinical hyperthyroidism and other one was hypothyroid at time of presentation with history of taking Radioactive iodine (RAI) for thyroid nodule few years back. Six of them were treated with antithyroid drugs, while 3 also received RAI as definitive treatment. One patient was on thyroxine as she was hypothyroid after receiving RAI few years back. Thyroid nodules, which occur in 10–15 % of patients with Graves’ disease, may present as pseudo-nodules, nodular goiter, hyperplastic nodules, differentiated thyroid cancer, or as AFTN. Presence of AFTN is quite rare, reported prevalence was 0.8–2.7 %. Treatment of these nodules may prove to be difficult due to the higher dose of RAI treatment needed compared with patients having Graves’ disease alone. Few cases have been reported so far but the most appropriate management approach needs to be determined.