Division of Rheumatology, Allergy and Immunology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, Taiwan.
Immunopharmacol Immunotoxicol. 2010 Dec;32(4):696-9. doi: 10.3109/08923971003677816. Epub 2010 Mar 4.
The pathogenesis of adult-onset Still's disease (AOSD), which is currently thought to be an autoimmune disorder, may share similarities with autoimmune hyperthyroidism. This report describes a middle-aged woman in whom hyperthyroidism and Still's disease developed concurrently. During the course of her illness, the hyperthyroidism was observed to be aggravated whenever her AOSD was in the active stage. After her AOSD activity was controlled, her hyperthyroidism improved clinically. The extent of activation of her hyperthyroidism was observed in parallel to the extent of activation of her AOSD. Furthermore, the patient developed neutropenia after receiving either propylthiouracil (PTU) or methimazole, both of which are standard accepted medications for treatment of hyperthyroidism. Immune mechanisms contributed to PTU induced neutropenia have been proposed, and hyperthyroid patients treated with standard antithyroid agents should be monitored for blood cell counts especially for AOSD patients. Corticosteroid may effect Graves' disease activity, and steroids may play a role in the treatment of hyperthyroidism if a patient had drug allergies to antithyroid agents.
成人Still 病（AOSD）的发病机制目前被认为是一种自身免疫性疾病，可能与自身免疫性甲状腺功能亢进症有相似之处。本报告描述了一位中年女性，她同时患有甲状腺功能亢进症和 Still 病。在她的疾病过程中，每当她的 AOSD 处于活动期时，甲状腺功能亢进症就会加重。当她的 AOSD 活动得到控制后，她的甲状腺功能亢进症在临床上得到了改善。她的甲状腺功能亢进症的激活程度与她的 AOSD 的激活程度平行。此外，该患者在接受丙硫氧嘧啶（PTU）或甲巯咪唑治疗后出现中性粒细胞减少症，这两种药物都是治疗甲状腺功能亢进症的标准药物。已经提出了免疫机制导致 PTU 诱导的中性粒细胞减少症的假说，并且接受标准抗甲状腺药物治疗的甲状腺功能亢进症患者应特别注意血细胞计数，尤其是 AOSD 患者。皮质类固醇可能会影响格雷夫斯病的活动，并且如果患者对抗甲状腺药物过敏，类固醇可能在治疗甲状腺功能亢进症中发挥作用。
