Sheehan's 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
Graves' 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. Tec 99m 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.