{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:16Z","timestamp":1784557036640,"version":"3.55.0"},"reference-count":64,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2019,1,31]],"date-time":"2019-01-31T00:00:00Z","timestamp":1548892800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,1,31]]},"abstract":"Summary<\/jats:title>\n Thymic enlargement (TE) in Graves\u2019 disease (GD) is often diagnosed incidentally when chest imaging is done for unrelated reasons. This is becoming more common as the frequency of chest imaging increases. There are currently no clear guidelines for managing TE in GD. Subject 1 is a 36-year-old female who presented with weight loss, increased thirst and passage of urine and postural symptoms. Investigations confirmed GD, non-PTH-dependent hypercalcaemia and Addison\u2019s disease (AD). CT scans to exclude underlying malignancy showed TE but normal viscera. A diagnosis of hypercalcaemia due to GD and AD was made. Subject 2, a 52-year-old female, was investigated for recurrent chest infections, haemoptysis and weight loss. CT thorax to exclude chest malignancy, showed TE. Planned thoracotomy was postponed when investigations confirmed GD. Subject 3 is a 47-year-old female who presented with breathlessness, chest pain and shakiness. Investigations confirmed T3 toxicosis due to GD. A CT pulmonary angiogram to exclude pulmonary embolism showed TE. The CT appearances in all three subjects were consistent with benign TE. These subjects were given appropriate endocrine treatment only (without biopsy or thymectomy) as CT appearances showed the following appearances of benign TE \u2013 arrowhead shape, straight regular margins, absence of calcification and cyst formation and radiodensity equal to surrounding muscle. Furthermore, interval scans confirmed thymic regression of over 60% in 6 months after endocrine control. In subjects with CT appearances consistent with benign TE, a conservative policy with interval CT scans at 6 months after endocrine control will prevent inappropriate surgical intervention.<\/jats:p>\n \n Learning points:<\/jats:title>\n \n \n Chest imaging is common in modern clinical practice and incidental anterior mediastinal abnormalities are therefore diagnosed frequently.<\/jats:p>\n <\/jats:list-item>\n \n Thymic enlargement (TE) associated with Graves\u2019 disease (GD) is occasionally seen in view of the above.<\/jats:p>\n <\/jats:list-item>\n \n There is no validated strategy to manage TE in GD at present.<\/jats:p>\n <\/jats:list-item>\n \n However, CT (or MRI) scan features of the thymus may help characterise benign TE, and such subjects do not require thymic biopsy or surgery at presentation.<\/jats:p>\n <\/jats:list-item>\n \n In them, an expectant \u2018wait and see\u2019 policy is recommended with GD treatment only, as the thymus will show significant regression 6 months after endocrine control.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-18-0119","type":"journal-article","created":{"date-parts":[[2019,1,31]],"date-time":"2019-01-31T11:24:11Z","timestamp":1548933851000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":3,"title":["Managing thymic enlargement in Graves\u2019 disease"],"prefix":"10.1530","volume":"2019","author":[{"given":"C","family":"Kamath","sequence":"first","affiliation":[{"name":"1Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Witczak","sequence":"additional","affiliation":[{"name":"2Section of Endocrinology, Department of Medicine, Ysbyty Ystrad Fawr, Caerphilly, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M A","family":"Adlan","sequence":"additional","affiliation":[{"name":"2Section of Endocrinology, Department of Medicine, Ysbyty Ystrad Fawr, Caerphilly, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L D","family":"Premawardhana","sequence":"additional","affiliation":[{"name":"1Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK"},{"name":"2Section of Endocrinology, Department of Medicine, Ysbyty Ystrad Fawr, Caerphilly, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref581","first-page":"239","article-title":"Hyperplasia of the thymus in Graves\u2019 disease. 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