Mount Sinai Medical Center, Miami Beach, Florida, USA.
J Investig Med High Impact Case Rep. 2023 Jan-Dec;11:23247096231191874. doi: 10.1177/23247096231191874.
Medications are known to affect the thyroid physiology and are a known cause of hypothyroidism. There is an ever-growing list of medications that affect the thyroid by 1 or more mechanisms. Mifepristone is presently used for the treatment of mild autonomous cortisol secretion (MACS). Hypothyroidism is not a known side effect of this medication. We present a 71-year-old woman with newly diagnosed impaired fasting glucose, dyslipidemia, and osteopenia presenting with a 3-year history of unintentional 15-pound weight gain (despite exercise and a good diet) and increased anxiety. Her physical examination was pertinent for mild lower extremity edema, easy bruising, and skin thinning. Workup revealed adrenocorticotropic hormone (ACTH)-independent MACS from bilateral micronodular hyperplasia of the adrenals. Since she was not a surgical candidate, medical management with mifepristone was chosen. While on mifepristone, she complained of excessive fatigue, a workup done revealed new-onset hypothyroidism. Given her symptoms and bloodwork, she was started on levothyroxine. After stopping mifepristone, she was biochemically and clinically euthyroid and was eventually off levothyroxine. The mechanism by which mifepristone induces hypothyroidism is unknown. Except for a multicenter case series suggesting that mifepristone increases thyroid hormone requirements in patients with central hypothyroidism, to the best of our knowledge, the literature on euthyroid patients developing hypothyroidism secondary to mifepristone is scarce. In conclusion, while the hypothyroidism seems reversible our case highlights the importance of getting baseline thyroid function tests (TFTs) and repeating them while on the medication. Treatment of hypothyroidism is based on symptoms and bloodwork.
药物已知会影响甲状腺生理功能，是导致甲状腺功能减退症的已知原因。越来越多的药物通过 1 种或多种机制影响甲状腺。米非司酮目前用于治疗轻度自主皮质醇分泌（MACS）。这种药物尚未发现会导致甲状腺功能减退症。我们报告了一位 71 岁的女性患者，新诊断为空腹血糖受损、血脂异常和骨质疏松症，有 3 年的体重意外增加 15 磅（尽管进行了锻炼和饮食良好）和焦虑增加的病史。她的体格检查有轻度下肢水肿、容易瘀伤和皮肤变薄。检查发现双侧肾上腺微结节性增生导致促肾上腺皮质激素（ACTH）非依赖性 MACS。由于她不是手术候选者，因此选择米非司酮进行药物治疗。在使用米非司酮期间，她主诉过度疲劳，进行检查后发现新发生的甲状腺功能减退症。鉴于她的症状和血液检查结果，她开始服用左甲状腺素。停用米非司酮后，她的生化和临床甲状腺功能正常，最终停用了左甲状腺素。米非司酮导致甲状腺功能减退症的机制尚不清楚。除了一项多中心病例系列研究表明米非司酮增加了中枢性甲状腺功能减退症患者的甲状腺激素需求外，据我们所知，关于因米非司酮而继发甲状腺功能减退症的甲状腺功能正常患者的文献很少。总之，虽然甲状腺功能减退症似乎是可逆的，但我们的病例强调了在开始用药前获得基线甲状腺功能检查（TFT）并在用药期间重复检查的重要性。甲状腺功能减退症的治疗基于症状和血液检查结果。
