AACE MENA 2025-Roundtable Case Based Discussion

Video Transcription

Video Summary

This case discusses a 43-year-old pilot with mild hyperthyroidism caused by a small toxic thyroid adenoma. Initial treatment with carbimazole normalized thyroid function, but the patient refused radioactive iodine or surgery due to hypothyroidism concerns. He underwent radiofrequency ablation (RFA) abroad in 2022. Post-RFA, his nodule disappeared, yet subclinical hyperthyroidism persisted for over two years with intermittent palpitations. Ultrasounds and scans showed no active nodule, and thyroid antibodies remained negative. Experts questioned the small nodule size as the hyperthyroidism source and the RFA’s efficacy. Subsequent findings suggested Graves’ disease despite negative antibodies, leading to carbimazole resumption and symptom improvement. The discussion highlighted rare cases of Graves’ disease following RFA, possibly due to antigen release from tissue injury or pre-existing subclinical autoimmunity unmasked by RFA. This case underscores the need for careful patient selection, monitoring, and further research on post-RFA autoimmune thyroid disease.

Keywords

toxic thyroid adenoma

radiofrequency ablation

subclinical hyperthyroidism

Graves’ disease

autoimmune thyroid disease