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新发肾病综合征背景下甲状腺功能减退症的恶化

Worsening Hypothyroidism in the Setting of New-Onset Nephrotic Syndrome.

作者信息

Wang Qi, Ravi Divya, Tang Zhiting, Nand Nikita, Dahhan Ala

机构信息

Internal Medicine, Rochester Regional Health, Rochester, USA.

Cardiology, Rochester Regional Health, Rochester, USA.

出版信息

Cureus. 2023 Aug 11;15(8):e43345. doi: 10.7759/cureus.43345. eCollection 2023 Aug.

DOI:10.7759/cureus.43345
PMID:37701005
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10493181/
Abstract

We present a case of a 54-year-old female with well-controlled hypothyroidism who experienced worsening symptoms due to nephrotic syndrome. The patient presented with fatigue, progressive shortness of breath on exertion, and anasarca for one month. Laboratory results revealed significantly elevated thyroid-stimulating hormone levels and nephrotic range proteinuria. A kidney biopsy showed stage I membranous nephropathy with positive phospholipase A2 receptor (PLA2R) findings. Her symptoms gradually improved after receiving a higher dose of levothyroxine, along with diuretics and lisinopril initiation. She continued to be closely monitored by both endocrinology and nephrology outpatient services. This case report highlights the importance of closely monitoring hypothyroidism treatment when significant proteinuria is present.

摘要

我们报告一例54岁女性患者，其甲状腺功能减退病情原本控制良好，但因肾病综合征而症状加重。患者出现疲劳、活动后进行性气短和全身水肿达1个月。实验室检查结果显示促甲状腺激素水平显著升高及肾病范围蛋白尿。肾活检显示为I期膜性肾病，磷脂酶A2受体（PLA2R）检测结果呈阳性。在接受更高剂量左甲状腺素以及开始使用利尿剂和赖诺普利治疗后，她的症状逐渐改善。内分泌科和肾内科门诊继续对她进行密切监测。本病例报告强调了在存在大量蛋白尿时密切监测甲状腺功能减退治疗的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb35/10493181/9570f072a7ac/cureus-0015-00000043345-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb35/10493181/93ec2d1022b3/cureus-0015-00000043345-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb35/10493181/9570f072a7ac/cureus-0015-00000043345-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb35/10493181/93ec2d1022b3/cureus-0015-00000043345-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb35/10493181/9570f072a7ac/cureus-0015-00000043345-i02.jpg

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Worsening Hypothyroidism in the Setting of New-Onset Nephrotic Syndrome.新发肾病综合征背景下甲状腺功能减退症的恶化
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本文引用的文献

1
It's Not Lupus This Time! A Case of Worsening Hypothyroidism in a Patient With Nephrotic Syndrome.这次不是狼疮！一例肾病综合征患者甲状腺功能减退加重的病例。
Cureus. 2022 May 26;14(5):e25355. doi: 10.7759/cureus.25355. eCollection 2022 May.
2
Nephrotic Syndrome as a Cause of Transient Clinical Hypothyroidism.肾病综合征作为短暂性临床甲状腺功能减退症的一个病因
Case Rep Endocrinol. 2021 Aug 30;2021:5523929. doi: 10.1155/2021/5523929. eCollection 2021.
3
Severity of Proteinuria Is Directly Associated With Risk of Hypothyroidism in Adults.
蛋白尿的严重程度与成人甲状腺功能减退症的风险直接相关。
J Clin Endocrinol Metab. 2021 Jan 23;106(2):e757-e762. doi: 10.1210/clinem/dgaa872.
4
Thyroid Hormone Transport and Transporters.甲状腺激素转运与转运蛋白
Vitam Horm. 2018;106:19-44. doi: 10.1016/bs.vh.2017.04.005. Epub 2017 Jun 12.
5
Nephrotic Syndrome Increases the Need for Levothyroxine Replacement in Patients with Hypothyroidism.肾病综合征增加了甲状腺功能减退患者左甲状腺素替代治疗的需求。
J Clin Diagn Res. 2016 Dec;10(12):OC10-OC12. doi: 10.7860/JCDR/2016/24046.8974. Epub 2016 Dec 1.
6
Exacerbation of underlying hypothyroidism caused by proteinuria and induction of urinary thyroxine loss: case report and subsequent investigation.蛋白尿导致潜在甲状腺功能减退加重及尿甲状腺素丢失：病例报告及后续调查
Endocr Pract. 2008 Jan-Feb;14(1):97-103. doi: 10.4158/EP.14.1.97.
7
Can urinary thyroid hormone loss cause hypothyroidism?尿甲状腺激素流失会导致甲状腺功能减退吗？
Lancet. 1991 Aug 24;338(8765):475-6. doi: 10.1016/0140-6736(91)90546-2.