an increased incidence of hashimoto thyroiditis has been reported in patients with turner 
 syndrome . in view of its pathogenic relationship with autoimmune thyroiditis we report the case of a 9-yr - old girl with turner syndrome who developed graves 
 disease during recombinant human gh therapy , and we discuss previous reports of this 
 association . the patient was the first child of healthy unrelated parents of normal stature , father 
 175.0  cm and mother 159.0  cm . the patient was born 
 after an uncomplicated pregnancy at a gestational age of 37 wks and 1 d. her birth weight 
 was 2490  g. on examination , lymphedema and webbed neck were detected . chromosomal analysis 
 of peripheral blood lymphocytes ( n=26 ) showed complete deletion of the short arm of the 
 second x chromosome ( karyotype : 45 , x ) . at the age of 5 yr and 2 mo , her height was 98.2  cm ( 2.25 sd ) and her weight was 14.4  kg 
 ( 1.48 sd ) . a gh stimulation test was performed , and 
 the peak gh values after stimulation with clonidine and arginine were 8.39 ng / ml and 5.56 
 ng / ml , respectively . of note is that diagnosis of complete gh deficiency is less than 5 
 ng / ml in this assay . recombinant human ( rh ) gh therapy ( 0.175  mg / kg / wk ) was initiated with 
 success ( fig . thyroid function tests showed a tsh level of 0.01 u / ml ( normal , 
 0.50 to 5.50 u / ml ) , a free ( f ) t4 value of 6.00 ng / dl ( normal , 0.85 to 1.80 
 ng / dl ) , and a free t3 value of 21.76 pg / ml ( normal , 2.50 to 5.50 pg / ml ) . anti - thyroglobulin antibody was 3.4 u / ml ( normal , < 0.3 u / ml ) . anti - thyroid peroxidase 
 antibody was 5.5 u / ml ( normal , < 0.3 u / ml ) . tsh receptor antibody ( trab ) was 52% ( normal , 
 < 15% ) . these results are compatible with a diagnosis of graves disease and treatment 
 with thiamazole was started . growth curve of the patient at the latest follow up ( 9 y old ) , the development of the patient s breast was tanner stage 
 1 . treatment with thiamazole was continued and the thyroid function has stayed within normal 
 ranges . the association of turner syndrome with graves disease was reported in english about 
 1020  years ago ( 1,2,3,4,5,6,7,8,9,10 ) . table 1table 1 graves disease in turner syndrome summarizes the historical thirteen known cases of graves disease with turner 
 syndrome , including our case . this table reveals that the clinical characteristics of 
 graves disease with turner syndrome are similar to those known generally in patients 
 without turner syndrome in terms of ages of the onset , symptoms and prognosis . treatment with rhgh was 
 given to 4 patients in table 1 , and it was 
 continued in 3 out of the 4 patients including our case . this continuation of gh treatment , 
 together with the successful treatment of hyperthyroidism , suggests that a direct link 
 between gh treatment and graves disease is unlikely . consistent with this hypothesis , the 
 incidence of hyperthyroidism in japanese patients with turner syndrome receiving rhgh 
 therapy is 0.40% , which is similar to overall incidence of hyperthyroidism in patients with 
 turner syndrome , 00.5% ( 11 , 12 ) . it is well known that hyperthyroidism in patients with turner syndrome leads to 
 acceleration of height velocity ( 6 , 13 ) . in our patient , the height velocity was not 
 increased by hyperthyroidism , probably because her growth had been already accelerated by 
 rhgh therapy before the onset of hyperthyroidism . it is important to monitor changes of thyroid function as well as growth parameters in 
 patients with turner syndrome , as is recommended by sybert and mccauley ( 14 ) .
an increased incidence of hashimoto thyroiditis has been reported in patients with 
 turner syndrome , but several cases of graves disease were also described ten to 20  years 
 ago . 
 we report the case of a patient with turner syndrome who developed graves disease , 
 3  years after successful treatment with recombinant human growth hormone ( gh ) . 
 a diagnosis 
 of graves disease was made and treatment with thiamazole was started , which resulted in 
 normalization of the thyroid function . 
 it is important to monitor thyroid function as well 
 as growth parameters in patients with turner syndrome .