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Graves' Disease with Functioning Nodules (Marine-Lenhart Syndrome)

Temple University School of Medicine, Philadelphia, Pennsylvania

Correspondence: For reprints contact: N. David Charkes, Sec. of Nuclear Medicine, Dept. of Radiology, Temple University School of Medicine, Philadelphia, Pa. 19140.

ABSTRACT

Ten hyperthyroid patients with functioning thyroid nodules were studied in whom Plummer's disease (autonomous nodular goiter) had been excluded by failure of TSH to stimulate suppressed extranodular tissue. The responses of the nodules and the extra nodular tissue to TSH administration were significantly different from those seen in Plummer's disease and were consistent with the responses noted in patients with Graves' disease. It was concluded that these patients had Graves' disease with incidental functioning nodules. In three of six treated patients, the nodules were relatively resistant to ¹³¹I therapy, as judged by dose requirement, post-treatment scintigrams, and measurements of nuclear polyploidy. Subtotal thyroidectomy may therefore be the treatment of choice in this syndrome. The frequency of occurrence of incidental functioning nodules was found to be 2.7% of 375 patients with Graves' disease referred to us for testing. In recognition of the investigators who first described this entity biochemically, it is proposed that Graves' disease with incidental functioning nodules be called the Marine Lenhart syndrome.

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