The coexistence of nodules can occur in up to 35% of patients and in 0.8-2.7% of cases these nodules are functioning adenomas, a combination that has been termed Marine-Lenhart syndrome [2-5].
The coexistence of Graves' disease and functioning nodules is called Marine-Lenhart syndrome, but the criteria for its diagnosis are not well established.
In order to reconcile the above discrepancies in the definition of the Marine-Lenhart syndrome, we propose the following criteria for the diagnosis and classification of patients with Graves' disease and functioning nodules: (1) thyroid function tests consistent with hyperthyroidism inclusive of serological testing for Graves' disease (TRAb/TSI); (2) increased radioiodine uptake and the presence of "cool" or "hot" nodules; thyroid nodularity should be supported by ultrasonography ; (3) thyroid nodule biopsy revealing a hyperplastic lesion or follicular adenoma, although, in the latter case, diagnostic surgery may be required to rule out a follicular carcinoma.
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