Marine-Lenhart Syndrome: Current Perspectives on Diagnosis and Management

Authors

  • Alexander Kam Universitas Andalas, Padang, West Sumatera, Indonesia/ M. Djamil General Hospital, Padang, West Sumatera, Indonesia
  • Yanne Pradwi Efendi Universitas Andalas, Padang, West Sumatera, Indonesia/ M. Djamil General Hospital, Padang, West Sumatera, Indonesia
  • Dinda Aprilia Universitas Andalas, Padang, West Sumatera, Indonesia/ M. Djamil General Hospital, Padang, West Sumatera, Indonesia
  • Eva Decroli Universitas Andalas, Padang, West Sumatera, Indonesia/ M. Djamil General Hospital, Padang, West Sumatera, Indonesia
  • Syafril Syahbuddin Universitas Andalas, Padang, West Sumatera, Indonesia/ M. Djamil General Hospital, Padang, West Sumatera, Indonesia
  • Suci Berlian Hemilton Universitas Andalas, Padang, West Sumatera, Indonesia

DOI:

https://doi.org/10.56260/sciena.v4i5.264

Keywords:

Marine-Lenhart Syndrome, Diagnosis, Management

Abstract

Marine-Lenhart syndrome (MLS) is an uncommon disorder characterised by the concurrent presence of Graves’ disease and hyperfunctioning thyroid nodules. Its global prevalence ranges between 2.7- 4.1% of Graves’ disease cases, presenting significant challenges in diagnosis and management. MLS is often difficult to detect due to limitations in autoimmune serology tests, thyroid ultrasonography, and access to nuclear medicine facilities. Diagnosis relies on a combination of clinical hyperthyroidism symptoms, the presence of specific thyroid antibodies, and scintigraphy findings that reveal "hot" or "cold" nodules. The primary therapeutic options for MLS include antithyroid drugs, radioactive iodine (RAI) therapy, and surgery. RAI is commonly employed as definitive treatment, often requiring higher doses to address the resistance of hyperfunctioning nodules. Surgery is indicated in cases involving large nodules, compressive symptoms, or suspected malignancies. Treatment strategies should be tailored to the individual clinical characteristics of each patient to minimize complications and ensure optimal outcomes. Advancing the diagnosis and management of MLS requires enhanced access to advanced diagnostic technologies and improved healthcare provider proficiency in identifying and treating the syndrome. A multidisciplinary and integrated approach is essential for achieving favorable clinical outcomes for MLS patients.

Author Biographies

Alexander Kam, Universitas Andalas, Padang, West Sumatera, Indonesia/ M. Djamil General Hospital, Padang, West Sumatera, Indonesia

Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, Medical Faculty

Yanne Pradwi Efendi, Universitas Andalas, Padang, West Sumatera, Indonesia/ M. Djamil General Hospital, Padang, West Sumatera, Indonesia

Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, Medical Faculty

Dinda Aprilia, Universitas Andalas, Padang, West Sumatera, Indonesia/ M. Djamil General Hospital, Padang, West Sumatera, Indonesia

Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, Medical Faculty

Eva Decroli, Universitas Andalas, Padang, West Sumatera, Indonesia/ M. Djamil General Hospital, Padang, West Sumatera, Indonesia

Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, Medical Faculty

Syafril Syahbuddin, Universitas Andalas, Padang, West Sumatera, Indonesia/ M. Djamil General Hospital, Padang, West Sumatera, Indonesia

Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, Medical Faculty

Suci Berlian Hemilton, Universitas Andalas, Padang, West Sumatera, Indonesia

General Practitioner, Medical Faculty

References

. Essien F, Cheatham C, Elkins B, Tate J. Manifestation of Marine-Lenhart Syndrome after failed radioactive iodine therapy. Clin Case Rep. 2021 Jun 1;9(6).

. Neuman D, Kuker R, Vendrame F. Marine-Lenhart Syndrome: Case Report, Diagnosis, and Management. Case Rep Endocrinol. 2018 Oct 24;2018:1–4.

. Danno H, Nishihara E, Kousaka K, Nakamura T, Kasahara T, Kudo T, et al. Prevalence and Treatment Outcomes of Marine-Lenhart Syndrome in Japan. Eur Thyroid J. 2021 Nov 1;10(6):461–7.

. Pokhrel B, Bhusal K. Graves Disease. In: NCBI Bookshelf A service of the National Library of Medicine, National Institutes of Health [Internet]. StatPearls Publishing; 2023.

. Ribeiro FCM, Ruas LA, J. AL, Sousa AA de, Araújo AF, Mwambire J, et al. Graves’ Disease and Marine Lenhart Syndrome: A Rare Clinical Presentation. Health N Hav. 2019;11(09):1169–76.

. Ribeiro FCM, Ruas LA, J. AL, Sousa AA de, Araújo AF, Mwambire J, et al. Graves’ Disease and Marine Lenhart Syndrome: A Rare Clinical Presentation. Health N Hav. 2019;11(09):1169–76.

. Kotwal A, Stan M. Thyrotropin Receptor Antibodies—An Overview. Vol. 34, Ophthalmic Plastic and Reconstructive Surgery. Lippincott Williams and Wilkins; 2018. p. S20–7.

. Zamora EA, Khare S, Cassaro S. Thyroid Nodule Continuing Education Activity. In: NCBI Bookshelf A service of the National Library of Medicine, National Institutes of Health [Internet]. StatPearls Publishing; 2023.

. Campennì A, Avram AM, Verburg FA, Iakovou I, Hänscheid H, de Keizer B, et al. The EANM guideline on radioiodine therapy of benign thyroid disease. Eur J Nucl Med Mol Imaging. 2023 Sep 1;50(11):3324–48.

. Durante C, Hegedüs L, Czarniecka A, Paschke R, Russ G, Schmitt F, et al. 2023 European Thyroid Association Clinical Practice Guidelines for thyroid nodule management. Eur Thyroid J. 2023;12(5).

. Essien F. Does Marine Lenhart Syndrome Really Exist? Corresponding Author*. Vol. 06, Medical Reports and Case Studies. 2021.

. Atmaca H, Çolak R, Yazici ZA, Kefeli M, Tosun FC. Marine-Lenhart syndrome with papillary thyroid carcinoma. Journal of Research in Medical Sciences. 2015.

. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016 Oct 1;26(10):1343–421.

. Builes Barrera CA, Castaño PA, Herrera Revollo P, Pérez Paternina ME, Rodriguez Arrieta LA. Type 2 Marine-Lenhart Syndrome: An Uncommon Cause of Thyrotoxicosis. Cureus. 2021 Dec 21;

. Agrawal K, Patro P, Meher B, Gnanasegaran G. Prevalence of Marine-Lenhart syndrome on 99mTc-thyroid scintigraphy and response to radioiodine: A single institutional retrospective study. World J Nucl Med. 2021 Oct;20(04):369–73.

. Mohan JR, Santhosh S, Sood A, Bhattacharya A, Mittall BR. Pertechnetate thyroid scan in Marine-Lenhart syndrome. Vol. 28, Indian Journal of Nuclear Medicine. 2013.

. Loscalzo J, Fauci A, Kasper D, Hauser S, Jameson J, Longo D. Harrison’s Principles of Internal Medicine. 21st ed. Vol. 2. 2022.

. Papini E, Monpeyssen H, Frasoldati A, Hegedüs L. 2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules. Eur Thyroid J. 2020 Jul 1;9(4):172–85.

. Quah NQX, Sobti MM, Wren AM, Scawn R, Kalogianni E, Cleland J, et al. Radioactive iodine treatment for Graves’ hyperthyroidism: incidence of Graves orbitopathy. Nucl Med Commun. 2024 Feb 1;45(2):103–7.

. Kotramada BB, Mehta AM, Malapure SS, Madhyastha SP, Pai K. Marine-Lenhart syndrome with a cold nodule: an uncommon entity. BMJ Case Rep. 2022 Jul 22;15(7).

. Takei M, Ishii H, Sato Y, Komatsu M. A Case of Marine-Lenhart Syndrome with a Negative TSH Receptor Antibody Titer Successfully Treated with a Fixed, Low Dose of I 131 . Case Rep Endocrinol. 2014;2014:1–4.

. Sharma A. Marine-Lenhart syndrome in two adolescents, including one with thyroid cancer: A case series and review of the literature. Vol. 30, Journal of Pediatric Endocrinology and Metabolism. Walter de Gruyter GmbH; 2017. p. 1337–43.

Downloads

Published

2025-08-29

How to Cite

Kam, A., Pradwi Efendi, Y., Aprilia, D., Decroli, E., Syahbuddin, S., & Berlian Hemilton, S. (2025). Marine-Lenhart Syndrome: Current Perspectives on Diagnosis and Management. Scientific Journal, 4(5), 336–343. https://doi.org/10.56260/sciena.v4i5.264

Issue

Section

Systematic Literature Review

Most read articles by the same author(s)