Abstract
Background: Alternating thyroid function between hypo- and hyperthyroidism is a very rare phenomenon attributed to the switch between the types of thyroid stimulating hormone receptor autoantibodies; thyroid stimulating antibody and thyroid stimulating hormone blocking antibody. Case Presentation: We report an 18 years old male who presented with hyperthyroidism attributed to Graves’ disease. He was treated with antithyroid medication. During follow up, his thyroid function was switching between hyper- and hypothyroidism which was difficult to treat with antithyroid medication. His laboratory investigations revealed high thyroid stimulating immunoglobulin and TSH binding inhibitory immunoglobulin. Due to the difficultly of managing him with antithyroid medication, he was offered a definitive management for his Graves’ disease. Conclusion: This case demonstrates a rare challenging presentation of Graves’ disease. Patients presenting with fluctuation in thyroid function between hyper-and hypothyroidism need a definitive management for Graves’ disease.
Highlights
The estimated prevalence of autoimmune thyroid diseases (AITD) is around 2% - 5% [1]
Alternating thyroid function between hypo- and hyperthyroidism is a very rare phenomenon attributed to the switch between the types of thyroid stimulating hormone receptor autoantibodies; thyroid stimulating antibody and thyroid stimulating hormone blocking antibody
Case Presentation: We report an 18 years old male who presented with hyperthyroidism attributed to Graves’ disease
Summary
The estimated prevalence of autoimmune thyroid diseases (AITD) is around 2% - 5% [1]. Among the most well-known AITD are Hashimoto Thyroiditis (HT) and Graves’ Disease (GD) which usually present as hypothyroidism and hyperthyroidism respectively [1]. This can be explained by the presence of two types of thyroid hormone receptor (TSHR) autoantibodies; thyroid stimulating antibody (TSAb) and TSH blocking antibody (TBAb) [4]. These autoantibodies (Abs) may switch from one type to another causing hyper- or hypothyroidism according to the predominant autoantibodies and this is the most likely cause responsible for alternating hyper- and hypothyroidism in some patients with GD [5]. We present an 18-year-old male with GD who presented with oscillating hyper- and hypothyroidism during his disease course
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