Novac R E, Florescu A, Gavril L G, Velicescu C
Emergency Hospital Moinesti - Endocrinology, Moinesti, Bacau.
"Gr. T. Popa" University of Medicine and Pharmacy - Endocrinology.
Acta Endocrinol (Buchar). 2024 Jan-Mar;20(1):117-120. doi: 10.4183/aeb.2024.117. Epub 2024 Oct 3.
We present the case of a 32 yeas old male, diagnosed 7 years ago with Graves disease, with numerous recidives which needed anti-thyroid medication, with poor response (hypo to hyper-thyroid status, with high variations of TSH and FT4) whom after a period of remission (8 months, no treatment) came in for a polymorphic symptomatology sugestive for hyperthyroidism. The hyperthyroid state was confirmed he had high TRAb (31 UI/ml . <1.75 UI/ml) - on his last check in the detection rate of TRAb was under 0.3 UI/ml. The thyroid ultrasound revels on the left lobe a small mass of 0.8/0.8 cm, with EU-TIRADS score of 4, that was newly diagnosed. Postoperative histopathology revealed papillary microcarcinoma developed on Hashitoxicosis- pT1aN0, of 1 mm in the middle of left thyroid lobe. The particularity of this case consists in a long evolution of Graves disease with numerous relapses, the appearance of a thyroid nodule after 7 years in which they identified a papillary microcacinoma associated with Hashimoto thyroiditis and also the postoperative recovery that was slowed by the parathyreoprive tetany.
我们报告一例32岁男性病例，7年前被诊断为格雷夫斯病，多次复发，需要使用抗甲状腺药物，但反应不佳（甲状腺功能从减退到亢进，促甲状腺激素和游离甲状腺素波动较大），在一段缓解期（8个月，未治疗）后，因出现提示甲亢的多形性症状前来就诊。甲亢状态得到证实，他的促甲状腺激素受体抗体水平较高（31 UI/ml，正常<1.75 UI/ml），而在他上次检查时，促甲状腺激素受体抗体的检测率低于0.3 UI/ml。甲状腺超声显示左叶有一个0.8/0.8 cm的小肿块，EU-TIRADS分类为4类，这是新诊断出的。术后组织病理学显示，在桥本毒性甲状腺肿基础上发生的乳头状微癌，pT1aN0，位于左甲状腺叶中部，大小为1 mm。该病例的特殊性在于格雷夫斯病病程长且多次复发，7年后出现甲状腺结节，其中发现与桥本甲状腺炎相关的乳头状微癌，以及术后因甲状旁腺功能减退性手足搐搦导致恢复缓慢。
