Due to the increased prevalence of papillary thyroid carcinoma (PTC), difficult cases and unexpected events have become more common during long-term follow-up. Herein we reported four cases that exhibited poor progress during long-term follow-up. All the cases were diagnosed with PTC and treated with total thyroidectomy before several years, and the patients had been newly diagnosed with recurrent and metastatic PTC. These four cases included recurred PTC with invasion of large blood vessels, a concomitant second malignancy, malignant transformation, and refractoriness to treatment. Physicians should closely monitor patients to promptly address unforeseen circumstances during PTC follow-up, including PTC recurrence and metastasis. Furthermore, we suggest that the development of a management protocol for refractory or terminal PTC is also warranted.

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Graves' disease is an autoimmune disorder that may present with various clinical manifestations of hyperthyroidism. Patients with Graves' disease have a greater number of thyroid nodules and a higher incidence of thyroid cancer compared with patients with normal thyroid activity. However, cases in which patients are diagnosed with recurrence of Graves' disease shortly after partial thyroidectomy for thyroid cancer are very rare. Here we report a case of hyperthyroid Graves' disease that occurred after partial thyroidectomy for papillary thyroid cancer. In this case, the patient developed hyperthyroidism 9 months after right hemithyroidectomy, and antithyroglobulin autoantibody and thyroid stimulating hormone receptor stimulating autoantibody were positive. Therefore, we diagnosed Graves' disease on the basis of the laboratory test results and thyroid ultrasonography findings. The patient was treated with and maintained on antithyroid drugs. The mechanism of the recurrence of Graves' disease in this patient is still unclear. The mechanism may have been the improper response of the immune system after partial thyroidectomy. To precisely determine the mechanisms in Graves' disease after partial thyroidectomy, further studies based on a greater number of cases are needed.

Citations

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• Graves’ disease diagnosed in remnant thyroid after lobectomy for thyroid cancer
  Meihua Jin, Ahreum Jang, Won Gu Kim, Tae Yong Kim, Won Bae Kim, Young Kee Shong, Min Ji Jeon, Byeong-Cheol Ahn
  PLOS ONE.2022; 17(3): e0265332.     CrossRef
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  Ahmad Housin, Michael Tamilia
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• Effects of energy-based ablation on thyroid function in treating benign thyroid nodules: a systematic review and meta-analysis
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• Total Thyroidectomy for Thyroid Cancer Followed by Thyroid Storm due to Thyrotropin Receptor Antibody Stimulation of Metastatic Thyroid Tissue
  Lars Folkestad, Frans Brandt, Thomas Brix, Marianne Vogsen, Lars Bastholt, Peter Grupe, Jeanette  Krogh Petersen, Laszlo Hegedüs
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  Kristina Heck, Christian Happel, Frank Grünwald, Huedayi Korkusuz
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• Development of Thyroid-Associated Ophthalmopathy in Patients Who Underwent Total Thyroidectomy
  Sun Young Jang, Ka Hyun Lee, Jong Rok Oh, Bo Yeon Kim, Jin Sook Yoon
  Yonsei Medical Journal.2015; 56(5): 1389.     CrossRef
• Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
  Won-Young Lee
  Endocrinology and Metabolism.2014; 29(3): 251.     CrossRef