Sir,
We read with interest the article, “Unilateral Graves' disease: The lesser known” by Manthri et al.[1] We congratulate the authors on their new entity of unilateral Graves' disease[2] and also the possible explanations for unilateral Graves' disease. The knifehappy surgeons shall be happy that if surgery needed in these patients of unilateral Graves' disease, might be a hemithyroidectomy rather than total thyroidectomy, thereby preventing the complications of permanent hypoparathyroidism, which is more common with surgery for Graves' disease. On the contrary, there have been anecdotal reports of unilateral Graves' disease operated by hemithyroidectomy with consequent contralateral lobe recurrence.[3] We have few queries which shall benefit future readers.
What was the mean duration of symptoms in these patients and were the patient put on anti-thyroid drugs before the nuclear medicine consultation? Did the authors use the clinical findings or laboratory findings criteria for the diagnosis of Graves' disease as proposed by the Japan Thyroid Association?[4] How many of these patients had eye signs of Graves' disease and whether any of the patients underwent thyroidectomy?
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Conflicts of interest
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References
- 1.Manthri RG, Ajit N, Vaikakkara S, Devi BV, Kalawat T. Unilateral Graves' disease: The lesser known. Indian J Nucl Med. 2019;34:96–8. doi: 10.4103/ijnm.IJNM_11_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Chen LC, Green JB. First reported case of unilateral Graves' disease in the left lobe of a bilobar thyroid gland. Thyroid. 2011;21:683–6. doi: 10.1089/thy.2010.0343. [DOI] [PubMed] [Google Scholar]
- 3.Sakata S, Fuwa Y, Goto S, Fukui M, Yuasa H, Takuno H, et al. Two cases of Graves' disease with presentation of unilateral diffuse uptake of radioisotopes. J Endocrinol Invest. 1993;16:903–7. doi: 10.1007/BF03348954. [DOI] [PubMed] [Google Scholar]
- 4.Japan Thyroid Association. Japan Guidelines | Japan Thyroid Association. 2019. [Last accessed on 2019 May 09]. Available from: http://www.japanthyroid.jp/en/guidelines.html#Gra .