Introduction:

Hyperthyroidism (HT) is a pathology that occurs due to the synthesis and excessive secretion of thyroid hormones by the thyroid gland and its prevalence worldwide is between 1.2 to 1.6%. The main etiology of HT is Graves’ disease (GD), followed by toxic multinodular goiter (MNG). The clinical manifestations of HT can vary from asymptomatic to a thyroid storm, a rare situation of severe acute and potentially fatal thyrotoxicosis. Marine Lenhart syndrome (MLS) consists of an HT that coexists with a toxic MNG and GD. It is a rare situation that occurs in 0.8 to 2.7% of patients with GD.

Case description:

A 50-year-old woman, with a personal history of unmedicated toxic, MNG, goes to an appointment due to an extreme weakness with functional impotence for walking, severe insomnia, emotional lability, and irritability associated with palpitations. She was referred to the emergency department where she was diagnosed with severe HT due to GD, having been hospitalized. There was clinical and laboratory stabilization with an improvement of symptoms, and she was discharged from the hospital with the probable diagnosis of MLS.

Comments:

This case demonstrates the importance of thyroid monitoring and supervision of symptoms in patients with thyroid disease. The family doctor has a fundamental role in controlling these situations because of the longitudinal monitoring of their patients. A broader approach to each patient and the link between primary and secondary health care allow the identification of specific clinical problems and their early treatment.

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