Thymic hyperplasia in Graves’ disease
A 30-year-old male presented with intermittent fever, weight loss, and dry cough of 2 months duration. He presented to various centers and was extensively evaluated for fever. Basic hematological and biochemical investigations were within normal limits.\nHe presented to our center as a case of pyrexia of unknown origin (PUO). On enquiry, he also gave history of weight loss of 10 kg (weight 56 kg) over 2 months despite increased appetite, excessive sweating, restlessness, increased anxiety, and frequent episodes of diarrhea. On evaluation, he was found to have thyromegaly and other features of hyperthyroidism such as digital tremors, warm moist palms, tachycardia (110-120/min), blood pressure 140/68, eye signs such as exophthalmos, lid lag, staring look with cardiovascular, and other systemic examinations being normal. His thyroid function tests were suggestive of hyperthyroidism (T3 2.4 ng/ml, T4 19 μg/dl, and TSH 0.09 μIU/ml). 99mTc-pertechnetate scan showed a diffuse thyromegaly with increased tracer uptake. A CECT chest done (as a part of PUO workup) showed an anterior mediastinal mass (5.6 × 2.1 × 6.0 cm) with mild contrast enhancement, suggestive of a thymic mass []. In view of close proximity of the mediastinal mass to the great vessels and other important structures in mediastinum, a FNAC or biopsy was not attempted.\nPatient was started on carbimazole 20 mg BD, propranolol 20 mg TDS, and supportive therapy. He gradually improved, became afebrile, gained 5 kg weight over the next 12 weeks and had gradual regression of clinical features of hyperthyroidism. His ATD dosage was titrated and continued. Repeat CECT scan chest at 12 weeks after initiation of ATD showed regression in the size of the mass (2.4 × 1.2 × 3.0 cm) []. Presently, the patient is clinically and biochemically euthyroid.