Fukahori Kyoko, Sawano Kentaro, Yoshida Hiroshi, Nagasaki Keisuke
Department of Pediatrics, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata, Japan.
Division of Pediatrics, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
BMJ Case Rep. 2022 Apr 22;15(4):e249571. doi: 10.1136/bcr-2022-249571.
A male junior high school student presented with failure to gain weight and acceleration of growth for 2 years. Free triiodothyronine and free thyroxine levels were elevated, and the thyroid-stimulating hormone (TSH) level was suppressed. TSH receptor antibody (TRAb) and thyroid-stimulating antibody were negative. On I-123 thyroid scintigraphy, iodine uptake was most pronounced in the upper pole of the right lobe. The patient was initially diagnosed with asymmetrical TRAb-negative Graves' disease (GD). His thyroid hormone level normalised with potassium iodide (KI) alone, and he became TRAb-positive 4 months after the initiation of KI therapy. This case demonstrates a rare presentation of GD that was initially TRAb-negative, which had asymmetrical iodine uptake on a thyroid scan and was confirmed to be TRAb positivity during the follow-up. KI monotherapy could be one of the effective treatment options for GD that is initially TRAb-negative.
一名男性初中生出现体重不增和生长加速2年。游离三碘甲状腺原氨酸和游离甲状腺素水平升高，促甲状腺激素（TSH）水平降低。促甲状腺激素受体抗体（TRAb）和促甲状腺抗体均为阴性。在I-123甲状腺闪烁扫描中，碘摄取在右叶上极最为明显。该患者最初被诊断为不对称性TRAb阴性的格雷夫斯病（GD）。仅使用碘化钾（KI）后其甲状腺激素水平恢复正常，且在KI治疗开始4个月后他的TRAb转为阳性。该病例展示了GD一种罕见的表现形式，最初TRAb为阴性，甲状腺扫描显示碘摄取不对称，且在随访期间证实TRAb转为阳性。KI单一疗法可能是最初TRAb阴性的GD的有效治疗选择之一。
