Nishihara Eijun, Fukata Shuji, Kimura Nobuhiko, Hagihara Masahiro, Kudo Takumi, Ohye Hidemi, Ito Mitsuru, Kubota Sumihisa, Amino Nobuyuki, Kuma Kanji, Miyauchi Akira
Kuma Hospital, Kobe, Japan.
Endocr J. 2006 Jun;53(3):357-61. doi: 10.1507/endocrj.k05-117. Epub 2006 May 20.
A case of hypothyroid Graves' disease occurred following external radiation therapy to the cervical region is described. Severe hypothyroidism developed in a 56-year-old man 6 months after external radiation therapy for submandibular cancer. Serological evaluation of thyroid autoimmunity revealed the presence of antithyroid antibodies and thyrotropin-binding inhibitory immunogloblins (TBII). Diplopia, limitation of downward gaze, and palpebral edema developed 2 years after levothyroxine replacement therapy. Ocular magnetic resonance imaging revealed marked hypertrophy of the bilateral extraocular muscles with signal hyperintensity on T2-weighted images. This infiltrative ophthalmopathy showed marked improvement after additional treatment with high-dose methylprednisolone and orbital radiation, in parallel with a decrease in TBII. These results suggest that radiation-associated thyroidal injury might be associated with the etiology of hypothyroid Graves' disease.
本文描述了一例因颈部外照射放疗后发生的甲状腺功能减退型格雷夫斯病。一名56岁男性在接受下颌下癌外照射放疗6个月后出现严重甲状腺功能减退。甲状腺自身免疫的血清学评估显示存在抗甲状腺抗体和促甲状腺素结合抑制性免疫球蛋白（TBII）。左甲状腺素替代治疗2年后出现复视、向下注视受限和眼睑水肿。眼部磁共振成像显示双侧眼外肌明显肥大，T2加权图像上信号强度增高。经大剂量甲泼尼龙和眼眶放疗额外治疗后，这种浸润性眼病明显改善，同时TBII降低。这些结果表明，与放疗相关的甲状腺损伤可能与甲状腺功能减退型格雷夫斯病的病因有关。
