Gastroenterology and Metabolism, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan.
Gastroenterological Surgery, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan.
BMJ Case Rep. 2022 Sep 15;15(9):e251857. doi: 10.1136/bcr-2022-251857.
A man in his 70s developed thyrotoxicosis due to painless thyroiditis after starting nivolumab, which was subsequently followed by severe hypothyroidism. We diagnosed him as chronic thyroiditis, initiated levothyroxine supplementation and treated appropriately. Retrospective CT images of the thyroid gland during the clinical course revealed that the CT attenuation value was high at first but gradually decreased. The high-density signal of the normal thyroid tissues reflects its function of concentrating inorganic iodine, and the progressive decrease of the CT density in the present case can be viewed as a reflection of the thyroid destruction and progressive loss of iodine during the clinical course of the development of chronic thyroiditis. Considering the high incidence rate of functional thyroid disease in patients treated with immune checkpoint inhibitors, CT density of the thyroid gland needs to be paid attention to as the first sign of thyroiditis in this patient population.
一位 70 多岁的男性在开始使用纳武利尤单抗后因无痛性甲状腺炎引发甲状腺毒症，随后出现严重的甲状腺功能减退症。我们诊断为慢性甲状腺炎，开始给予左甲状腺素补充，并进行了适当治疗。回顾性分析甲状腺 CT 图像显示，在疾病进展过程中，甲状腺 CT 衰减值起初较高，但逐渐下降。正常甲状腺组织的高密度信号反映了其浓缩无机碘的功能，而在本病例中 CT 密度的逐渐下降可以看作是慢性甲状腺炎发展过程中甲状腺破坏和碘逐渐丢失的反映。鉴于免疫检查点抑制剂治疗患者中功能性甲状腺疾病的发生率较高，对于此类患者人群，甲状腺 CT 密度需要作为甲状腺炎的首发征象加以关注。
