Association of Paget’s Disease of Bone and Graves’:A series of two Cases

Abstract

ABSTRACT
Introduction: Hyperthyroidism is related with increased bone remodelling, decreased bone density, osteoporosis and increased risk of bone fractures. But the relation between hyperthyroidism and metabolic disorders of bone like Paget’s disease is unclear. Case report series: We diagnosed Paget’s disease associated with Graves’ in our two patients. In literature, we found only one case published about this association to date. The first patient was 68 years old female who admitted to our outpatient clinic with weight loss, low back pain and fatigue. The other patient was 61 years old male suffering from fatigue and palpitation whose Paget’s disease was diagnosed 3 years ago. Both patients had elevated levels of serum alchaline phosphatase, decreased thyroid stimulating hormone levels associated with elevated levels of triiodothyronine and thyroxine. Their Tc99m thyroid scintigraphy revealed homogeneously increased activity and marked hyperplasia in thyroid glands indicating Graves’ disease. And Tc 99 MDP labelled whole body bone scan was consistent with Paget’s disease in both patients. Conclusion: Hyperthyroidism is related with bone resorbtion. But different effects of thyroid hormones by their receptors on osteoclast and osteoblasts may be the case. Therefore we suggest that the relation between thyroid hormones and metabolic bone disorders must be researched widely.