Antonelli Alessandro, Fallahi Poupak, Tolari Simone, Ferrari Silvia Martina, Ferrannini Ele
Department of Internal Medicine, University of Pisa, School of Medicine, Pisa, Italy.
Am J Med Sci. 2008 Sep;336(3):288-90. doi: 10.1097/MAJ.0b013e31815b21ab.
In a 58-year-old woman with nontoxic nodular goiter, a fine-needle aspiration biopsy showed the presence of papillary thyroid cancer, which was treated with total thyroidectomy in June 2000 and a subsequent ablative dose of 131-radioiodine. A posttherapy whole body scan showed the presence of residual tissue in the neck. On physical examination, she did not exhibit any signs or symptoms of thyroid-associated ophthalmopathy. A subsequent whole body scan and serum thyroglobulin determination were negative. In July 2004, she developed left retrobulbar pain, discomfort, palpebral retraction, and exophthalmos associated with the appearance of antithyrotropin receptor autoantibodies. Symptoms progressively worsened, paralleling the incremental increase in autoantibodies, and then spontaneously remitted as autoantibodies disappeared. The parallel trend of antithyrotropin receptor autoantibodies titres and thyroid-associated ophthalmopathy suggests a role of these autoantibodies in the pathogenesis of thyroid-associated ophthalmopathy.
一名58岁患有无毒性结节性甲状腺肿的女性，细针穿刺活检显示存在甲状腺乳头状癌，于2000年6月接受了甲状腺全切除术，并随后给予了消融剂量的131碘放射性治疗。治疗后全身扫描显示颈部存在残留组织。体格检查时，她未表现出任何甲状腺相关眼病的体征或症状。随后的全身扫描和血清甲状腺球蛋白测定均为阴性。2004年7月，她出现左眼球后疼痛、不适、睑裂回缩和突眼，同时出现抗促甲状腺素受体自身抗体。症状逐渐加重，与自身抗体的逐渐增加平行，然后随着自身抗体消失而自发缓解。抗促甲状腺素受体自身抗体滴度与甲状腺相关眼病的平行趋势表明这些自身抗体在甲状腺相关眼病的发病机制中起作用。
