Case Report: Marine-Lenhart Syndrome in a Male Patient

Öz

Marine-Lenhart syndrome is defined as Graves' disease accompanied with a functioning thyroid nodule(s). In this rare syndrome, two of the clinic tables may coexist or functioning nodules may be added to Graves’ disease in subsequent years. This syndrome is generally seen in females and thyroid nodules shows generally benign characteristics in biopsy results. In this paper, we present a 28 year-old man who admitted to our clinic with the complaint of exophthalmos and weight loss and diagnosed as Marine-Lenhart syndrome based on a toxic thyroid adenoma detected with imaging studies and, clinical and laboratory findings consistent with Graves' disease.

 

Anahtar Kelimeler

• Graves disease, Marine-Lenhart syndrome, toxic nodule

Olgu Sunumu: Marine-Lenhart Sendromu Olan Bir Erkek Hasta

Öz

Graves hastalığı ve fonksiyonel nodül veya nodüllerin birlikteliği Marine-Lenhart sendromu olarak adlandırılır. Oldukça nadir görülen bu sendromda bahsedilen iki ayrı durum aynı zamanda olabileceği gibi toksik adenom yıllar içerisinde tabloya eklenebilir. Hastalar genelde bayandır ve yapılan biyopsi sonuçlarına göre nodüller büyük çoğunlukla benign karakterdedir. Bu yazıda, egzoftalmus ve kilo kaybı şikayetleri nedeni ile Graves Hastalığı düşünülen ve yapılan tetkikler sonucunda aynı zamanda toksik adenom saptanan 28 yaşında bir erkek hasta sunulmuştur.

 

Anahtar Kelimeler

• Graves hastalığı, Marine-Lenhart sendromu, toksik nodül

Kaynakça

1. Broga-Basaria M, Basaria S. Marine-Lenhart syndrome. Thyroid 2003;13:991.
2. Cakir M. Diagnosis of Marine-Lenhart syndrome. Thyroid 2004;14:555.
3. Nishikawa M, Yoshimura M, Yoshikawa N, Toyoda N, Yonemoto T, Ogawa Y, et al. Coexistence of an autonomously functioning thyroid nodule in a patient with graves' disease: An unusual presentation of Marine-Lenhart s yndrome. Endocrine Journal 1997; 44(4): 571-4.
4. Cakir M. Marine-Lenhart syndrome. Journal of the national medical association 2005; 97: 1036-8.
5. Dobyns BM, Sheline GE, Workman JB, Tompkins EA, McConahey WM, BeckerDV. Malignant and benign neoplasms of the thyroid in patients treatedfor hyperthyroidism: a report of the cooperative thyrotoxicosis therapyfollow-up study. J Clin Endocrinol Metab 1974; 38:976–8.
6. Kim WB, Han SM, Kim TY, Nam-Goong IS, Gong G, Lee HK, et al. Ultrasonographic screening for detection of thyroid cancer in patients with Graves’ disease. Clin Endocrinol(Oxf) 2004;60:719-5.
7. Gerenova J, Buysschaert M, de Burbure CY, Daumerie C. Prevalence of throid cancer in Graves’ disease: a retrospective study of a cohort of 103 patients treated surgically. Eur J intern Med 2003;14:321-5.
8. Mishra A, Mishra SK. Throid nodüles in Graves’ disease implications in an endemically iodine deficent area. J Postgrad Med 2001;47:244-7.

9. Cantalamessa L, Baldini M, Orsatti A, Meroni L, Amodei V, Castagnone D. Thyroid nodules in Graves disease and the risk of thyroid carcinoma. Arch Intern Med 1999;159:1705–8.
10. Scherer T, Wohlschlaeger-Krenn E, Bayerle-Eder M, Passler C, Reiner-Concin A, Krebs M, et all. A Case of simultaneous occurrenceof Marine – Lenhart syndrome and a papillary thyroid microcarcinoma. BMC Endocrine Disorders 2013;13:16.
11. Kraimps JL, Bouin-Pineau MH, Mathonnet M, De Calan L, Ronceray J, VissetJ, et al. Multicentre study of thyroid nodules in patients with Graves’ disease. Br J Surg 2000; 87:1111–3.
12. Pacini F, Elisei R, Di Coscio GC, Anelli S, Macchia E, Concetti R, et al. Thyroid carcinoma in thyrotoxic patients treatedby surgery. J Endocrinol Invest 1988;11:107–12.
13. De Rosa G, Testa A, Maurizi M, Satta MA, Aimoni C, Artuso A, et al. Thyroid carcinoma mimicking a toxic adenoma. Eur J Nucl Med 1990;17:179–84.
14. Kim TS, Asato R, Akamizu T, Harada D, Nakashima Y, Higashi T, et al. A rare case of hyperfunctioning papillary carcinoma of the thyroid gland. Acta Otolaryngol Suppl 2007; 557:55–7.
15. Erdogan MF, Anil C, Ozer D, Kamel N, Erdogan G. Is it useful to routinely biopsy hot nodules in iodine deficient areas J Endocrinol Invest 2003;26:128–31.
16. Charkes ND. Graves’ disease with functioning nodules (Marine Lenhart syndrome). J Nucl Med 1972;13:885-92.
17. Carnell NE, Valente WA. Throid nodules in Graves’ disease: classification, characterization and response to treatment. Thyroid 1998;8:647-52.
18. Chandramouly B, Mann D, Cunningham RP, Giegerich E. Marine-Lenhart syndrome. Graves' disease with pooly functioning nodules. Clin Nucl Med 1992;17:905-6.
19. Parma J, Duprez L, Van Sande J, Cochaux P, GervyC, Mockel J, et al. Somatic mutations in the thyrotropin receptor gene cause hyperfunctioning thyroid adenomas. Nature 1993;365:649-51.
20. Takeshita A, Nagayama Y, Yokoyama N, Ishikawa N, Ito K, Yamashita T, et al. Rarity of oncogenic mutations in the thyrotropin receptor of autonomously functioning thyroid nodules in Japan. J Clin Endocrinol Metab 1995;80:2607-11.
21. Frasca F, Nucera C, Pellegriti G, Gangemi P, Attard M, Stella M, et al. BRAF(V600E) mutation and the biology of papillary thyroid cancer. Endocr Relat Cancer 2008;15:191–05.