Shen Guohua, Cui Futao, Huang Rui, Kuang Anren
Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.
Medicine (Baltimore). 2017 Nov;96(45):e8550. doi: 10.1097/MD.0000000000008550.
There is a low risk of developing Graves disease (GD) with elevated thyrotropin receptor antibodies (TRAbs) in patients undergoing radioiodine therapy for toxic adenoma.
An old female patient with a history of Hashimoto thyroiditis was referred to our department due to thyrotoxic symptoms. After the administration of radioiodine, a significant remission was achieved. However, after 4 months, she was referred to our department again due to recurrence of hyperthyroid symptoms.
Based on the results of laboratory test, thyroid scan and ultrasound examination, she was diagnosed as thyrotoxicosis induced by toxic adenoma at the first visit. However, 4 months later, she was diagnosed as Graves' disease at the second visit.
She received radioiodine therapy two times with different doses of 15 mCi and 12 mCi.
After the administration of 15 mCi radioiodine, her thyroid hormones and clinical symptoms showed significant improvement. However, 4 months later, she presented thyrotoxicosis again. After the second radioiodine therapy with a lower dose, her clinical symptoms moved towards normalization during regular follow up.
Toxic adenoma and GD are considered as 2 distinct disease entities; however, radioiodine therapy for toxic adenoma may induce GD. We should learn to differentiate these 2 disorders prior to radioiodine therapy because of different treatment strategies and goals.
毒性腺瘤患者接受放射性碘治疗时，促甲状腺素受体抗体（TRAbs）升高，发生格雷夫斯病（GD）的风险较低。
一名有桥本甲状腺炎病史的老年女性患者因甲状腺毒症症状转诊至我科。给予放射性碘治疗后，病情显著缓解。然而，4个月后，她因甲亢症状复发再次转诊至我科。
根据实验室检查、甲状腺扫描和超声检查结果，首次就诊时诊断为毒性腺瘤所致甲状腺毒症。然而，4个月后，第二次就诊时诊断为格雷夫斯病。
她接受了两次不同剂量（15毫居里和12毫居里）的放射性碘治疗。
给予15毫居里放射性碘后，她的甲状腺激素和临床症状有显著改善。然而，4个月后，她再次出现甲状腺毒症。第二次给予较低剂量放射性碘治疗后，在定期随访期间她的临床症状趋于正常。
毒性腺瘤和GD被认为是两种不同的疾病实体；然而，毒性腺瘤的放射性碘治疗可能诱发GD。由于治疗策略和目标不同，在放射性碘治疗前我们应学会区分这两种疾病。
