Sharma Animesh
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J Pediatr Endocrinol Metab. 2017 Nov 27;30(12):1237-1243. doi: 10.1515/jpem-2017-0223.
The coexistence of functional thyroid nodules and Graves' disease (GD) is a rare condition known as Marine-Lenhart syndrome. Thyroid cancer has been described in several adults, but never in children, with Marine-Lenhart syndrome. This paper discusses the challenges in diagnosis and the unique management of this condition in children, in the context of extant literature.
In this case report, two adolescent female patients with Marine-Lenhart syndrome, aged 15 and 16 years, exhibited biochemical evidence of hyperthyroidism, and were found to have unilateral hyperfunctioning thyroid nodules via thyroid scintigraphy. Additionally, both patients showed elevated thyroid-stimulating immunoglobulins (TSI) and increased glandular activity, confirming background GD. Notably, one patient was also diagnosed with intranodular thyroid cancer upon preoperative examination. Both patients were treated via surgical resection. Summary and outlook: Diagnosis of Marine-Lenhart syndrome can be made in patients with functional thyroid nodules and increased glandular activity on thyroid scintigraphy. Standard doses of radioiodine ablation are not effective in the majority of patients and should be avoided due to the increased risk for thyroid cancer, making thyroidectomy the preferred treatment.
功能性甲状腺结节与格雷夫斯病（GD）并存是一种罕见病症，称为马-莱综合征。甲状腺癌在数名患有马-莱综合征的成人中已有报道，但在儿童中尚未有过报道。本文结合现有文献，探讨了儿童该病症诊断中的挑战及独特的治疗方法。
在本病例报告中，两名患有马-莱综合征的青春期女性患者，年龄分别为15岁和16岁，表现出甲状腺功能亢进的生化证据，经甲状腺闪烁扫描发现有单侧高功能甲状腺结节。此外，两名患者的促甲状腺素受体抗体（TSI）均升高，腺体活性增强，证实存在背景性GD。值得注意的是，一名患者在术前检查时还被诊断为结节内甲状腺癌。两名患者均接受了手术切除治疗。总结与展望：对于甲状腺闪烁扫描显示功能性甲状腺结节且腺体活性增强的患者，可诊断为马-莱综合征。标准剂量的放射性碘消融对大多数患者无效，且由于甲状腺癌风险增加应避免使用该方法，因此甲状腺切除术是首选治疗方法。
