BÁO CÁO CA LÂM SÀNG: SUY GIÁP DO VIÊM TUYẾN GIÁP TỰ MIỄN ĐẾN SAU BỆNH GRAVES ĐÃ ĐẠT THUYÊN GIẢM

Abstract

Graves’ disease treated medically and achieving remission may progress to hypothyroidism after several years, with an estimated incidence of 20 - 30% [1, 5]. Approximately one-third of these cases are attributed to the development of TSH receptor-blocking antibodies, whereas the remaining cases are related to autoimmune thyroiditis [4, 6]. We report a case of a patient diagnosed with Graves’ disease in August 2019, who presented with typical hyperthyroidism and was treated with thionamides for 19 months, and subsequently achieved long-term remission. In August 2025, the patient developed goiter accompanied by biochemical hypothyroidism, findings consistent with autoimmune thyroiditis. Although a thyroid biopsy (the diagnostic gold standard for thyroiditis) was not performed, systematic analysis of clinical features, diagnostic reasoning, and therapeutic response suggests that this case represents a typical example of functional transition within the autoimmune thyroid disease spectrum, driven by the predominance of different autoimmune mechanisms at a given time. This observation reinforces the concept that Graves’ disease belongs to the spectrum of autoimmune thyroid disorders, in which different phenotypes may sequentially emerge or coexist in the same individual, determined by the interplay between genetic predisposition and environmental factors. Long-term follow-up is therefore essential, even among patients with sustained remission.