Journal List > J Korean Soc Endocrinol > v.20(1) > 1063836

Kim, Yoo, Kim, Chang, Yeon, and Shin: Two Cases of Apathetic Hyperthyroidism associated with Peripheral Eosinophilia

Abstract

Peripheral eosinophilia is perpetually associated with many disease conditions like asthma, parasitic disease, IL-2 therapy, hypereosinophilic syndrome and eosinophilia/myalgia syndrome. Furthermore, peripheral eosinophilia may also be linked with Graves' disease, which is induced by thyroid-stimulating anti-TSH receptor antibodies and is related to type 2 helper T cell (Th2) predominant condition that is dependent on humoral immunity. In some of the cases of Graves' disease, thyrotoxicosis may induce peripheral eosinophilia associated with relative cortisol deficiency. In our present study, we present a case of two patients who were suffering from Graves' disease without any thyrotoxic symptoms and exhibited increased levels of peripheral eosinophil count. But, the count was observed to decreas in euthyroid state.

Figures and Tables

Fig. 1
Thyroid sonogram shows slightly enlarged both thyroid glands
jkse-20-78-g001
Fig. 2
99mTc-O4 thyroid scan shows mild diffuse enlargement with increased uptake (case 1).
jkse-20-78-g002
Fig. 3
Blood eosinophil counts are decreased after antithyroid drug medication (case 1)
jkse-20-78-g003
Fig. 4
99mTc-O4 thyroid scan shows diffuse enlargement with increased uptake (case 2).
jkse-20-78-g004
Fig. 5
Blood eosinophil counts are decreased after antithyroid drug medication (case 2).
jkse-20-78-g005

References

1. Hamid Q, Azzawi M, Ying S, Mogbel R, Wardlaw AJ, Corrigan CJ, Bradley B, Durham SR, Collins JV, Jeffery PK. Expression of mRNA for interleukin-5 in mucosal bronchial biopsies from asthma. J Clin Invest. 1991. 87:1541–1546.
2. Limaye AP, Abrams JS, Silver JE, Ottesen EA, Nutman TB. Regulation of parasite-induced eosinophilia: selectively increased interleukin 5 production in helminth-infected patients. J Exp Med. 1990. 172:399–402.
3. van Haelst Pisani C, Kovach JS, Kita H, Leiferman KM, Gleich GJ, Silver JE, Dennin R, Abrams JS. Administration of interleukin-2 results in increased plasma concentration of IL-5 and eosinophilia in patients with cancer. Blood. 1991. 78:1538–1544.
4. Owen WF, Rothenberg ME, Peterson J, Weller PF, Silberstein D, Sheffer AL, Stevens RL, Soberman RJ, Austen KF. Interleukin 5 and phenotypically altered eosinophilis in the blood of patients with the idiopathic hypereosinophilic syndrome. J Exp Med. 1989. 170:343–348.
5. Owen WF, Petersen J, Sheff DM, Folkerth RD, Anderson RJ, Corson JM, Sheffer AL, Austen KF. Hypodense eosinophilis and interleukin 5 activity in the blood of patients with the eosinophilia-myalgia syndrome. Proc Natl Acad Sci USA. 1990. 87:8647–8651.
8. Chiorato L, Mariotti S, Pinchera A. Thyroid disease in the elderly. Bailliere's Clin Endocrinol Metab. 1997. 11:251–270.
9. McKenzie IM, Zakarija M. DeGroot LJ, editor. Hyperthyroidism. Endocrinology. 1995. 3rd ed. Philadelphia: W.B. Saunders Co.;688–689.
10. Thorn GW, Forsham PH, Prunty FTG, Hills AG. A test for adrenal cortical insufficiency. Journal of the American Medical Association. 1948. 137:1005–1009.
11. Beishuizen A, Thijs LG. Relative adrenal failure in intensive care: an identifiable problem requiring treatment? Best Pract Res Clin Endocrinol Metab. 2001. 15:513–531.
TOOLS
Similar articles