Marine-Lenhart Syndrome about a Case

The most common cause of hyperthyroidism is autoimmune (Graves Basedow disease).It usually presents with diffuse goiter, but between 25-30% have thyroid's nodules.Most of them are cold nodules on scintigraphy, therefore, hypo functioning and between 0.8 -2.7% are hyper functioning1-5.The association of thyrotoxicosis due to Graves' disease (GBD) and toxic nodules is what is called Marine-Lenhart syndrome (MLS).It is rare and the prevalence ranges between 2.7 -4.1%3,6.It's characterized by the presentation of Graves' disease accompanied by hyper functioning's nodules with the following characteristics: a) thyroid scintigraphy performed with Tc-99m Pertechnetiate, which shows Graves' disease with one or more hyper functioning nodules; (b) hyper uptake in nodules after increase in TSH level due to radio-ablation; (c) return to nodal function after stimulation with endogenous or exogenous TSH; (d) benign histopathology.They present thyroid-stimulating antibodies.Although these characteristics are discussed7.This entity is more common in women, between 40 -50 years old, with hyperthyroidism of several years of evolution and failed treatments with ATS.