Endocrinology, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA.
Endocrinology, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
BMJ Case Rep. 2020 Nov 3;13(11):e236465. doi: 10.1136/bcr-2020-236465.
We report a case of a 21-year-old young woman who was initially diagnosed with hyperthyroidism secondary to Graves' disease and spontaneously switched to hypothyroidism in a year. While most autoimmune hypothyroidism is due to Hashimoto's disease, in her case, we suspect that her hypothyroidism is due to a switch of antibody dominance from thyroid stimulating hormone (TSH) receptor-stimulating antibody (TS Ab) to TSH receptor-blocking antibody (TB Ab). Switching from dominant TS Ab activity to dominant TB Ab activity is a rare phenomenon. Optimal management of this condition is not known. Loss of follow-up and medication non-adherence has made medical management in this young woman of reproductive age further challenging.
我们报告了一例 21 岁年轻女性的病例，她最初被诊断为格雷夫斯病引起的甲状腺功能亢进症，并在一年内自发转变为甲状腺功能减退症。虽然大多数自身免疫性甲状腺功能减退症是由于桥本氏病引起的，但在她的情况下，我们怀疑她的甲状腺功能减退症是由于甲状腺刺激激素（TSH）受体刺激抗体（TSAb）到 TSH 受体阻断抗体（TBAb）的抗体优势转换引起的。从主要的 TSAb 活性转变为主要的 TBAb 活性是一种罕见现象。这种情况下的最佳治疗方法尚不清楚。由于失去随访和药物依从性，这位年轻的育龄女性的医学管理更加具有挑战性。
