Graves' disease with functioning nodules (Marine-Lenhart syndrome).

Abstract

Summary Ten hyperthyroid patients with functioning thyroid nodules were studied in whom Plummer9s 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 Plummer9s disease and were consistent with the responses noted in patients with Graves9 disease. It was concluded that these patients had Graves9 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 Graves9 disease referred to us for testing. In recognition of the investigators who first described this entity biochemically, it is proposed that Graves9 disease with incidental functioning nodules be called the Marine Lenhart syndrome.