年轻女性自身免疫性甲状腺疾病患者甲状腺功能的快速变化。
Rapid Changes of Thyroid Function in a Young Woman with Autoimmune Thyroid Disease.
机构信息
Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,
Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
出版信息
Med Princ Pract. 2019;28(4):397-400. doi: 10.1159/000499754. Epub 2019 Mar 22.
Abstract
OBJECTIVE
A conversion from Hashimoto's thyroiditis to Graves' disease and vice versa leads to diagnostic and therapeutic challenges.
CLINICAL PRESENTATION AND INTERVENTION
A 30-year-old female presented with overt hyperthyroidism and negative thyroid-stimulating hormone receptor antibodies (TRAbs). Since hashitoxicosis was assumed, the patient was treated with propranolol. Within the next few weeks, the patient developed severe overt hypothyroidism, which was treated with levothyroxine. However, after several more weeks, she presented with overt hyperthyroidism once again, this time showing elevated TRAbs.
CONCLUSION
We suggest educating patients and physicians to recognize changes in thyroid function and close monitoring of unclear cases of overt hyperthyroidism.
摘要
目的
桥本甲状腺炎向格雷夫斯病的转化和反之亦然会导致诊断和治疗上的挑战。
临床表现和干预
一名 30 岁女性出现明显的甲状腺功能亢进和促甲状腺激素受体抗体（TRAbs）阴性。由于假设存在桥本甲状腺毒症，因此给予患者普萘洛尔治疗。在接下来的几周内，患者出现严重的明显甲状腺功能减退，给予左甲状腺素治疗。然而，几周后，她再次出现明显的甲状腺功能亢进，此时 TRAbs 升高。
结论
我们建议教育患者和医生识别甲状腺功能的变化，并密切监测不明确的明显甲状腺功能亢进病例。
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本文引用的文献
1
Diagnostic Values of Free Triiodothyronine and Free Thyroxine and the Ratio of Free Triiodothyronine to Free Thyroxine in Thyrotoxicosis.游离三碘甲状腺原氨酸、游离甲状腺素及游离三碘甲状腺原氨酸与游离甲状腺素比值在甲状腺毒症中的诊断价值
Int J Endocrinol. 2018 Jun 4;2018:4836736. doi: 10.1155/2018/4836736. eCollection 2018.
2
2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis.2016年美国甲状腺协会甲状腺功能亢进症及其他甲状腺毒症病因的诊断和管理指南。
Thyroid. 2016 Oct;26(10):1343-1421. doi: 10.1089/thy.2016.0229.
3
Metamorphic thyroid autoimmunity in Down Syndrome: from Hashimoto's thyroiditis to Graves' disease and beyond.唐氏综合征中的甲状腺自身免疫性病变：从桥本甲状腺炎到格雷夫斯病及其他。
Ital J Pediatr. 2015 Nov 11;41:87. doi: 10.1186/s13052-015-0197-4.
4
Autoimmune thyroid disease: mechanism, genetics and current knowledge.自身免疫性甲状腺疾病：机制、遗传学及当前认知
Eur Rev Med Pharmacol Sci. 2014;18(23):3611-8.
5
Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement.甲状腺功能减退症治疗指南：由美国甲状腺协会甲状腺激素替代特别工作组制定。
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6
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