Endocrine Abstracts

Introduction: Graves’ disease is an autoimmune thyroiditis, less common in men but with relapse of hyperthyroidism significantly more frequent in men than in women after anti-thyroid medications’ withdrawal. Craniopharyngioma is a rare brain tumor which arises in the pituitary stalk and project into the hypothalamus. The distribution by age is bimodal with a slight male predominance and a poor survival rate for older than 65 years. The association of these pathologies is extremely rare.

Observation

We report the case of a 67 years-old patient who presented a severe thyrotoxicosis due to a relapse of a Graves’ disease in remission since 2009. At the moment of presentation the patient was in treatment with levothyroxine for a central hypothyroidism secondary of a craniopharingyoma surgery. Clinically he presented tachycardia, weight loss, confusion, anorexia and biologically he had low TSH value and very high FT4 (100 pmol/l) and FT3 (50 pmol/l) values which were increasing 5 days after stopping the levothyroxine. TSH receptor antibodies were positives (2.8 U/l) and the I-123 scintigraphy found an intense and uniform fixation confirming the relapse of Graves’ disease. A treatment with carbimazole 60 mg per day was started with a strictly surveillance of hepatic enzymes. There was a decrease of thyroid hormones and hepatic enzymes and also symptoms in 2 weeks. A thyroidectomy is to discuss, because of the relapse and the severity of the symptoms, after achieving the euthyroid status.

Conclusion: We described here, for the first time, an association of a relapsing Graves’ disease in patient with hormonal supplementation for central hypothyroidism after surgery of craniopharyngioma, with a favorable evolution after treatment with anti-thyroid medications.