自身免疫性甲状腺炎由桥本甲状腺炎向格雷夫斯病转变。

Autoimmune Thyroiditis Shifting from Hashimoto's Thyroiditis to Graves' Disease.

机构信息

Department of Internal Medicine, Division of Endocrinology and Metabolism, Aichi Medical University School of Medicine, Nagakute 480-1195, Aichi, Japan.

Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute 480-1195, Aichi, Japan.

出版信息

Medicina (Kaunas). 2023 Apr 13;59(4):757. doi: 10.3390/medicina59040757.

DOI:10.3390/medicina59040757

PMID:37109715

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10141468/

Abstract

In 15-20% of cases, Graves' disease (GD) shifts to Hashimoto's thyroiditis (HT), while the shift from HT to GD is rare. We present a case of a patient in whom HT shifted to GD, along with a literature review. A 50-year-old woman with myxedema was diagnosed with Hashimoto's disease due to hypothyroidism and the presence of antibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TgAb); she also had thyroid stimulating antibodies (TSAb) without any signs of GD. Although thyroid hormone replacement therapy improved her thyroid function, 2 months later, hyperthyroidism appeared and did not improve after discontinuation of the replacement therapy. The patient was diagnosed with GD, which improved with antithyroid agent administration. To date, only 50 cases regarding conversion from HT to GD have been reported. The median age is 44 years (range, 23-82 years), and the median time of conversion is 7 years (range, 0.1-27 years). The male-to-female ratio of HT conversion to GD is 1:9, closer to that of regular GD (1:10) than that of general HT (1:18). All patients received thyroid hormone replacement therapy for hypothyroidism due to HT. Continuous evaluation of TSAb levels is recommended in HT, particularly in cases of TSAb-positive and those under replacement, since it may help predict conversion to GD. Evaluating the clinical characteristics of patients with HT preceding GD is crucial to ensure appropriate treatment and reduce the risk of adverse events.

摘要

在 15-20%的病例中，格雷夫斯病（GD）会转变为桥本甲状腺炎（HT），而从 HT 转变为 GD 则较为罕见。我们报告了 1 例 HT 转变为 GD 的病例，并进行了文献复习。一位 50 岁女性因黏液性水肿而被诊断为桥本氏病，其甲状腺功能减退症和甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TgAb）阳性提示桥本氏病；她还存在甲状腺刺激抗体（TSAb），但没有 GD 的任何迹象。尽管甲状腺激素替代疗法改善了她的甲状腺功能，但 2 个月后出现了甲亢，并且在停止替代治疗后没有改善。该患者被诊断为 GD，服用抗甲状腺药物后病情改善。迄今为止，仅有 50 例关于从 HT 转变为 GD 的报道。中位年龄为 44 岁（范围，23-82 岁），中位转变时间为 7 年（范围，0.1-27 年）。HT 向 GD 转变的男女比例为 1:9，更接近常规 GD（1:10），而不是一般 HT（1:18）。所有患者均因 HT 导致的甲状腺功能减退症接受甲状腺激素替代治疗。鉴于 HT 可能向 GD 转变，建议对 HT 患者持续评估 TSAb 水平，尤其是对 TSAb 阳性和接受替代治疗的患者。评估 GD 之前的 HT 患者的临床特征对于确保适当的治疗和降低不良事件的风险至关重要。