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Autoimmune switch from hyperthyroidism to hypothyroidism in Graves’ disease
  1. Preethi Padmanaban and
  2. Rohit Jain
  1. Endocrinology, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
  1. Correspondence to Dr Rohit Jain; rjain{at}


We report a case of a 21-year-old young woman who was initially diagnosed with hyperthyroidism secondary to Graves’ disease and spontaneously switched to hypothyroidism in a year. While most autoimmune hypothyroidism is due to Hashimoto’s disease, in her case, we suspect that her hypothyroidism is due to a switch of antibody dominance from thyroid stimulating hormone (TSH) receptor-stimulating antibody (TS Ab) to TSH receptor-blocking antibody (TB Ab). Switching from dominant TS Ab activity to dominant TB Ab activity is a rare phenomenon. Optimal management of this condition is not known. Loss of follow-up and medication non-adherence has made medical management in this young woman of reproductive age further challenging.

  • endocrine system
  • thyroid disease
  • thyrotoxicosis
  • thyroiditis
  • endocrinology

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  • Contributors PP was involved in patient care, acquisition of data, drafting and revision of manuscript. RJ was involved in patient care, revision and final approval of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.