Department of General Pediatrics, Nihon University Nerima-Hikarigaoka Hospital, Nihon University of School Medicine, 2-11-1, Hikarigaoka, Nerima-ku, Tokyo, Japan 179-0072.
Mod Rheumatol. 2013 Mar;23(2):397-400. doi: 10.1007/s10165-012-0670-5. Epub 2012 Jun 6.
We report on a 24-year-old woman with juvenile idiopathic arthritis (JIA) who developed subacute thyroiditis (SAT) while being treated with etanercept. She had suffered from JIA for 12 years, and her arthritis proved refractory to treatment with ibuprofen, prednisolone, and methotrexate. For the past 5 years, the patient had been treated successfully with etanercept at 25 mg/week. The patient more recently complained of high fever and lassitude, and presented with anterior neck swelling and tenderness. Palpation of the thyroid gland revealed it to be warm, erythematous, tender, and diffusely swollen. Laboratory tests revealed an increased erythrocyte sedimentation rate and C-reactive protein level. Thyroid function tests revealed decreased levels of thyrotropin-stimulating hormone, increased levels of free triiodothyronine, free thyroxine, and thyroglobulin, and an absence of thyroid autoantibodies. Sonography showed a diffusely reduced predominantly hypoechoic thyroid gland. Unenhanced computed tomography of the neck showed a homogeneously and mildly reduced thyroid gland. Serum titers of several viruses were not significant and so were considered unlikely to be the pathogens. On the basis of these presented findings, we diagnosed SAT, and etanercept therapy was withdrawn. The patient was treated with antibiotics and an increased prednisolone dose was initiated. She became symptom free and showed improved laboratory test results within 2 weeks, and was euthyroid by 3 months. Three months later, the patient developed hypothyroidism, although 6 months further on, the patient was asymptomatic on prednisolone, methotrexate, and levothyroxine therapy. In conclusion, whether SAT is a specific adverse event in this case in response to etanercept remains unclear. Nevertheless, the possibility of SAT should be considered in such patients on etanercept treatment.
我们报告了一例 24 岁女性，患有幼年特发性关节炎（JIA），在接受依那西普治疗时发生亚急性甲状腺炎（SAT）。她患有 JIA 12 年，其关节炎对布洛芬、泼尼松龙和甲氨蝶呤治疗无效。在过去的 5 年中，患者一直使用依那西普 25mg/周成功治疗。最近，患者主诉高热和乏力，并出现前颈部肿胀和触痛。触诊甲状腺时发现其发热、红斑、触痛，弥漫性肿胀。实验室检查显示红细胞沉降率和 C 反应蛋白水平升高。甲状腺功能检查显示促甲状腺激素刺激激素水平降低，游离三碘甲状腺原氨酸、游离甲状腺素和甲状腺球蛋白水平升高，且甲状腺自身抗体阴性。超声显示弥漫性低回声为主的甲状腺减少。颈部未增强 CT 显示甲状腺均匀且轻度减少。几种病毒的血清滴度不显著，因此不太可能是病原体。基于这些临床表现，我们诊断为 SAT，并停用依那西普治疗。患者接受了抗生素治疗，并开始增加泼尼松龙剂量。她在 2 周内症状消失，实验室检查结果改善，3 个月时甲状腺功能正常。3 个月后，患者出现甲状腺功能减退，但 6 个月后，患者在泼尼松龙、甲氨蝶呤和左甲状腺素治疗下无症状。总之，SAT 是否是该患者对依那西普治疗的特异性不良反应尚不清楚。然而，在接受依那西普治疗的此类患者中，应考虑 SAT 的可能性。
