Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, Italy.
University of Milan, Milan, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Autoimmun Rev. 2023 Feb;22(2):103238. doi: 10.1016/j.autrev.2022.103238. Epub 2022 Nov 24.
Since 1997, when the first case of autoimmune hyperthyroidism induced by Interferon (IFN)-β1b therapy was described, we know about the risk of thyroid dysfunction related to this treatment, particularly in patients with preexisting thyroid autoimmune disorders (AITD). A 60-year-old female, with a 15-year history of euthyroid autoimmune thyroiditis and a 3-year history of Multiple Sclerosis (MS), was admitted to our department for the evaluation of hyperthyroidism. Twenty months before, she had started specific immunomodulant IFN-β1a therapy (30 μg/week). At the first visit, the patient complained tachycardia, weight loss, blurry vision with swollen eyes and excessive lacrimation; thyroid tests showed hyperthyroidism with positive TSH-receptor-autoantibodies. Further evaluation with orbit Magnetic Resonance Imaging (MRI) revealed bilaterally mild enlargement of the extraocular muscles, supporting the suspect of Graves' ophthalmopathy (GO). To our knowledge, this is the first report of Graves' disease (GD) and ophthalmopathy associated with IFN-β1a treatment in a patient with MS. Furthermore, this case could open new interesting knowledge behind GD immunopathogenesis.
自 1997 年首次描述干扰素（IFN）-β1b 治疗引起的自身免疫性甲状腺功能亢进症以来，我们已经了解到这种治疗与甲状腺功能障碍相关的风险，尤其是在存在甲状腺自身免疫性疾病（AITD）的患者中。一名 60 岁女性，患有 15 年的甲状腺功能正常的自身免疫性甲状腺炎和 3 年的多发性硬化症（MS）病史，因甲状腺功能亢进症就诊于我科。20 个月前，她开始接受特定的免疫调节剂 IFN-β1a 治疗（每周 30 μg）。首次就诊时，患者诉心动过速、体重减轻、眼睛肿胀和流泪过多导致视力模糊；甲状腺检查显示甲状腺功能亢进，促甲状腺激素受体自身抗体阳性。进一步的眼眶磁共振成像（MRI）评估显示双侧眼外肌轻度肿大，支持格雷夫斯眼病（GO）的怀疑。据我们所知，这是首例在 MS 患者中与 IFN-β1a 治疗相关的 GD 和眼病的报告。此外，该病例可能为 GD 免疫发病机制提供了新的有趣的知识。
