{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:55Z","timestamp":1784557075201,"version":"3.55.0"},"reference-count":12,"publisher":"Bioscientifica","issue":"2","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"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":[[2025,4,1]]},"abstract":"\n Summary<\/jats:title>\n Thymic hyperplasia in Graves\u2019 disease is rarely identified due to the absence of routine imaging, but not uncommonly present. It is usually seen when imaging is performed for other reasons. Despite thymic hyperplasia becoming a more commonly identified occurrence, follow-up imaging scans and multi-disciplinary team (MDT) approach are still recommended to distinguish this benign transformation from more significant differentials. These steps can lead to distress in patients. Therefore, clinicians and radiologists being aware of this correlation between thymic hyperplasia and Graves\u2019 disease can add reassurances about the most likely diagnosis whilst the patient is undergoing limited further investigation to rule out differentials and subsequently, avoid unnecessary intervention. Here, we report a case of Graves\u2019 disease with thymic hyperplasia in a young woman who initially presented with non-specific eye symptoms and incidental mediastinal mass, in which involvement of multiple speciality teams was important to rule out thymoma and myasthenia gravis (MG).<\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Although Graves\u2019 disease with thymic hyperplasia is not uncommon, it is sometimes difficult to diagnose with one imaging scan due to the overlap of radiological characteristics of other important differentials; an MDT discussion and further imaging scans are needed to confirm the diagnosis in some cases.<\/jats:p>\n <\/jats:list-item>\n \n Getting MDT involvement early would quickly assist in ruling out more significant differentials and avoid unnecessary surgical intervention by concluding thymic hyperplasia.<\/jats:p>\n <\/jats:list-item>\n \n Clinicians having knowledge on the relation between Graves\u2019 disease and thymic hyperplasia may reassure the patient by explaining the possible resolution with treatment, while awaiting further MDT discussion.<\/jats:p>\n <\/jats:list-item>\n \n To rule out ocular MG in Graves\u2019 disease patients, additional investigations and neurology referral are often required as the serum antibody tests are less sensitive in ocular MG than generalised MG.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-24-0125","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T13:54:26Z","timestamp":1744120466000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["Multi-disciplinary collaboration in diagnosing thymic hyperplasia in a Graves\u2019 disease patient"],"prefix":"10.1530","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2770-2344","authenticated-orcid":true,"given":"Khin Yadanar","family":"Kyaw","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Thant","family":"Lwin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alistair","family":"Gummow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Ugur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"J Autoimmun","first-page":"121","article-title":"Associated autoimmunity in Addison's disease","volume":"8","author":"Zelissen PM","year":"1995","unstructured":"Zelissen PM\n, \nBast EJ\n & \nCroughs RJ\n\n. Associated autoimmunity in Addison's disease. J Autoimmun 1995 8 121\u2013130. (https:\/\/doi.org\/10.1006\/jaut.1995.0009)"},{"key":"bib2","series-title":"Indian J Endocrinol Metab","first-page":"521","article-title":"Thymic hyperplasia in Graves' disease","volume":"17","author":"Kotwal N","year":"2013","unstructured":"Kotwal N\n, \nSingh Y\n, \nMenon A\n, et al.\n Thymic hyperplasia in Graves' disease. Indian J Endocrinol Metab 2013 17 521\u2013523. (https:\/\/doi.org\/10.4103\/2230-8210.111676)"},{"key":"bib3","series-title":"Lancet","first-page":"776","article-title":"The thymus in thyroid disease","volume":"2","author":"Gunn A","year":"1964","unstructured":"Gunn A\n, \nMichie W\n & \nIrvine WJ\n\n. The thymus in thyroid disease. Lancet 1964 2 776\u2013778. (https:\/\/doi.org\/10.1016\/s0140-6736(64)90558-6)"},{"key":"bib4","series-title":"BMJ Case Rep","article-title":"Thymic hyperplasia and its spontaneous resolution with treatment of Graves\u2019 hyperthyroidism","volume":"2016","author":"Shanmugasundaram M","year":"2016","unstructured":"Shanmugasundaram M\n, \nVaradhan L\n, \nKatreddy MVR\n, et al.\n Thymic hyperplasia and its spontaneous resolution with treatment of Graves\u2019 hyperthyroidism. BMJ Case Rep 2016 2016 bcr2016215285. (https:\/\/doi.org\/10.1136\/bcr-2016-215285)"},{"key":"bib5","series-title":"Endocrinol Metab Clin North Am","first-page":"73","article-title":"The pathogenesis of Graves' disease","volume":"27","author":"McIver B","year":"1998","unstructured":"McIver B\n & \nMorris JC\n\n. The pathogenesis of Graves' disease. Endocrinol Metab Clin North Am 1998 27 73\u201389. (https:\/\/doi.org\/10.1016\/s0889-8529(05)70299-1)"},{"key":"bib6","series-title":"J Clin Investig","first-page":"2228","article-title":"Thymic hyperplasia in patients with Graves' disease. Identification of thyrotropin receptors in human thymus","volume":"98","author":"Murakami M","year":"1996","unstructured":"Murakami M\n, \nHosoi Y\n, \nNegishi T\n, et al.\n Thymic hyperplasia in patients with Graves' disease. Identification of thyrotropin receptors in human thymus. J Clin Investig 1996 98 2228\u20132234. (https:\/\/doi.org\/10.1172\/JCI119032)"},{"key":"bib7","series-title":"Radiographics","first-page":"335","article-title":"The thymus: a comprehensive review","volume":"26","author":"Nishino M","year":"2006","unstructured":"Nishino M\n, \nAshiku SK\n, \nKocher ON\n, et al.\n The thymus: a comprehensive review. Radiographics 2006 26 335\u2013348. (https:\/\/doi.org\/10.1148\/rg.262045213). published correction appears in Radiographics 2017 37 1004. (https:\/\/doi.org\/10.1148\/rg.2017174002)"},{"key":"bib8","series-title":"JCEM Case Rep","article-title":"Thymic hyperplasia and Graves' disease: a nonincidental association","volume":"1","author":"Pla Peris B","year":"2023","unstructured":"Pla Peris B\n, \nAbell\u00e1n Galiana P\n, \nMaravall Royo FJ\n, et al.\n Thymic hyperplasia and Graves' disease: a nonincidental association. JCEM Case Rep 2023 1 luad083. (https:\/\/doi.org\/10.1210\/jcemcr\/luad083)"},{"key":"bib9","series-title":"Endocrinol Diabetes Metab Case Rep","article-title":"Managing thymic enlargement in Graves\u2019 disease","volume":"2019","author":"Kamath C","year":"2019","unstructured":"Kamath C\n, \nWitczak J\n, \nAdlan MA\n, et al.\n Managing thymic enlargement in Graves\u2019 disease. Endocrinol Diabetes Metab Case Rep 2019 2019 18-0119. (https:\/\/doi.org\/10.1530\/EDM-18-0119)"},{"key":"bib10","series-title":"J Chin Med Assoc","first-page":"91","article-title":"Myasthenia gravis with thymoma and coexistent central hypothyroidism","volume":"72","author":"Yeh H-H","year":"2009","unstructured":"Yeh H-H\n, \nTung Y-W\n, \nYang C-C\n, et al.\n Myasthenia gravis with thymoma and coexistent central hypothyroidism. J Chin Med Assoc 2009 72 91\u201393. (https:\/\/doi.org\/10.1016\/S1726-4901(09)70030-9)"},{"key":"bib11","article-title":"Simultaneous ocular myasthenia gravis and thyroid eye disease: beware","author":"Sadaka A","year":"2016","unstructured":"Sadaka A\n, \nBerry S\n & \nLee AG\n\n. Simultaneous ocular myasthenia gravis and thyroid eye disease: beware. Ophthalmology Times, 2016. [Preprint]. (https:\/\/www.ophthalmologytimes.com\/view\/simultaneous-ocular-myasthenia-gravis-and-thyroid-eye-disease-beware). Accessed on 2 October 2024."},{"key":"bib12","series-title":"Indian J Ophthalmol","first-page":"985","article-title":"Ocular myasthenia gravis: a review","volume":"62","author":"Nair AG","year":"2014","unstructured":"Nair AG\n, \nPatil-Chhablani P\n, \nVenkatramani DV\n, et al.\n Ocular myasthenia gravis: a review. Indian J Ophthalmol 2014 62 985\u2013991. (https:\/\/doi.org\/10.4103\/0301-4738.145987)"}],"container-title":["Endocrinology, Diabetes & Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2025\/2\/EDM-24-0125.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2025\/2\/EDM-24-0125.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2025\/2\/EDM-24-0125.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:48:32Z","timestamp":1784555312000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3838"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":12,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.1530\/edm-24-0125","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,1]]}}}