Graves' Disease Progressing to Hashimoto's Thyroiditis

THE ASSOCIATION of Graves' disease and hypothyroidism with chronic lymphocytic thyroiditis has long been recognized. In some cases, hypothyroidism seems to be the final outcome of Graves' thyrotoxicosis. 1 Many reports are not completely substantiated, however, and none, to our knowledge, reports on the histological appearance of the thyroid gland at both stages of the disease in the same patient. Report of a Case A 39-year-old woman (height, 159 cm; weight, 55 kg) was seen in 1972 with thyrotoxicosis, unilateral exophthalmos, and a large, smooth goiter. The six-hour sodium iodide uptake was raised at 68% (normal, 25% to 35% dose), and the scan was homogenous. The patient was euthyroid during antithyroid drug therapy (carbimazole, 30 mg/day), as confirmed at repeated checkups during 1972 and 1973. Treatment was discontinued voluntarily by the patient from 1973 to January 1977. At that time, the patient was again found to be thyrotoxic with a