Hypothyroidism with Graves' disease.

A 27-year-old woman had rapidly progressive ophthalmopathy and pretibial myxedema. The protein-bound iodine concentration was 2.5μg/100 ml. The 24-hour radioactive iodine uptake was 0.6% and did not increase after stimulation with thyrotrophin. Results of a serum assay for the long-acting thyroid stimulator (LATS) were positive with a response index of 273%. The antithyroglobulin titer was 1:512 and a thyroid biopsy showed thyroiditis. The findings in this case emphasize that Graves' disease is a systemic illness in which the typical manifestations may occur without hyperthyroidism and this can be explained by a lack of sufficient functional thyroid tissue to respond to those factors which would ordinarily produce thyrotoxicosis. In hypothyroidism, where the uptake of radioactive iodine is insufficent to demonstrate nonsuppressibility, positive finding of a LATS assay suggests Graves' disease.

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