van Os Erim, Noordam Cees, Hart W Peter, Draaisma Jos M T
Universitair Medisch Centrum St Radboud, afd. Kindergeneeskunde, Nijmegen, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:B87.
A 14-year-old boy presented with fatigue and abdominal pain. Laboratory tests revealed a primary hypothyroidism with circulating auto-antibodies against thyroid peroxidase (TPO), anaemia and an elevated level of creatine kinase (CK). A diagnosis of auto-immune hypothyroidism with associated anaemia and myopathy was made. Thyroid hormone replacement therapy was started. However, six months later, he still complained of fatigue. He had unexpectedly varying thyroid function tests and the anaemia and the elevated level of CK persisted. Analysis of the other hormonal axes demonstrated a secondary adrenal insufficiency which was treated with hydrocortisone suppletion therapy. If a patient suffering from hypothyroidism does not respond appropriately to therapy or even deteriorates, adrenal insufficiency should always be considered. Patients with one type of auto-immune endocrinopathy have a greater risk at developing other types of auto-immune endocrinopathies.
一名14岁男孩出现疲劳和腹痛症状。实验室检查显示原发性甲状腺功能减退，伴有抗甲状腺过氧化物酶（TPO）循环自身抗体、贫血以及肌酸激酶（CK）水平升高。诊断为自身免疫性甲状腺功能减退伴贫血和肌病。开始进行甲状腺激素替代治疗。然而，六个月后，他仍诉说疲劳。他的甲状腺功能检查结果出人意料地波动，贫血和CK水平升高持续存在。对其他激素轴的分析显示继发性肾上腺功能不全，采用氢化可的松补充疗法进行治疗。如果甲状腺功能减退患者对治疗无适当反应甚至病情恶化，应始终考虑肾上腺功能不全。患有一种自身免疫性内分泌病的患者发生其他类型自身免疫性内分泌病的风险更高。
