A case of hypothyroid Graves' disease following external radiation therapy to the cervical region

Endocr J. 2006 Jun;53(3):357-61. doi: 10.1507/endocrj.k05-117. Epub 2006 May 20.

Abstract

A case of hypothyroid Graves' disease occurred following external radiation therapy to the cervical region is described. Severe hypothyroidism developed in a 56-year-old man 6 months after external radiation therapy for submandibular cancer. Serological evaluation of thyroid autoimmunity revealed the presence of antithyroid antibodies and thyrotropin-binding inhibitory immunogloblins (TBII). Diplopia, limitation of downward gaze, and palpebral edema developed 2 years after levothyroxine replacement therapy. Ocular magnetic resonance imaging revealed marked hypertrophy of the bilateral extraocular muscles with signal hyperintensity on T2-weighted images. This infiltrative ophthalmopathy showed marked improvement after additional treatment with high-dose methylprednisolone and orbital radiation, in parallel with a decrease in TBII. These results suggest that radiation-associated thyroidal injury might be associated with the etiology of hypothyroid Graves' disease.

Publication types

  • Case Reports

MeSH terms

  • Carcinoma, Squamous Cell / radiotherapy
  • Diplopia / diagnostic imaging
  • Diplopia / etiology
  • Graves Disease / diagnosis*
  • Graves Disease / etiology*
  • Graves Ophthalmopathy / etiology
  • Humans
  • Hypothyroidism / diagnosis*
  • Hypothyroidism / etiology*
  • Male
  • Middle Aged
  • Radiation Injuries / etiology*
  • Radiotherapy / adverse effects*
  • Submandibular Gland Neoplasms / radiotherapy*
  • Ultrasonography