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Table of Contents
LETTER TO THE EDITOR
Year : 2013  |  Volume : 17  |  Issue : 2  |  Page : 366

Identifying Marine-Lenhart syndrome on a 99m Tc-pertechnetate thyroid scan


1 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Department of Nuclear Medicine, B. L. Kapur Hospital, New Delhi, India

Date of Web Publication28-Mar-2013

Correspondence Address:
Nishikant A Damle
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.109698

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How to cite this article:
Damle NA, Mishra R. Identifying Marine-Lenhart syndrome on a 99m Tc-pertechnetate thyroid scan. Indian J Endocr Metab 2013;17:366

How to cite this URL:
Damle NA, Mishra R. Identifying Marine-Lenhart syndrome on a 99m Tc-pertechnetate thyroid scan. Indian J Endocr Metab [serial online] 2013 [cited 2020 Jul 12];17:366. Available from: http://www.ijem.in/text.asp?2013/17/2/366/109698

Sir,

Graves disease coexistent with a nodular goiter is referred to as Marine-Lenhart syndrome. It is also called nodular Graves disease. [1] We present here the technetium pertechnetate thyroid scan image with an emphasis for endocrinologists and nuclear medicine physicians to identify this variant, as it is more resistant to radioiodine than the classical diffuse toxic goiter of Graves disease.

A 38-year-old male presented to our institution with complaints of weight loss and tremors since 2 months. His thyroid profile was suggestive of thyrotoxicosis. A thyroid scan done 20 minutes after intravenous administration of 5 mCi 99m Tc-Pertechnetate showed an enlarged thyroid with intense uptake in both lobes as well as a left thyroid nodule with intense uptake [Figure 1]. Background tracer activity was suppressed. His Radioactive Iodine Uptake (RAIU) was 31.8% at 2 h (laboratory normal (5-15%)) and 83.6% at 24 h (laboratory normal (15-35%)).
Figure 1: 99mTc-pertechnetate thyroid scan showing an enlarged thyroid with intense uptake in both lobes as well as a left thyroid nodule (arrow) with intense uptake [Figure 1]. Background tracer activity appears suppressed

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The association of thyroid nodules with Graves disease is found in 25-30% [2],[3] of patients affected by Graves disease. More than 95% of these nodules are hypoactive and a small percentage is hyperactive. Therefore, patients with Marine-Lenhart syndrome can have thyrotoxicosis due to the Graves disease as well as the nodule, which may be hyperfunctioning at the outset or may develop autonomicity after a variable period of time. [4],[5],[6] Genetic alterations of the thyroid stimulating hormone TSH receptors are suspected in the development of the Marine-Lenhart syndrome in patients affected by the Graves disease.

The amount of radioiodine required to relieve the hyperthyroidism in these patients is greater than the corresponding mean, median, or mode dose required for patients with diffuse toxic goiter. This is said to be the result of the large size of these goiters as well as the relative radio-resistance of some of them. [1] This variant of Graves disease should therefore be kept in mind.

 
   References Top

1.Charkes ND. Graves' disease with functioning nodules (Marine-Lenhart syndrome). J Nucl Med 1972;13:885-92.  Back to cited text no. 1
    
2.Kim WB, Han SM, Kim TY, Nam-Goong IS, Gong G, Lee HK, et al. Ultrasonographic screening for detection of thyroid cancer in patients with Graves' disease. Clin Endocrinol 2004;60:719-25.  Back to cited text no. 2
    
3.Mishra A, Mishra SK. Thyroid nodules in Graves' disease: Implications in an endemically iodine deficient area. J Postgrad Med 2001;47:244-7.  Back to cited text no. 3
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4.Braga-Basaria M, Basaria S. Marine-Lenhart syndrome. Thyroid 2004;14:1107.  Back to cited text no. 4
    
5.Cakir M. Marine-Lenhart syndrome. J Natl Med Assoc 2005;97:1036-8.  Back to cited text no. 5
    
6.Cakir M. Diagnosis of Marine-Lenhart syndrome. Thyroid 2004;14:555.  Back to cited text no. 6
    


    Figures

  [Figure 1]


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2 An uncommon case of Marine-Lenhart syndrome
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