胸腺增生可准确检测到新发 Graves 甲亢，并在恢复甲状腺功能正常后消退。
Thymic hyperplasia is accurate to detect new-onset Graves' hyperthyroidism and resolves after restoring euthyroidism.
机构信息
Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", 80138, Naples, Italy.
Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
出版信息
J Endocrinol Invest. 2024 Oct;47(10):2487-2497. doi: 10.1007/s40618-024-02355-w. Epub 2024 Mar 30.
PURPOSE
Abnormal liver blood tests (ALBTs), neutropenia (NEU) and thymic hyperplasia (TH) are new features of Graves' disease (GD). Our objectives were: (a) to calculate the accuracy of TH in discriminating between Graves' and non-Graves' thyrotoxicosis, compared to ALBTs, NEU and Graves' orbitopathy (GO); (b) to explore the outcome of GD-associated TH and non-GD-associated TH.
METHODS
We prospectively analyzed consecutive adult patients with newly diagnosed thyrotoxicosis from January 2018 to June 2023. TH was detected via neck ultrasound (nUS) then confirmed and followed by magnetic resonance imaging (MRI). For GD vs non-GD clinical sensitivity (SE) and specificity (SPEC), accuracy, positive predictive value (PPV) and negative predictive value (NPV) of GO, TH, ALBTs and NEU were calculated.
RESULTS
264 thyrotoxic patients were included. TH was found in 16.4% (20/122) of GD vs 1.4% (2/142) in non-GD (p < 0.001). SE, SPEC, accuracy, PPV and NPV of the four extrathyroidal manifestations of GD were as follows, respectively: GO 26%, 100%, 66%, 100%, 61%; ALBTs 41%, 89%, 69%, 76%, 66%; NEU 5%, 100%, 56%, 100%, 55%; TH 16%, 98%, 61%, 91%, 98%. In 18 of them, TH regressed within 12 months after achieving euthyroidism under anti-thyroid drug therapy, while in the remaining 2, TH regressed 6 months after thyroid surgery. In the two non-GD patients with TH, thymus disappeared along with euthyroidism.
CONCLUSIONS
TH in the hyperthyroidism scenario provides a high PPV for GD. A conservative approach for the diagnostic work-up and initial management of thyrotoxicosis-associated TH should be adopted.
目的
异常的肝脏血液检查（ALBTs）、中性粒细胞减少症（NEU）和胸腺增生（TH）是格雷夫斯病（GD）的新特征。我们的目的是：（a）与 ALBTs、NEU 和格雷夫斯眼病（GO）相比，计算 TH 区分 GD 和非 GD 甲状腺毒症的准确性；（b）探讨 GD 相关 TH 和非 GD 相关 TH 的结局。
方法
我们前瞻性分析了 2018 年 1 月至 2023 年 6 月期间连续确诊的新诊断甲状腺毒症的成年患者。通过颈部超声（nUS）检测 TH，然后通过磁共振成像（MRI）进行确认和随访。对于 GD 与非 GD，计算 GO、TH、ALBTs 和 NEU 的临床敏感度（SE）和特异性（SPEC）、准确性、阳性预测值（PPV）和阴性预测值（NPV）。
结果
共纳入 264 例甲状腺毒症患者。GD 中发现 TH 占 16.4%（20/122），而非 GD 中为 1.4%（2/142）（p<0.001）。GD 四种甲状腺外表现的 SE、SPEC、准确性、PPV 和 NPV 分别为：GO 26%、100%、66%、100%、61%；ALBTs 41%、89%、69%、76%、66%；NEU 5%、100%、56%、100%、55%；TH 16%、98%、61%、91%、98%。在其中 18 例中，在抗甲状腺药物治疗下达到甲状腺功能正常后 12 个月内 TH 消退，而在其余 2 例中，在甲状腺手术后 6 个月内 TH 消退。在 2 例非 GD 患者中，TH 消失的同时甲状腺功能也恢复正常。
结论
在甲状腺毒症情况下，TH 提供了对 GD 的高 PPV。对于甲状腺毒症相关 TH 的诊断性检查和初始治疗，应采取保守的方法。
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