A case of unilateral Graves' disease with review of literature.

Introduction: Graves's disease is classically considered to involve both the lobe of thyroid gland but rarely there can be unilateral involvement of the thyroid gland in this condition. Case: A 30 year housewife presented to us with hyperadrenergic symptom suggestive of thyrotoxicosis. On examination there was diffuse enlargement of thyroid left greater than right. Thyroid ultrasound even following review did not reveal any nodule. Technetium 99 thyroid scan showed uptake in the left lobe of thyroid. TSH receptor antibody was positive further to support the diagnosis of unilateral Graves' disease. On literature review it was found to have predominant involvement of right lobe. All the cases which were treated with hemithyroidectomy went on to develop thyrotoxicosis involving other lobe. Hence we propose unilateral to bilateral involvement of the thyroid being natural history of the Graves' disease. The time duration in unilateral to bilateral involvement is usually very small. Hence, it's rarely encountered with unilateral involvement in clinical practice unless thyroid scan is done in early part of the disease. Due to some differences in between the thyroid lobe either anatomically or due to infection the unilateral to bilateral progression is slower or hence can be picked up. Conclusion: We present a case of Graves' disease with unilateral involvement of the thyroid on the left side.We propose unilateral to bilateral involvement of the thyroid being natural history of the Graves' disease. Unilateral graves should be treated with treatment to target both lobe of thyroid. [ABSTRACT FROM AUTHOR]