Introduction: Marine-Lenhart syndrome (MLS) is now understood to be a combination of Graves’ disease and autonomously functioning thyroid nodule(s) (AFTNs). The prevalence of the syndrome and suitable treatments for those living in iodine-sufficient areas are uncertain. Objectives: We aimed to investigate the prevalence, treatment, and prognosis of MLS in Japan, an iodine-sufficient area. Methods: This study involved patients who visited our hospital between February 2005 and August 2019. Among patients with both thyrotoxicosis and thyroid nodule(s) larger than 10 mm, MLS and isolated AFTNs were diagnosed based on serum thyroid-stimulating hormone receptor antibody levels and scintigraphy using radioiodine or technetium-99m and thyroid uptake. Results: Twenty-two patients were found to have MLS, compared to 372 with isolated AFTNs and 8,343 with Graves’ disease, during the period. Therefore, the rate of MLS cases was 0.26% among all patients with Graves’ disease (22/8,343). Treatments and outcomes were assessed for cases of MLS (n = 18) and isolated AFTNs (n = 269). Antithyroid drugs (ATDs) were withdrawn in 27.8% of cases in the MLS group and 10.3% in the isolated AFTN group. There was no significant difference in the clinical outcome after ATD withdrawal between the 2 groups. However, the rate of hypothyroidism after radioactive iodine (RAI) administration was significantly higher in the MLS group than in the isolated AFTN group (42.9 vs. 9.0%, p = 0.005) despite similar doses of RAI. Conclusions: The prevalence of MLS among patients with Graves’ disease was 0.26% in Japan. RAI therapy induces hypothyroidism more frequently than in those with AFTNs probably because RAI is taken up in the surrounding Graves’ tissues.
Eur Thyroid J

中文翻译：

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日本 Marine-Lenhart 综合征的患病率和治疗结果

简介： Marine-Lenhart 综合征 (MLS) 现在被认为是格雷夫斯病和自主功能甲状腺结节 (AFTN) 的组合。对于生活在碘充足地区的人来说，该综合征的患病率和合适的治疗方法尚不确定。目的：我们旨在调查碘充足地区日本 MLS 的患病率、治疗和预后。方法：本研究纳入 2005 年 2 月至 2019 年 8 月就诊的患者。在甲状腺毒症和甲状腺结节大于 10 mm 的患者中，根据血清促甲状腺激素受体抗体水平和使用放射性碘或锝99m和甲状腺摄取进行闪烁扫描。结果：在此期间，发现 22 名患者患有 MLS，相比之下，372 名患者患有孤立的 AFTN，8,343 名患者患有格雷夫斯病。因此，在所有 Graves 病患者中，MLS 病例的发生率为 0.26% (22/8,343)。评估了 MLS ( n = 18) 和孤立的 AFTN ( n = 269)病例的治疗和结果。在 MLS 组中有 27.8% 的病例停用了抗甲状腺药物 (ATDs)，在孤立的 AFTN 组中有 10.3% 的病例停用了抗甲状腺药物 (ATD)。ATD停药后2组临床结局无显着差异。然而，尽管 RAI 的剂量相似，但 MLS 组的放射性碘 (RAI) 给药后甲状腺功能减退的发生率显着高于孤立的 AFTN 组（42.9% vs. 9.0%，p = 0.005）。结论：日本 Graves 病患者中 MLS 的患病率为 0.26%。RAI 治疗比 AFTN 患者更频繁地诱发甲状腺功能减退，这可能是因为 RAI 被周围的 Graves 组织吸收。
欧洲甲状腺杂志