Kyaw Khin Yadanar, Lwin Min Thant, Gummow Alistair, Ugur Antonia
Endocrinol Diabetes Metab Case Rep. 2025 Apr 8;2025(2). doi: 10.1530/EDM-24-0125. Print 2025 Apr 1.
Thymic hyperplasia in Graves' disease is rarely identified due to the absence of routine imaging, but not uncommonly present. It is usually seen when imaging is performed for other reasons. Despite thymic hyperplasia becoming a more commonly identified occurrence, follow-up imaging scans and multi-disciplinary team (MDT) approach are still recommended to distinguish this benign transformation from more significant differentials. These steps can lead to distress in patients. Therefore, clinicians and radiologists being aware of this correlation between thymic hyperplasia and Graves' disease can add reassurances about the most likely diagnosis whilst the patient is undergoing limited further investigation to rule out differentials and subsequently, avoid unnecessary intervention. Here, we report a case of Graves' disease with thymic hyperplasia in a young woman who initially presented with non-specific eye symptoms and incidental mediastinal mass, in which involvement of multiple speciality teams was important to rule out thymoma and myasthenia gravis (MG).
Although Graves' disease with thymic hyperplasia is not uncommon, it is sometimes difficult to diagnose with one imaging scan due to the overlap of radiological characteristics of other important differentials; an MDT discussion and further imaging scans are needed to confirm the diagnosis in some cases. Getting MDT involvement early would quickly assist in ruling out more significant differentials and avoid unnecessary surgical intervention by concluding thymic hyperplasia. Clinicians having knowledge on the relation between Graves' disease and thymic hyperplasia may reassure the patient by explaining the possible resolution with treatment, while awaiting further MDT discussion. To rule out ocular MG in Graves' disease patients, additional investigations and neurology referral are often required as the serum antibody tests are less sensitive in ocular MG than generalised MG.
由于缺乏常规影像学检查，格雷夫斯病中的胸腺增生很少被发现，但并非不常见。它通常在因其他原因进行影像学检查时被发现。尽管胸腺增生越来越常见，但仍建议进行随访影像学扫描和多学科团队（MDT）评估，以将这种良性病变与更严重的鉴别诊断区分开来。这些步骤可能会给患者带来困扰。因此，临床医生和放射科医生了解胸腺增生与格雷夫斯病之间的这种关联，可以在患者接受有限的进一步检查以排除鉴别诊断时，就最可能的诊断给予患者更多安心，从而避免不必要的干预。在此，我们报告一例年轻女性格雷夫斯病合并胸腺增生的病例，该患者最初表现为非特异性眼部症状和偶然发现的纵隔肿块，其中多个专科团队的参与对于排除胸腺瘤和重症肌无力（MG）很重要。
尽管格雷夫斯病合并胸腺增生并不罕见，但由于其他重要鉴别诊断的放射学特征重叠，有时仅凭一次影像学扫描难以诊断；在某些情况下，需要进行MDT讨论和进一步的影像学扫描来确诊。尽早让MDT参与将有助于迅速排除更严重的鉴别诊断，并通过确定胸腺增生来避免不必要的手术干预。了解格雷夫斯病与胸腺增生之间关系的临床医生可以在等待进一步的MDT讨论时，通过解释治疗可能带来的缓解情况来安抚患者。为了排除格雷夫斯病患者的眼肌型MG，通常需要进行额外的检查并转诊至神经科，因为血清抗体检测在眼肌型MG中比全身型MG的敏感性更低。
