array:23 [ "pii" => "S238702062400370X" "issn" => "23870206" "doi" => "10.1016/j.medcle.2024.02.017" "estado" => "S300" "fechaPublicacion" => "2024-09-13" "aid" => "6638" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;163:262-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2387020624003711" "issn" => "23870206" "doi" => "10.1016/j.medcle.2024.03.015" "estado" => "S300" "fechaPublicacion" => "2024-09-13" "aid" => "6652" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;163:263-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Eosinophilic granulomatosis with polyangiitis: A rare case of central airway stenosis with normal eosinophil levels" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "263" "paginaFinal" => "264" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Granulomatosis eosinofílica con poliangitis: un caso de estenosis de la vía aérea central con niveles normales de eosinófilos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 722 "Ancho" => 1450 "Tamanyo" => 336369 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">EGPA tracheoscopy and pathological findings of a case of central airway stenosis. (A) Bronchoscope showed obvious granulation tissue hyperplasia (red arrow) and central airway stenosis. (B) Central airway biopsy (hematoxylin–eosin staining) showed that eosinophil infiltration in blood vessels and tissues was very obvious (300×, eosinophils are shown by red arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Long-zhao Li, Kai Sun, Hong-wu Wang" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Long-zhao" "apellidos" => "Li" ] 1 => array:2 [ "nombre" => "Kai" "apellidos" => "Sun" ] 2 => array:2 [ "nombre" => "Hong-wu" "apellidos" => "Wang" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624003711?idApp=UINPBA00004N" "url" => "/23870206/0000016300000005/v1_202409110904/S2387020624003711/v1_202409110904/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2387020624003723" "issn" => "23870206" "doi" => "10.1016/j.medcle.2024.03.016" "estado" => "S300" "fechaPublicacion" => "2024-09-13" "aid" => "6665" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2024;163:260-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Personalized dosage of Givosiran in acute intermittent porphyria" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "260" "paginaFinal" => "261" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dosis personalizada de Givosiran en porfiria intermitente aguda" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manuel Garrido Montes, Roberto Pertusa Mataix, Jose Salvador Garcia Morillo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Manuel" "apellidos" => "Garrido Montes" ] 1 => array:2 [ "nombre" => "Roberto" "apellidos" => "Pertusa Mataix" ] 2 => array:2 [ "nombre" => "Jose Salvador" "apellidos" => "Garcia Morillo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624003723?idApp=UINPBA00004N" "url" => "/23870206/0000016300000005/v1_202409110904/S2387020624003723/v1_202409110904/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Marine–Lenhart syndrome as a cause of thyrotoxicosis: A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "262" "paginaFinal" => "263" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rosanna del Carmen Zambrano-Infantino, Noelia Álvarez-Mena, Francisco Sebastián-Palacid" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Rosanna del Carmen" "apellidos" => "Zambrano-Infantino" "email" => array:1 [ 0 => "rosannamedicina@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Noelia" "apellidos" => "Álvarez-Mena" ] 2 => array:2 [ "nombre" => "Francisco" "apellidos" => "Sebastián-Palacid" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Nuclear Medicine, Hospital Clínico Universitario de Valladolid, Valladolid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Marine-Lenhart como causa de tirotoxicosis. Estudio de un caso" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Graves’ disease (GD) is one of the most frequent autoimmune thyroid diseases, primarily characterized by thyroid hyperfunction, leading to the development of thyrotoxicosis and goitre. On the other hand, the presence of thyroid nodules is a common finding in clinical practice, and their study is essential, particularly when malignancy is suspected.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> A rare disorder known as Marine–Lenhart syndrome (MLS) arises from the simultaneous presence of GD and autonomously functioning thyroid nodules (AFTNs). The main features of this syndrome are the absence of exophthalmos, the presence of diffuse goitre, and autonomously functioning thyroid nodules; these could be autonomously functioning nodules (toxic adenoma or toxic multinodular goitre). Identifying this entity is important because it often exhibits a poor response to antithyroid treatment, necessitating higher doses of radioiodine therapy.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> This article aimed to report a case of a patient diagnosed with GD and findings in the thyroid scintigraphy of MLS.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 50-year-old woman with a one-year history of GD, treated with methimazole resulting in normalized thyroid hormone levels, presented with persistent fatigue, fever, palpitations, flushing, and neck pain for over three weeks. Physical examination revealed tachycardia and a grade 1 goitre. Laboratory tests indicated suppressed TSH levels (<0.01<span class="elsevierStyleHsp" style=""></span>mUI/L), elevated free thyroxine (6.9<span class="elsevierStyleHsp" style=""></span>ng/dL), and positive thyroid peroxidase (TPO) and TSH receptor antibodies. Ultrasonography images showed a diffuse goitre with nodules in both lobes. A Technetium-99 thyroid scan displayed diffuse enlargement of the thyroid gland with non-homogeneous tracer uptake in both lobes. Notably, there was an area of reduced uptake in the right lower pole, suggestive of a non-functioning nodule, while two areas with higher uptake were localized in the right superior pole and the middle-left lobule, indicative of functional thyroid nodules. The biopsy of the non-functioning nodule was negative for malignancy. Considering the previous medical history of GD and the concurrent presence of a goitre with two functioning nodules, these findings pointed towards MLS. Consequently, the patient was successfully treated with high doses of I-131.</p><p id="par0015" class="elsevierStylePara elsevierViewall">N. David Charkes coined the term “Marine–Lenhart syndrome” to honour David Marine and Carl Lenhart, who meticulously examined the histopathology and iodine content of the thyroid gland in 69 cases with exophthalmic goitre in 1911. Within that cohort, eleven cases exhibited the presence of thyroid nodules. Charkes established the eponymous after identifying 10 cases with functioning nodules within a series case of GD.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> It has been reported that approximately 10%–15% of patients with GD exhibit nodules; however, only 0.8%–2.7% have functional adenomas corresponding to MLS.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Numerous authors have identified significant age differences between patients diagnosed with GD and those with MLS. The median age of presentation for GD is typically around the 30s, while MLS tends to be more frequently identified in individuals in their 50s, as in the present case. This observation has led to the hypothesis that the functional autonomy of nodules may have evolved over many years within goitre in patients due to GD.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Distinguishing between multinodular toxic goitre and MLS is crucial because patients with MLS typically exhibit a poor response to antithyroid treatment. In the case of multinodular toxic goitre, scintigraphy shows increased uptake in the nodules while suppressing activity in the rest of the gland. On the other hand, in MLS, scintigraphic images reveal elevated uptake in the nodule and widespread uptake in the surrounding extranodular tissue. When our patient debuted with GD was treated with antithyroid therapy, and recurrence was appreciated. In MLS, it has been observed that choosing antithyroid drugs as the first-line treatment often fails to achieve normalization of thyroid hormones. Effectively, treating MLS necessitates higher doses of I-131 than those typically used.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As shown above, we reported a case of MLS, which was diagnosed by Technetium-99 thyroid scintigraphy and was successfully treated by high doses of I-131.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical approval</span><p id="par0030" class="elsevierStylePara elsevierViewall">The present study was approved by the institutional review board of our institution and with the 2013 Helsinki declaration and its later amendments or comparable ethical standards.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">Informed consent was obtained from the participant to be included in the study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Consent for publication</span><p id="par0040" class="elsevierStylePara elsevierViewall">The participant signed consent regarding publishing its data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">There is no source of funding.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authors’ contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Design: R.D.C.Z.-I. Data collection or processing: R.D.C.Z.-I. Analysis or interpretation: R.D.C.Z.-I., N.A.-M., F.S.-P. Literature search: R.D.C.Z.-I. Writing: R.D.C.Z.-I. Manuscript revision: N.A.-M. All authors read and approved the final manuscript.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">Rosanna del Carmen Zambrano-Infantino, Noelia Álvarez-Mena, and Francisco Sebastián-Palacid declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical approval" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Informed consent" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Consent for publication" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Funding" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thyroid nodules: diagnosis and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Wong" 1 => "S.G. Farrell" 2 => "M. Grossmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5694/mja17.01204" "Revista" => array:6 [ "tituloSerie" => "Med J Aust" "fecha" => "2018" "volumen" => "209" "paginaInicial" => "92" "paginaFinal" => "98" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29996756" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Marine–Lenhart syndrome with a cold nodule: an uncommon entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.B. Kotramada" 1 => "A.M. Mehta" 2 => "S.S. Malapure" 3 => "S.P. Madhyastha" 4 => "K. Pai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bcr-2022-251138" "Revista" => array:5 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2022" "volumen" => "15" "paginaInicial" => "e251138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35868808" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Graves’ disease with functioning nodules (Marine–Lenhart syndrome)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N.D. Charkes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Nucl Med" "fecha" => "1972" "volumen" => "13" "paginaInicial" => "885" "paginaFinal" => "892" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4678244" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type 2 Marine–Lenhart syndrome: an uncommon cause of thyrotoxicosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.A. Builes Barrera" 1 => "P.A. Castano" 2 => "P. Herrera Revollo" 3 => "M.E. Perez Paternina" 4 => "L.A. Rodriguez Arrieta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7759/cureus.20558" "Revista" => array:5 [ "tituloSerie" => "Cureus" "fecha" => "2021" "volumen" => "13" "paginaInicial" => "e20558" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35103137" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of Marine–Lenhart syndrome on (99m)Tc-thyroid scintigraphy and response to radioiodine: a single institutional retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Agrawal" 1 => "P.S.S. Patro" 2 => "B.R. Meher" 3 => "G. Gnanasegaran" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/wjnm.wjnm_130_20" "Revista" => array:6 [ "tituloSerie" => "World J Nucl Med" "fecha" => "2021" "volumen" => "20" "paginaInicial" => "369" "paginaFinal" => "373" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35018152" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016300000005/v1_202409110904/S238702062400370X/v1_202409110904/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016300000005/v1_202409110904/S238702062400370X/v1_202409110904/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062400370X?idApp=UINPBA00004N" ]
Journal Information
Letter to the Editor
Marine–Lenhart syndrome as a cause of thyrotoxicosis: A case report
Síndrome de Marine-Lenhart como causa de tirotoxicosis. Estudio de un caso
Rosanna del Carmen Zambrano-Infantino
, Noelia Álvarez-Mena, Francisco Sebastián-Palacid
Corresponding author
Department of Nuclear Medicine, Hospital Clínico Universitario de Valladolid, Valladolid, Spain