Eon Ju Jeon; Eui Dal Jung

doi:10.11106/jkta.2014.7.1.96

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Jeon and Jung: A Case of Graves’ Disease Following Subacute Thyroiditis Presented with Creeping

Case Report

J Korean Thyroid Assoc 2014;7(1):96-101.

Published online: 29 May 2014

DOI: https://doi.org/10.11106/jkta.2014.7.1.96

A Case of Graves’ Disease Following Subacute Thyroiditis Presented with Creeping

Eon Ju Jeon, Eui Dal Jung

Department of Internal Medicine, Catholic University of Daegu, School of Medicine, Daegu, Korea

Correspondence: Eui Dal Jung, MD, Department of Internal Medicine, Catholic University of Daegu, School of Medicine, 3056-6 Daemyung–4 dong, Nam–gu, Daegu 705-718, Korea Tel: 82-53-650-4098, Fax: 82-53-651-4009, E-mail: jed15@cu.ac.kr

Received 2 September 2013 Accepted 3 January 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The occurrence of Graves’ disease following subacute thyroiditis (SAT) is rare. The pathophysiology of it is not well known. We report a case of Graves’ disease following SAT presented with creeping. A 45-year-old woman presented with neck pain, and thyrotoxic symptoms. Neck pain migrated from left lobe to right lobe of the thyroid. Thyroid scan revealed decreased uptake in the both lobes except the superior portion of the right thyroid gland. Initially, the patient was diagnosed with SAT and treated with steroid therapy. Four months later, thyroid function test showed suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine (T4) and TSH receptor antibody. Thyroid scan revealed increased uptake compatible with Graves’ disease. The autoimmune alteration after SAT may lead to the development of Graves’ disease in the susceptible patients. These patients should be monitored for the development of Graves’ disease.

Keywords: Creeping thyroiditis, Graves’ disease, Subacute thyroiditis

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Fig. 1.

Thyroid ultrasound in transverse view showed a homogeneous parenchyma of the right lobe (A) and a heterogeneous hypoechoic area of the left lobe (arrow, B) during a local clinic visit.

Fig. 2.

Thyroid scan with Tc-99m pertechnetate showed decreased tracer activity in thyroid gland except focal uptake of the upper of right lobe (arrow, A) during a first visit to our hospital and increased tracer uptake in thyroid gland after 4 months (B).

Fig. 3.

Thyroid ultrasound showed a heterogeneous parenchyma (A) and less blood flows (B) on the inferior aspects of the right lobe in transverse view and longitudinal view (C). The Left lobe showed homogeneous parenchyma in transverse view (D) during a first visit.

Fig. 4.

Changes of thyroid function test. TSH: thyroid-stimulating hormone, TSH-r-Ab: TSH-receptor antibody, ESR: erythrocyte sedimentation rate.

Fig. 5.

Thyroid ultrasound in transverse view showed a heterogeneous parenchyma (A) and an increased blood flows (B) of the thyroid gland after 4 months.

Table 1.

Therapy according to progress

Visit	Medication
During a local clinic	Prednisolone 15 mg/day for 2 weeks Prednisolone 5 mg/day for 2 weeks
During a first visit	Prednisolone 30 mg/day for 2 weeks → taperingstop about 2 weeks b-blocker 40 mg/day
After 4 months	Methimazole 30 mg/day b-blocker 40 mg/day

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