{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:48Z","timestamp":1784557068941,"version":"3.55.0"},"reference-count":14,"publisher":"Bioscientifica","issue":"3","license":[{"start":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T00:00:00Z","timestamp":1688169600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"\n Summary<\/jats:title>\n Rare patients who have both thyroid-stimulating hormone (TSH) receptor-stimulating and -blocking antibodies can develop \u2018pendulum swinging\u2019 thyroid dysfunction. A 9-year-old girl with Down syndrome was treated with carbimazole for Graves\u2019 disease. After 2 years of treatment, she became profoundly biochemically hypothyroid, and this persisted after carbimazole was discontinued. Low-dose L-thyroxine was commenced. This was subsequently also discontinued as biochemical hyperthyroidism developed. TSH receptor antibody bioassay identified both TSH receptor-stimulating and -blocking antibodies. Mild hyperthyroidism persisted and while consultations regarding definitive treatment were ongoing, medication was not recommenced. Thyroid function normalised spontaneously and she has remained euthyroid for the past 3 years. Previous reports have advised definitive treatment; however, our patient developed spontaneous remission which has been prolonged and definitive therapies have been avoided. It is not yet known how commonly this particular phenomenon occurs.<\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Rare patients who have both TSH receptor-stimulating and -blocking antibodies can switch between hyperthyroidism and hypothyroidism or vice versa during treatment with antithyroid drugs or thyroxine.<\/jats:p>\n <\/jats:list-item>\n \n Metamorphic thyroid autoimmunity is more common in Down syndrome.<\/jats:p>\n <\/jats:list-item>\n \n Switching between hyperthyroidism and hypothyroidism and back again is less commonly reported.<\/jats:p>\n <\/jats:list-item>\n \n Definitive treatment such as radioactive iodine or thyroidectomy are usually recommended.<\/jats:p>\n <\/jats:list-item>\n \n Prolonged remission was achieved off all medication, without recourse to definitive treatments.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-23-0064","type":"journal-article","created":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T07:33:03Z","timestamp":1692171183000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":2,"title":["Spontaneous remission of pendulum swinging thyroid disease in Down syndrome"],"prefix":"10.1530","volume":"2023","author":[{"given":"Katriona","family":"Fox","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Regional Hospital Mullingar, Co. Westmeath, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisling","family":"Fitzsimons","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Regional Hospital Mullingar, Co. Westmeath, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhana","family":"Sharif","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Regional Hospital Mullingar, Co. Westmeath, Ireland"},{"name":"Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland"},{"name":"School of Medicine, University College Dublin, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham Robert","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Medicine, University College Dublin, Dublin, Ireland"},{"name":"Department of Clinical Biochemistry and Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5997-0560","authenticated-orcid":true,"given":"Michael Joseph","family":"O\u2019Grady","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Regional Hospital Mullingar, Co. Westmeath, Ireland"},{"name":"School of Medicine, University College Dublin, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Clinical Endocrinology","first-page":"110","article-title":"Hyperthyroidism in a population with Down syndrome (DS)","volume":"71","author":"Goday-Arno","year":"2009","unstructured":"Goday-Arno ACerda-Esteva MFlores-Le-Roux JAChillaron-Jordan JJCorretger JM & Cano-P\u00e9rez JF. Hyperthyroidism in a population with Down syndrome (DS). Clinical Endocrinology200971110\u2013114. (https:\/\/doi.org\/10.1111\/j.1365-2265.2008.03419.x)"},{"key":"bib2","series-title":"European Journal of Endocrinology","first-page":"591","article-title":"Peculiarities of Graves' disease in children and adolescents with Down's syndrome","volume":"162","author":"De Luca","year":"2010","unstructured":"De Luca FCorrias ASalerno MWasniewska MGastaldi RCassio AMussa AAversa TRadetti G & Arrigo T. 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