Sheehanfs syndrome co.existing with Graves' disease

Abstract

Sheehanfs syndrome (SS), which is an important cause of hypopituitarism, is common in developing countries. The most common presentation is the absence of lactation and amenorrhea. Hypothyroidism rather than  hyperthyroidism is the usual expected phenomenon in SS. Postpartum hyperthyroidism is also common and Gravesf disease (GD) is an important cause of postpartum hyperthyroidism. Here we report a case of a  22-year-old female patient in our clinic presented symptoms of  amenorrhea, lack of lactation, palpitations and sweating. Her physical  examination revealed goiter, moist skin and proptosis. Her laboratory evaluation showed suppressed thyroid stimulating hormone, elevated
levels of free thyroxine and free triiodothyronine. Thyroid antibodies were positive. Tec99m thyroid scintigraphy results were gland hyperplasia and increased uptake consistent with GD. She gave birth 7 months ago; after delivery she had a history of prolonged bleeding, amenorrhea and inability to lactate. She had hypogonadotropic hypogonadism, hyperprolactinemia and growth hormone deficiency. Serum cortisol and adrenocorticotropic hormone levels were normal. Her magnetic resonance imaging was empty sella. Our diagnosis was GD co.existing with SS. GD with concomitant
hypopituitarism is rare but has been described previously, but there are no reports of GD occurring with SS. In this case study, we report a patient with GD associated with SS.

Key words: Graves, hyperthyroidism, Sheehanfs syndrome