Late-onset Graves’ disease after hemithyroidectomy: a case report

BACKGROUND: Among hyperthyroidism cases, Graves' disease is the most common, with incidence peaking between 30 and 60 years of age. Hemithyroidectomy is sometimes performed for conditions such as thyroid tumors, and Graves' disease may develop from the residual thyroid tissue postoperatively. The occurrence of Graves' disease in the residual thyroid gland after resection of neoplastic lesions is very rare. Here, we present two cases of patients in their 70 s who developed Graves' disease years after hemithyroidectomy, along with a literature review. CASE PRESENTATION: Case 1 involved a 71-year-old Japanese female who underwent left hemithyroidectomy for papillary cancer. Three years postoperatively, she was diagnosed with Graves' disease. Case 2 concerned a 75-year-old Japanese female who underwent left hemithyroidectomy, with pathology confirming a follicular adenoma. Eight years after the operation, she was diagnosed with Graves' disease. CONCLUSIONS: It is rare for a patient to develop Graves' disease many years after hemithyroidectomy. A possible leakage of thyroid antigens may be involved; however, attributing cases that develop several years later to the effects of surgery remains uncertain. It is possible that a certain period passed with subclinical Graves' disease, even if thyroid-stimulating hormone receptor antibody (TRAb) and thyroid-stimulating antibody were produced under the influence of surgery. If the surgical effect was limited, patients may have developed Graves' disease from Hashimoto's disease. If TRAb had been measured during postoperative follow-up, it could have led to an earlier diagnosis.