Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
Hormones (Athens). 2013 Apr-Jun;12(2):298-304. doi: 10.14310/horm.2002.1414.
Euthyroid Graves' orbitopathy (GO) combined with incidental papillary thyroid microcarcinoma has rarely been reported.
A 61-year-old Caucasian woman initially presented with progressive fatigue, exophthalmos, and thyroid function tests within normal limits. She underwent thyroidectomy, was found to have two incidental papillary thyroid microcarcinomas, and received radioactive iodine ablation to eliminate thyroid antigen. In addition to following her eye disease, TSH-receptor antibodies, thyroid stimulating immunoglobulins, and serum thyroglobulin measurements were recorded, demonstrating no evidence of thyroid cancer at four-year follow-up. At first, she had mild GO, developing into moderate-to-severe GO, and at 4 years she had Hertel measurements of 20 mm in both eyes.
This report underscores the difficulty of managing GO even when thyroid function is normal(ized) and thyroid antigen exposure has been minimized. In addition, it illustrates why antithyroidal antibodies should be considered in cases of concomitant papillary thyroid cancer, as thyroid cells can be stimulated not only by TSH but also by TSH-receptor stimulating antibodies.
甲状腺功能正常的格雷夫斯眼病（GO）合并偶然发现的甲状腺乳头状微小癌很少见。
一名 61 岁的白人女性最初表现为进行性疲劳、眼球突出和甲状腺功能检查在正常范围内。她接受了甲状腺切除术，发现有两个偶然发现的甲状腺乳头状微小癌，并接受了放射性碘消融以消除甲状腺抗原。除了随访眼部疾病外，还记录了 TSH 受体抗体、甲状腺刺激免疫球蛋白和血清甲状腺球蛋白的测量值，在四年的随访中没有发现甲状腺癌的证据。起初，她患有轻度 GO，发展为中重度 GO，4 年后双眼赫特尔测量值均为 20 毫米。
即使甲状腺功能正常（化）并且甲状腺抗原暴露最小化，管理 GO 也具有挑战性。此外，它说明了为什么在同时发生甲状腺乳头状癌的情况下应考虑抗甲状腺抗体，因为甲状腺细胞不仅可以受到 TSH 的刺激，还可以受到 TSH 受体刺激抗体的刺激。
