GRAVES-DISEASE OCCURRING AFTER SUBACUTE THYROIDITIS - REPORT OF A CASE AND REVIEW OF THE LITERATURE

A 57-year-old woman with no previous personal or family history of thy roid disease developed typical subacute thyroiditis, with pain and ten derness in the anterior cervical region, fever, mild thyrotoxicosis; t hyroid autoantibodies were negative, serum thyroglobulin (TG) levels w ere increased, radioactive iodine uptake (RAIU) values were decreased, urinary iodine excretion was normal, and erythrocyte sedimentation ra te (ESR) elevated. Symptoms subsided with glucocorticoid treatment, wi th normalization of serum thyroid hormone and TG levels. Four months l ater, while still on a low dose of glucocorticoid, she had recurrence of hyperthyroidism, with no thyroid pain or tenderness, high RAIU valu es, positive thyroid-directed autoantibodies including TSH-receptor an tibody. HLA typing showed positivity for B35 and DR3, suggesting a gen etic susceptibility for both subacute thyroiditis and Graves' disease. The development of Graves' disease after subacute thyroiditis is extr emely rare, suggesting that a genetic susceptibility to the disease mu st exist in such an instance.