Panfilova E A, Kruk L P, Isaeva M P, Osmanova P O, Bostanova F A, Troshina E A
Endocrinology Research Centre.
Russian Medical Academy of Continuous Professional Education.
Probl Endokrinol (Mosk). 2020 Nov 5;66(5):24-30. doi: 10.14341/probl12420.
The main autoimmune thyroid diseases are Hashimoto's thyroiditis (HT) and Graves' disease (GD). Despite the significant differences in a pathogenesis and a clinical picture between HT and GD, the literature describes the cases of the conversion of one autoimmune disease to another, which, according to one version, is associated with a change in the balance between the levels of a stimulating and blocking antibodies to the thyroid-stimulating hormone receptor. At the same time, there are more frequent observations of the transition of GD to HT, and much less often describe, on the contrary, the development of GD against the background of HT. The article presents a clinical case of the conversion of HT to GD. A detailed algorithm of the conservative management according to the «block-replace» scheme is described, indicating the results of laboratory and instrumental examination. At the time of describing the clinical case, the result of the treatment can be considered successful. The predictors such as a low level of the thyroid-stimulating hormone receptor and thyroid volume before discontinuation of the thyrostatic therapy suggest a low risk of the recrudescence of GD.According to the authors, the phenomenon of the conversion of one autoimmune thyroid disease to another, in addition to the scientific interest, is important for the practitioners, since a timely change in the diagnostic paradigm can significantly change the treatment strategy and the favorably affect the prognosis of disease, preventing the development of complications.
主要的自身免疫性甲状腺疾病是桥本甲状腺炎（HT）和格雷夫斯病（GD）。尽管HT和GD在发病机制和临床表现上存在显著差异，但文献中描述了一种自身免疫性疾病转变为另一种的病例，根据一种说法，这与促甲状腺激素受体刺激抗体和阻断抗体水平之间平衡的改变有关。同时，更常见的是观察到GD转变为HT，相反，在HT背景下发生GD的描述则少得多。本文介绍了一例HT转变为GD的临床病例。描述了根据“阻断-替代”方案进行保守治疗的详细算法，并指出了实验室和仪器检查的结果。在描述该临床病例时，治疗结果可被视为成功。在停用抗甲状腺药物治疗前，促甲状腺激素受体水平低和甲状腺体积等预测因素表明GD复发风险低。作者认为，一种自身免疫性甲状腺疾病转变为另一种的现象，除了具有科学意义外，对从业者也很重要，因为及时改变诊断模式可显著改变治疗策略，并对疾病预后产生有利影响，预防并发症的发生。
