Pearson S, Donnellan C, Turner L, Noble E, Seejore K, Murray R D
Departments of Endocrinology.
Departments of Gastroenterology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospitals NHS Trust, LeedsUK.
Endocrinol Diabetes Metab Case Rep. 2017 Jun 7;2017. doi: 10.1530/EDM-17-0030. eCollection 2017.
We present the case of a thirty-year-old female patient who was referred to the endocrinology team with an enlarging goitre and biochemical hypothyroidism. She had been dependent on total parenteral nutrition for the previous six years as a result of intestinal failure thought to be caused by possible underlying mitochondrial disease. The patient also suffers from a Desmin myopathy, and at present, the exact aetiology behind her intestinal failure is not certain. The goitre was smooth and had been enlarging slowly over the previous few months. Thyroid peroxidase antibodies were found to be within normal range. Further analysis of the case showed that twelve months earlier the patients total parenteral nutrition (TPN) feed had been altered as a result of manganese toxicity. The current feeding regimen did not contain a trace element additive which had previously supplied iodine supplementation. A little detective work established that iodine content to the TPN had been reduced, the trace element additive (Additrace) was recommenced providing 1 µmol of iodine per day, equating to 130 µg of iodine. Following this change, thyroid-stimulating hormone levels returned to normal and the goitre quickly reduced in size. We present a rare case of endemic goitre and hypothyroidism in a patient receiving inadequate iodine supplementation through total parenteral nutrition.
Endemic goitre and hypothyroidism secondary to iodine deficiency are rare in the developed world. However, the diagnosis should be considered in the setting of a diffuse goitre and negative thyroid antibodies.Although rare, endemic goitre should be considered in patients who present with hypothyroidism and who are dependent on total parenteral nutrition.Treatment with levothyroxine is not required in endemic goitre as thyroid function tests generally normalise with the addition of iodine to the diet/total parenteral nutrition regimen.Iodine supplementation at a level recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) was observed to quickly normalise this patient's thyroid function tests.
我们报告一例30岁女性患者，因甲状腺肿大和生化性甲状腺功能减退被转诊至内分泌科团队。由于肠道衰竭，她在过去六年一直依赖全胃肠外营养，肠道衰竭被认为可能是由潜在的线粒体疾病引起的。该患者还患有结蛋白肌病，目前其肠道衰竭的确切病因尚不确定。甲状腺肿大质地光滑，在过去几个月中缓慢增大。甲状腺过氧化物酶抗体在正常范围内。对该病例的进一步分析显示，12个月前患者的全胃肠外营养（TPN）配方因锰中毒而改变。目前的喂养方案中没有先前提供碘补充的微量元素添加剂。经过一番调查发现，TPN中的碘含量降低了，重新开始使用微量元素添加剂（Additrace），每天提供1微摩尔碘，相当于130微克碘。经过这一改变后，促甲状腺激素水平恢复正常，甲状腺肿大迅速缩小。我们报告了一例罕见的地方性甲状腺肿和甲状腺功能减退病例，该患者通过全胃肠外营养摄入碘不足。
碘缺乏继发的地方性甲状腺肿和甲状腺功能减退在发达国家很少见。然而，在弥漫性甲状腺肿且甲状腺抗体阴性的情况下应考虑该诊断。虽然罕见，但对于出现甲状腺功能减退且依赖全胃肠外营养的患者应考虑地方性甲状腺肿。地方性甲状腺肿一般不需要用左甲状腺素治疗，因为在饮食/全胃肠外营养方案中添加碘后甲状腺功能检查通常会恢复正常。观察到按照欧洲临床营养与代谢学会（ESPEN）推荐的水平补充碘能使该患者的甲状腺功能检查迅速恢复正常。
