Jaring Cristina Vianzon, Rivera-Arkoncel Maria Luisa Cecilia, Lantion-Ang Frances Lina
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines, Philippine General Hospital, Manila, Philippines.
BMJ Case Rep. 2012 Jan 10;2012:bcr0920114766. doi: 10.1136/bcr.09.2011.4766.
A 47-year-old Filipino woman presented with goitre of 3 months' duration. She had no symptoms of thyrotoxicosis or hypothyroidism. Her thyroid was diffusely enlarged. Thyrotropin was elevated and free thyroxine was low. Ultrasound revealed slightly enlarged thyroid with diffuse parenchymal disease. Antithyroid peroxidase antibody was elevated. She was started on levothyroxine at 1.6 mcg/kg body weight/day and dose was adjusted to maintain the thyrotropin level within normal limits. Four years after the diagnosis of Hashimoto's thyroiditis was made, the patient started to experience malaise, generalised weakness and fatigue. Functional screening for other autoimmune endocrinopathy was done. Fasting 8 a.m serum cortisol was noted to be markedly decreased. She was diagnosed with autoimmune polyglandular syndrome type 2 (Schmidt syndrome). Physiologic dose of prednisone was started which afforded significant improvement in the patient's symptoms. The patient is on regular follow-up and clinically well.
一名47岁的菲律宾女性因持续3个月的甲状腺肿前来就诊。她没有甲状腺毒症或甲状腺功能减退的症状。她的甲状腺弥漫性肿大。促甲状腺激素升高，游离甲状腺素降低。超声显示甲状腺轻度肿大，伴有弥漫性实质病变。抗甲状腺过氧化物酶抗体升高。她开始接受左甲状腺素治疗，剂量为1.6微克/千克体重/天，并根据需要调整剂量以维持促甲状腺激素水平在正常范围内。在诊断为桥本甲状腺炎四年后，患者开始出现不适、全身无力和疲劳。对其他自身免疫性内分泌病进行了功能筛查。上午8点空腹血清皮质醇显著降低。她被诊断为2型自身免疫性多腺体综合征（施密特综合征）。开始使用生理剂量的泼尼松，患者症状有明显改善。患者定期随访，目前临床状况良好。
