Journal List > Int J Thyroidol > v.9(2) > 1082742

Int J Thyroidol. 2016 Nov;9(2):174-179. Korean.
Published online November 30, 2016.  https://doi.org/10.11106/ijt.2016.9.2.174
Copyright © 2016. the Korean Thyroid Association. All rights reserved.
Two Cases of Graves' Disease Presented with Atypical Symptoms
Won Sang Yoo and Hyun Kyung Chung
Department of Internal Medicine, Dankook University Medical College, Cheonan, Korea.

Correspondence: Hyun Kyung Chung, MD, PhD, Department of Internal Medicine, Dankook University Hospital, 16-5 Anseo-dong San, Cheonan 31116, Korea. Tel: 82-41-550-7664, Fax: 82-41-556-0524, Email: chkendo@dankook.ac.kr
Received May 03, 2016; Revised May 26, 2016; Accepted June 01, 2016.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

We describe here two Graves' patients who have presented with atypical symptoms. Interestingly, both of them had symptoms related to imbalance of body fluid homeostasis. Chief complaint of a 35-year-old woman (case 1) was the ipsilateral edema of upper body. A 33-year-old man (case 2) who had severe polyuria has referred from urology department with impression of diabetes insipidus. Both of them denied any typical symptoms of Graves' disease at presentation. These rare extrathyroid manifestations of Graves' disease were completely subsided after antithyroid drug treatment. We introduce their clinical courses and possible pathophysiological mechanisms of the atypical symptoms of Graves' disease.

Keywords: Graves' disease; Edema; Polyuria

Figures


Fig. 1
Left dominant ipsilateral edema of upper extremity (case 1) at presentation (A), after 6 months antithyroid drug treatment (B).
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Fig. 2
Computed tomography of the case 1. Initial CT scans (A) showed diffuse increased soft tissue density in anterior mediastinum (A. long arrows), multiple lymph node enlargement in left axillary (A. short arrow) and ipsilateral edema in upper trunk (B). Follow-up CT scans after 6 months antithyroid drug treatment showed significantly decreased extent of soft tissue density in anterior mediastinum (C. long arrows), lymph node enlargement in left axillary (C. short arrow) and improved edema in upper trunk (D).
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Fig. 3
Thyroid uptake (Tc-99m) scan of case 1 (A) and case 2 (B).
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Tables


Table 1
Water deprivation test (case 2)
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