RAPIDLY PROGRESSIVE THYROID FAILURE IN GRAVES-DISEASE AFTER PAINFUL ATTACK IN THE THYROID-GLAND

We studied a new type of Graves' disease: rapidly progressive thyroid failure after painful attack in the thyroid gland. Four women with the mean (+/-SD) age of 51+/-3.2 years had newly diagnosed hyperthyroid G raves' disease. A severe painful episode developed in the thyroid glan ds of two patients and permanent hypothyroidism occurred spontaneously within 2 or 3 months thereafter. Two to three episodes of pain develo ped in the thyroid glands of the other two patients during antithyroid drug therapy. There was a transient rise in serum thyrotropin level a fter each painful episode and permanent hypothyroidism developed 6 to 8 months after the initial painful attack. The clinical picture is cha racterized by moderate to severe pain in the thyroid gland with tender ness. Patients responded to steroid or anti-inflammatory therapy. Duri ng painful attack, increased or normal thyroid radioiodine uptake, ele vated levels of C-reactive protein, and an elevated erythrocyte sedime ntation rate were found, but there was no cytological evidence of suba cute thyroiditis. After painful attack, serum thyroid stimulation anti body began to decrease in three of the patients while thyroid stimulat ion blocking antibody developed in one patient. This is a rapid and se lf-destructive process of the Graves' thyroid gland, which appears to be associated with painful attack in the thyroid gland.