Vita Roberto, Cernaro Valeria, Benvenga Salvatore
Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University hospital, AOU Policlinico G. Martino, Messina, Italy.
Rev Assoc Med Bras (1992). 2019 Jul 22;65(6):830-833. doi: 10.1590/1806-9282.65.6.830.
Even though stress has been long known as a provocative factor for Graves' disease, its relationship with Hashimoto's thyroiditis is more controversial. Studies on this topic are scanty. This paper aims to report a case of stress-induced Hashitoxicosis.
Here we report a case of Hashitoxicosis induced by a psychological stressful event in a 28-year-old woman with Hashimoto's thyroiditis. She had remained stably euthyroid for 12 years. She was first observed in April 2016, while euthyroid. She came back after 11 months because of fatigue and palpitations, in the absence of neck pain. Thyroid function tests revealed moderate thyrotoxicosis (undetectable TSH; FT4 36.94 pmol/L, normal values 9.0-24.46; FT3 13.50 pmol/L, normal values 3.07-6.14) with negative TSH-receptor antibodies. In the previous three months, she had experienced a psychological stressful event. Inflammatory markers were negative, and the white cell count was normal. Thyroid ultrasound revealed a modest increase in vascularization. Transient subclinical hypothyroidism ensued after seven weeks and spontaneously recovered. On the last visit, the patient was still on euthyroidism. (TSH 1.01 mU/L; FT4 9.22 pmol/L; FT3 3.98 pmol/L). We also performed HLA serotyping and genotyping.
This case demonstrates that, similarly to Graves' disease, Hashitoxicosis can also be triggered by stressful life events.
尽管长期以来人们都知道压力是格雷夫斯病的诱发因素，但其与桥本甲状腺炎的关系更具争议性。关于这一主题的研究很少。本文旨在报告一例压力诱发的桥本甲状腺毒症病例。
我们在此报告一例28岁患有桥本甲状腺炎的女性因心理压力事件诱发桥本甲状腺毒症的病例。她甲状腺功能正常并维持了12年。2016年4月首次就诊时，她甲状腺功能正常。11个月后，她因疲劳和心悸前来复诊，无颈部疼痛。甲状腺功能检查显示中度甲状腺毒症（促甲状腺激素检测不到；游离甲状腺素36.94pmol/L，正常范围9.0 - 24.46；游离三碘甲状腺原氨酸13.50pmol/L，正常范围3.07 - 6.14），促甲状腺激素受体抗体阴性。在之前的三个月里，她经历了一次心理压力事件。炎症指标为阴性，白细胞计数正常。甲状腺超声显示血管化略有增加。七周后出现短暂性亚临床甲状腺功能减退，随后自行恢复。最后一次就诊时，患者甲状腺功能仍正常。（促甲状腺激素1.01mU/L；游离甲状腺素9.22pmol/L；游离三碘甲状腺原氨酸3.98pmol/L）。我们还进行了人类白细胞抗原血清分型和基因分型。
该病例表明，与格雷夫斯病类似，桥本甲状腺毒症也可由生活中的压力事件引发。
