Objective: To describe a possible association between Graves' disease and nephrotic syndrome attributable to minimal change nephropathy and to review the literature related to renal diseases in patients with Graves' disease.
Methods: The clinical, laboratory, and renal biopsy findings in a patient with Graves' disease and minimal change nephropathy are discussed. In addition, the pertinent English-language literature published from 1966 to 2001, determined by means of a MEDLINE search, is reviewed.
Results: A 29-year-old woman underwent assessment by her primary-care physician because of palpitations, sweating, and a 4.5-kg weight loss. Physical examination revealed a diffuse goiter and tremors of the extremities but no ophthalmologic signs. Laboratory tests confirmed a diagnosis of thyrotoxicosis. Treatment was initiated with propylthiouracil and propranolol. Four weeks later, she presented to the University of Louisville Hospital with increasing swelling of her legs and periorbital puffiness. Examination revealed generalized edema, ascites, and pleural effusion. She continued to have features of thyrotoxicosis. Laboratory tests showed undetectable thyroid-stimulating hormone (<0.03 mIU/mL) and homogeneously increased 123I thyroid uptake and scan. A 24-hour urine collection revealed urinary protein excretion of 6.75 g. Antinuclear antibodies, serum complement levels, hepatitis, and human immunodeficiency virus (HIV) screen were normal. A kidney biopsy specimen revealed features consistent with minimal change disease on light, immunofluorescence, and electron microscopy. The patient had an excellent clinical and laboratory response to treatment with radioactive iodine and corticosteroids, and she was asymptomatic at 6-month follow-up.
Conclusion: To the best of our knowledge, this is the first report of the concomitant occurrence of Graves' disease and minimal change disease in the absence of any other immunologic disorder known to be associated with minimal change nephropathy.