Background: The development of Graves’ disease (GD) from Hashimoto’s thyroiditis (HT) has sporadically been reported, but no data are available concerning the prevalence of this sequence of events in GD patients. Our aim was to ascertain HT antecedents in the history of GD children in order to assess for the first time the relative frequency of the event sequence leading from HT to GD in a pediatric population. Study Population and Results: In 105/109 patients, no HT antecedents were documented at GD presentation. The remaining 4 patients had previously exhibited a picture of HT with either hypothyroidism or euthyroidism. The interval between HT diagnosis and GD presentation ranged from 1.5 to 2.8 years. Serum thyrotropin receptor antibodies were higher in the patients with no HT antecedents. Conclusions: In at least 3.7% of the children with GD, hyperthyroidism may be preceded by HT presentation with either hypothyroidism or euthyroidism. The clinical course of GD in these patients is not different from the one observed in those with no HT antecedents. Our report confirms the existence of a continuum between HT and GD within the spectrum of autoimmune thyroid diseases.

Ilicki A, Marcus C, Karlsson FA: Hyperthyroidism and hypothyroidism in monozygotic twins: detection of stimulating and blocking TSH receptor antibodies using the FRTL5-cell line. J Endocrinol Invest 1990;13:327–331.
Tani J, Yoshida K, Fukazawa H, Kiso Y, Sayama N, Mori K, Alzawa Y, Hori H, Nakasato N, Abe K: Hyperthyroid Graves’ disease and primary hypothyroidism caused by TSH receptor antibodies in monozygotic twins: case report. Endocr J 1998;45:117–121.
Aust G, Krohn K, Morgenthaler NG, Schroeder S, Edelmann J, Brylla E: Graves’ disease and Hashimoto’s thyroiditis in monozygotic twins: case study as well as transcriptomic and immunohistological analysis of thyroid tissues. Eur J Endocrinol 2006;154:13–20.
Desai MP, Karandikar S: Autoimmune thyroid disease in childhood: a study of children and their families. Indian Pediatr 1999;36:659–668.
Doniach D: Humoral and genetic aspects of thyroid autoimmunity. Clin Endocrinol Metab 1975;4:267–285.
Wood LC, Ingbar SH: Hypothyroidism as a late sequela in patients with Graves’ disease treated with antithyroid agents. J Clin Invest 1979;64:1429–1436.
Takasu N, Yamada T, Sato A, Nakagawa M, Komiya I, Nagasawa Y, Asawa T: Graves’ disease following hypothyroidism due to Hashimoto’s disease: studies of eight cases. Clin Endocrinol 1990;33:687–698.
le Berre JP, Rousseau C, Dupuy O, Bordier L, Mayaudon H, Bauduceau B: Unusual evolution of autoimmune hypothyroidism: occurrence of Graves’ disease (in French). Rev Med Interne 2004;25:841–843.
Ludgate M, Emerson CH: Metamorphic thyroid autoimmunity. Thyroid 2008;18:1035–1037.
Wasniewska M, Salerno M, Cassio A, Corrias A, Aversa T, Zirilli G, Capalbo D, Bal M, Mussa A, De Luca F: Prospective evaluation of the natural course of idiopathic subclinical hypothyroidism in childhood and adolescence. Eur J Endocrinol 2009;160:417–421.
Ohye H, Nishihara E, Sasaki I, Kubota S, Fukata S, Amino N, Kuma K, Miyauchi A: Four cases of Graves’ disease which developed after painful Hashimoto’s thyroiditis. Intern Med 2006;45:385–389.
Champion B, Gopinath B, Ma G, El-Kaissi S, Wall JR: Conversion to Graves’ hyperthyroidism in a patient with hypothyroidism due to Hashimoto’s thyroiditis documented by real-time thyroid ultrasonography. Thyroid 2008;18:1135–1137.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.