Treatment of Fibrous Dysplasia of Bone with Non-Autoimmune Hyperthyroidism in FD/MAS

In patients with fibrous dysplasia of bone, thyroid involvement is a recognised feature of FD/MAS (fibrous dysplasia/McCune–Albright syndrome). A subset of these patients develops non-autoimmune hyperthyroidism arising from FD/MAS-related thyroid disease, requiring a specific management approach that takes both the skeletal condition and thyroid status into account.

Thyroid lesions consistent with FD/MAS — with or without non-autoimmune hyperthyroidism — define this sub-population. The presence of active hyperthyroidism, its duration, and the characteristics of any thyroid nodules all shape the clinical decision. Careful evaluation of the thyroid is central to determining the right therapeutic pathway.

The protocol distinguishes between short-term and long-standing hyperthyroidism. For disease duration exceeding five years, a definitive intervention — either surgical or ablative — is indicated, with mandatory pre-treatment nodule evaluation when radio-ablation is considered. The full protocol details the evaluation sequence, criteria for each option, and the complete management algorithm.