Kaplowitz Paul B
Division of Endocrinology, Children's National Medical Center, 111 Michigan Ave NW, Washington, 20010, DC, USA.
Int J Pediatr Endocrinol. 2012 May 2;2012(1):9. doi: 10.1186/1687-9856-2012-9.
While it is recognized that patients sometimes recover from autoimmune hypothyroidism, little is known about how rapidly this may occur.
Two 13 year old girls had severe primary hypothyroidism (total T4 14.2 nmol/L with TSH 468 miU/L and total T4 7.7 nmol/L with TSH 183 miU/L) accompanied by goiter and positive thyroid peroxidase antibodies. There were delays in starting thyroid hormone replacement, and complete reversal of hypothyroidism was documented within 2 months in both cases. One of the girls had recurrence of severe hypothyroidism after being euthyroid for 18 months.
There are few published studies which have looked systematically at reversibility of acquired hypothyroidism, but one Japanese study found that recovery from autoimmune hypothyroidism may occur within weeks. Other causes of primary hypothyroidism (TSH-blocking antibodies, iodine excess, medications) seem less likely, so this probably represents rapid spontaneous reversal of autoimmune hypothyroidism.
Patients with severe autoimmune hypothyroidism may have spontaneous normalization of thyroid tests within weeks to months after diagnosis. This suggests that reevaluating the need for thyroid hormone replacement in selected patients with persistently normal TSH during therapy should be considered.
虽然人们认识到患者有时会从自身免疫性甲状腺功能减退症中康复，但对于这种康复可能多快发生却知之甚少。
两名13岁女孩患有严重原发性甲状腺功能减退症（总T4分别为14.2nmol/L，促甲状腺激素为468mIU/L；总T4为7.7nmol/L，促甲状腺激素为183mIU/L），伴有甲状腺肿大和甲状腺过氧化物酶抗体阳性。甲状腺激素替代治疗开始延迟，但两例均在2个月内记录到甲状腺功能减退症完全逆转。其中一名女孩在甲状腺功能正常18个月后出现严重甲状腺功能减退症复发。
很少有已发表的研究系统地观察获得性甲状腺功能减退症的可逆性，但一项日本研究发现，自身免疫性甲状腺功能减退症可能在数周内康复。原发性甲状腺功能减退症的其他原因（促甲状腺激素阻断抗体、碘过量、药物）似乎可能性较小，因此这可能代表自身免疫性甲状腺功能减退症的快速自发逆转。
严重自身免疫性甲状腺功能减退症患者在诊断后数周至数月内甲状腺检查可能会自发恢复正常。这表明在治疗期间，对于促甲状腺激素持续正常的部分患者，应考虑重新评估甲状腺激素替代治疗的必要性。
