Hyperthyroidism following primary hypothyroidism in association with polyendocrine autoimmunity

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Abstract
A 37 yr old male with a strong family history of autoimmune disease presented with typical symptoms of hyperthryoidism. He had exophthalmos but no goiter. Hyperthyroidism was confirmed by failure of 131I neck uptake to suppress after 7 days treatment with triiodothyronine. Six years previously a diagnosis of primary hypothyroidism was made. At diagnosis of hyperthyroidism, thyroglobulin antibodies, thyroidal microsomal antibodies and thyroid stimulating Ig were detected. The absence of thyroid growth stimulating Ig and presence of Ig blocking TSH-induced growth may account for the absence of goiter throughout. HLA -B8, -B, -DR3 and -DR4 genotypes, low C4 complement concentrations and islet cell autoantibodies were detected at the time of diagnosis and 1 yr later diabetes mellitus developed.