Rouiller Nathalie, Nicod Lalonde Marie, Sykiotis Gerasimos P
Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Service of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Front Nucl Med. 2022 Mar 15;2:858062. doi: 10.3389/fnume.2022.858062. eCollection 2022.
The manifestation of Graves' disease (GD) in patients treated with radioactive iodine (RAI) for hyperfunctioning thyroid nodules (RAI-induced GD or post-RAI GD) remains a long-standing challenge in radionuclide therapy. Known risk factors for post-RAI GD include preexisting subclinical hyperthyroidism, positive thyroid peroxidase autoantibodies (TPOAb), positive TSH receptor autoantibodies (TRAb) or otherwise undiagnosed GD. However, these risk factors are not present in all patients with post-RAI GD, and therefore it cannot always be predicted in a reliable manner if a given patient has a high risk for RAI-induced GD or not.
We describe the case of a 64 year-old woman known for hyperthyroidism due to toxic nodular goiter; she was treated initially with carbimazole, and then, due to recurrence, underwent RAI treatment. Three months later, symptomatic hyperthyroidism persisted. Diagnosis of new-onset GD was made based on typical ultrasound findings and newly-positive TRAb. Our patient had only positive thyroglobulin antibodies (TgAb) before RAI treatment, whereas TPOAb were negative.
In the literature, TgAb have never been reported as a possible risk factor for RAI-induced GD. The present case suggests that the assessment for pre-existing autoimmunity in patients considering RAI for hyperfunctioning thyroid nodules should probably also include TgAb.
对于因功能亢进性甲状腺结节接受放射性碘（RAI）治疗的患者，格雷夫斯病（GD）的表现（放射性碘诱导的GD或放射性碘治疗后GD）仍是放射性核素治疗中一个长期存在的挑战。放射性碘治疗后GD的已知风险因素包括既往存在的亚临床甲状腺功能亢进、甲状腺过氧化物酶自身抗体（TPOAb）阳性、促甲状腺激素受体自身抗体（TRAb）阳性或其他未诊断的GD。然而，并非所有放射性碘治疗后GD的患者都存在这些风险因素，因此，对于特定患者是否有放射性碘诱导GD的高风险，并不总能以可靠的方式进行预测。
我们描述了一名64岁女性的病例，该患者因毒性结节性甲状腺肿导致甲状腺功能亢进；她最初接受甲巯咪唑治疗，随后因复发接受放射性碘治疗。三个月后，症状性甲状腺功能亢进持续存在。基于典型的超声检查结果和新出现的TRAb阳性，诊断为新发GD。我们的患者在放射性碘治疗前仅甲状腺球蛋白抗体（TgAb）呈阳性，而TPOAb为阴性。
在文献中，从未报道过TgAb是放射性碘诱导GD的可能风险因素。本病例表明，对于考虑因功能亢进性甲状腺结节接受放射性碘治疗的患者，对既往自身免疫的评估可能还应包括TgAb。
