SUN-566 Sspontaneous Oscillating Hypothyroidism and Hyperthyroidism: A Rare Autoimmune Entity

Abstract

Graves disease is autoimmune thyroid disorder with overproduction of thyroid hormones secondary to production of TSH receptor antibodies (TSAB). Many of patients diagnosed with graves disease in end stage or after treatment with ablation therapy develop hypothyroidism need life long treatment with thyroxin replacement therapy its very common for Graves disease to covert to Hypothyroid, we describe here rare phenomenon “Oscillating hypothyroidism and hyperthyroidism” in this rare entity of endocrine disorder patients with hypothyroidism spontaneously convert to Graves disease. Pathophysiology behind this rare phenomenon is production of antibodies TSH receptor stimulating (TSAb) and TSH receptor blocking antibodies (TBAb) most likely accounts for presentations of alternating hyperthyroidism and hypothyroidism. To achieve stability of thyroid function, definitive therapy is recommended to remove the pathological thyroid either with surgery of via radioactive iodine ablation. We present her case of 37-year-old female with the PMH of type 1 Diabetes and Hoshimoto thyroiditis being treated with subcutaneous insulin and Levothyroxine, patients thyroid disorder has been controlled with levothyxine for 2 decades, She presented to ED with the complaint of thyroid storm, patient had all symptoms of thyrotoxicosis along with thyroid opthalamopathy (exophthalmos), thyromegaly, thyroid bruit, pretibial myxedema, labs works showed high free T3, high free T4 and very low TSH and Positive TSAb and increase Iodine uptake ( previous labs showed : very high TSh , FT4, FT3 and Positive TBAb , Patient was diagnosed with Graves disease and treated with radioactive thyroid ablation and life long thyroid replacement therapy. This is one of rare disorder in which patients condition keeps switching between hypo to hyper thyroid and vice versa , definite therapy for this treatment is surgical ablation of affected gland.