Revista Medica Herediana
ISSN 1018-130X versión impresa
A 34-year-old woman came to hospital with a recent history of asymptomatic diffuse thyroid enlargement and normal thyroid profile. Physical examination showed a palpable nodule in the left lobe. Ultrasound confirmed a solid nodule in the left lobe with increased Doppler color flow. The anti TPO antibodies were positive, and fine needle biopsy showed no malignant cells. Six months later, she returned because of weight loss, palpitations, heat intolerance, and hand tremor. Thyroid hormones were TSH 0,01 mIU/dL and free T4 4,59 ng/dL. Thyroid scan identified homogeneously increased uptake throughout the gland, especially in the middle of both lobes. Treatment was started with methimazole and propanolol. After six months of treatment, her symptoms disappeared, and thyroid profile was normal, and she received a high dose of I-131. Graves’ disease with functioning nodules is known as Marine-Lenhart syndrome. The frequency is rare, only 1- 2,7% of patients with Graves’ disease have concomitant functioning nodules. Functional nodules may be more resistant to radioiodine therapy than the extranodular tissue; generally required higher dose of radioactive iodine for ablation.(Rev Med Hered 2011;22:143-146).
Palabras llave: Marine-Lenhart syndrome; Graves disease; hyperthyroidism; thyroid nodules.
Universidad Peruana Cayetano Heredia
Facultad de Medicina "Alberto Hurtado"
Av. Honorio Delgado 430 Urb. Ingenieria, San Martin de Porres
Lima 100 - Peru