Martins Luísa Correia, Coutinho Ana Rita, Jerónimo Mónica, Caetano Joana Serra, Cardoso Rita, Dinis Isabel, Mirante Alice
Department of Pediatric Endocrinology, Diabetes and Growth, Pediatric Unit, Coimbra Hospital and Universitary Center , Coimbra, 3030 , Portugal.
Endocrinol Diabetes Metab Case Rep. 2016;2016:150131. doi: 10.1530/EDM-15-0131. Epub 2016 Feb 9.
Alternating between hyper- and hypo-thyroidism may be explained by the simultaneous presence of both types of TSH receptor autoantibodies (TRAbs) - thyroid stimulating autoantibodies (TSAbs) and TSH blocking autoantibodies (TBAbs). It is a very rare condition, particulary in the pediatric age. The clinical state of these patients is determined by the balance between TSAbs and TBAbs and can change over time. Many mechanisms may be involved in fluctuating thyroid function: hormonal supplementation, antithyroid drugs and levels of TSAbs and TBAbs. Frequent dose adjustments are needed in order to achieve euthyroidism. A definitive therapy may be necessary to avoid switches in thyroid function and frequent need of therapeutic changes. We describe an immune-mediated case of oscillating thyroid function in a 13-year-old adolescent. After a short period of levothyroxine treatment, the patient switched to a hyperthyroid state that was only controlled by adding an antithyroid drug.
Autoimmune alternating hypo- and hyper-thyroidism is a highly uncommon condition in the pediatric age.It may be due to the simultaneous presence of both TSAbs and TBAbs, whose activity may be estimated in vitro through bioassays.The clinical state of these patients is determined by the balance between TSAbs and TBAbs and can change over time.The management of this condition is challenging, and three therapeutic options could be considered: I-131 ablation, thyroidectomy or pharmacological treatment (single or double therapy).Therapeutic decisions should be taken according to clinical manifestations and thyroid function tests, independent of the bioassays results.A definitive treatment might be considered due to the frequent switches in thyroid function and the need for close monitoring of pharmacological treatment. A definitive treatment might be considered due to the frequent switches in thyroid function and the need for close monitoring of pharmacological treatment.
甲状腺功能亢进和减退交替出现可能是由于同时存在两种类型的促甲状腺激素受体自身抗体（TRAbs）——甲状腺刺激自身抗体（TSAbs）和促甲状腺激素阻断自身抗体（TBAbs）。这是一种非常罕见的情况，尤其是在儿童时期。这些患者的临床状态取决于TSAbs和TBAbs之间的平衡，并且可能随时间变化。甲状腺功能波动可能涉及多种机制：激素补充、抗甲状腺药物以及TSAbs和TBAbs的水平。为了实现甲状腺功能正常，需要频繁调整剂量。可能需要进行确定性治疗以避免甲状腺功能的波动以及频繁进行治疗调整的需求。我们描述了一名13岁青少年免疫介导的甲状腺功能振荡病例。在短期左甲状腺素治疗后，患者转变为甲状腺功能亢进状态，仅通过添加抗甲状腺药物才得以控制。
自身免疫性甲状腺功能减退和亢进交替在儿童时期是一种非常罕见的情况。这可能是由于TSAbs和TBAbs同时存在，其活性可通过体外生物测定来估计。这些患者的临床状态取决于TSAbs和TBAbs之间的平衡，并且可能随时间变化。这种情况的管理具有挑战性，可以考虑三种治疗选择：I - 131消融、甲状腺切除术或药物治疗（单一或联合治疗）。治疗决策应根据临床表现和甲状腺功能检查做出，而不依赖于生物测定结果。由于甲状腺功能频繁波动以及需要密切监测药物治疗，可能需要考虑进行确定性治疗。由于甲状腺功能频繁波动以及需要密切监测药物治疗，可能需要考虑进行确定性治疗。
