Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey.
Endocr Pract. 2014 Nov;20(11):e207-10. doi: 10.4158/EP14097.CR.
To present the rare case of a patient who developed destructive thyroiditis accompanied by transient thyrotoxicosis resulting from infliximab therapy for the treatment of psoriasis.
The clinical presentation and management of a case with infliximab-associated thyroiditis is described with a brief review of the literature.
A 57-year-old male who suffered from psoriasis was treated with infliximab therapy for 4 years. Thyroid function tests were normal before infliximab therapy. When the patient presented in our clinic, he had thyrotoxicosis and was using propylthiouracil. A 99m Technetiumpertechnetate thyroid scintigraphy scan showed no visualization of either thyroid lobe or decreased thyroid iodine uptake. Thyroid-stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody (anti-TPO Ab) and thyroglobulin antibody (anti-Tg Ab) were negative. Thyroid ultrasonography revealed a heterogeneous thyroid gland without nodules. After stopping propylthiouracil therapy, we advised monitoring of his thyroid function tests in the following weeks, and infliximab therapy for psoriasis was continued. Four weeks later, his thyroid function tests showed an elevated TSH level with normal levels of free triiodothyronine and thyroxine (FT3 and FT4, respectively), and levothyroxine treatment was administered to the patient. Thyroid function tests normalized after levothyroxine treatment. One year later, infliximab therapy was stopped because of clinical remission. Simultaneously, levothyroxine treatment was also stopped. His thyroid function tests were normal 6 weeks after the cessation of levothyroxine treatment.
To our knowledge, the present report is the third infliximab-associated thyroid disorder case. Periodic follow-up of thyroid function tests is necessary during infliximab therapy.
介绍一例罕见病例，患者因银屑病接受英夫利昔单抗治疗而发生破坏性甲状腺炎伴短暂甲状腺毒症。
描述了一例伴英夫利昔单抗相关性甲状腺炎的病例的临床表现和处理方法，并简要复习了文献。
一名 57 岁男性，患有银屑病，接受英夫利昔单抗治疗 4 年。英夫利昔单抗治疗前甲状腺功能检查正常。当患者就诊于我院时，出现甲状腺毒症，正在使用丙硫氧嘧啶。99m 锝甲状腺扫描未见甲状腺两叶显影或甲状腺碘摄取减少。促甲状腺激素（TSH）受体抗体、甲状腺过氧化物酶抗体（抗-TPO Ab）和甲状腺球蛋白抗体（抗-Tg Ab）均为阴性。甲状腺超声显示甲状腺不均匀，无结节。停用丙硫氧嘧啶后，我们建议在接下来的几周内监测其甲状腺功能检查，同时继续使用英夫利昔单抗治疗银屑病。4 周后，其甲状腺功能检查显示 TSH 水平升高，游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）水平正常，给予左甲状腺素治疗。左甲状腺素治疗后甲状腺功能检查恢复正常。1 年后，因临床缓解停用英夫利昔单抗。同时，也停用了左甲状腺素。停用左甲状腺素 6 周后，其甲状腺功能检查正常。
据我们所知，本报告是第三例与英夫利昔单抗相关的甲状腺疾病病例。在英夫利昔单抗治疗期间，需要定期随访甲状腺功能检查。
