Boubaker Karima, Ounissi Mondher, Khiari Karima, Harzallah Amel, Abbes Monia, El Younsi Fethi, Ben Abdellah Taieb, Ben Maïz Hedi, Kaaroud Hayet, Kheder Adel
Service de médecine A, hôpital Charles-Nicolle, boulevard 9-Avril, Bab Souika, 1006 Tunis, Tunisie.
Nephrol Ther. 2010 Jul;6(4):251-4. doi: 10.1016/j.nephro.2010.03.009. Epub 2010 May 20.
Abnormal thyroid hormone production and metabolism are relatively common in chronic renal failure and in regular haemodialysis. Graves' disease is a very unusual condition and is difficult to identify. We report a case of Graves' disease in a patient on regular hemodialysis.
A 26-year-old man undergoing regular hemodialysis from unknown chronic nephropathy since four years. The patient suffered from unexplained slimming and aggressiveness. On admission, he had an irritability, tremor of the extremities, arterial hypertension not controlled by the medical treatment, discrete asynergy oculo-palpebral, glare of the glance and protrusion of the ocular spheres. The thyroid was non palpable. Biological tests demonstrated hyperthyroidism. Thyroid-stimulating hormone receptor antibodies were positive. Thyroid echography and scintiscanning showed vascular and hyperfonctionnel character of the thyroid. The patient was treated radically by radioactive iodine 131 therapy after medical preparation by antithyroid agent. He developed hypothyroidism treated by substitutive treatment.
The diagnosis of Graves' disease must be evoked even in the absence of specific symptoms in haemodialysis patients. In front of clinical symptoms, since the conventional treatment is effective and inoffensive.
甲状腺激素产生和代谢异常在慢性肾衰竭及常规血液透析患者中较为常见。格雷夫斯病是一种非常罕见的病症，难以识别。我们报告一例接受常规血液透析患者的格雷夫斯病病例。
一名26岁男性，因不明原因慢性肾病接受常规血液透析已四年。该患者出现不明原因的体重减轻和易怒。入院时，他有烦躁、肢体震颤、药物治疗无法控制的动脉高血压、轻微的眼球睑协同失调、目光炯炯及眼球突出。甲状腺触诊未及。生物学检查显示甲状腺功能亢进。促甲状腺激素受体抗体呈阳性。甲状腺超声检查和闪烁扫描显示甲状腺具有血管丰富和功能亢进的特征。在使用抗甲状腺药物进行药物准备后，患者接受了放射性碘131根治性治疗。他出现了甲状腺功能减退，接受替代治疗。
即使在血液透析患者没有特定症状时，也必须考虑格雷夫斯病的诊断。面对临床症状时，由于常规治疗有效且无害。
