Sharma Pranjali
Endocrinology, Scripps Clinic, La Jolla, USA.
Cureus. 2025 Apr 8;17(4):e81900. doi: 10.7759/cureus.81900. eCollection 2025 Apr.
Graves' disease, caused by autoimmune thyrotropin receptor antibody-mediated activation of the thyroid, is characterized by hyperthyroidism, orbitopathy, dermopathy, and acropachy. Graves' disease is treated by anti-thyroid drug therapy, radioactive iodine ablation, or total thyroidectomy. We report the case of a 39-year-old female patient with hyperthyroidism secondary to Graves' disease that was managed through lifestyle interventions only. On presentation, she reported intermittent headaches and had an undetectable thyroid-stimulating hormone (TSH) level. Two weeks later, repeat testing showed an undetectable TSH, free thyroxine (free T4) 2.7 ng/dL (normal range: 0.70-1.48 ng/dL), total triiodothyronine (T3) 5.08 ng/mL (normal range: 0.40-1.93 ng/mL), thyrotropin receptor antibody (TRAb) 20.3 IU/L (reference range: ≤1.75 IU/L), thyroid stimulating immunoglobulin (TSI) 2.3 IU/L (reference range: ≤0.54 IU/L), thyroid peroxidase antibody (TPO) 7.66 IU/mL (reference range: <5.61 IU/mL), confirming hyperthyroidism due to Graves' disease. An iodine-123 (I-123) thyroid uptake and scan showed homogeneously increased iodine uptake (68%) at 4 hours (normal range: 3-16%) and (60%) 24 hours (normal range: 8-25%). The patient was prescribed anti-thyroid drug therapy through methimazole but elected not to take it due to concerns about side effects. She incorporated lifestyle interventions and, over a span of three months, was able to improve clinically and biochemically (TSH: 0.824 mcIU/mL, free T4: 0.77 ng/dL, total T3: 0.73 ng/mL, TRAb: 2.93 IU/L, TSI: 0.26 IU/L, and TPO antibody: undetectable). The lifestyle interventions she pursued included going dairy and gluten-free, ingestion of one to two Brazil nuts daily, regular exercise, mindfulness-based stress management, and cold-water immersion therapy. We review the evidence behind these interventions and discuss the utility of these measures in the management of Graves' disease.
格雷夫斯病由自身免疫性促甲状腺素受体抗体介导的甲状腺激活引起，其特征为甲状腺功能亢进、眼眶病、皮肤病和指端粗厚症。格雷夫斯病通过抗甲状腺药物治疗、放射性碘消融或甲状腺全切除术进行治疗。我们报告了一例39岁女性格雷夫斯病继发甲状腺功能亢进患者，该患者仅通过生活方式干预进行管理。初诊时，她自述间歇性头痛，促甲状腺激素（TSH）水平检测不到。两周后，复查显示TSH检测不到，游离甲状腺素（游离T4）2.7 ng/dL（正常范围：0.70 - 1.48 ng/dL），总三碘甲状腺原氨酸（T3）5.08 ng/mL（正常范围：0.40 - 1.93 ng/mL），促甲状腺素受体抗体（TRAb）20.3 IU/L（参考范围：≤1.75 IU/L），甲状腺刺激免疫球蛋白（TSI）2.3 IU/L（参考范围：≤0.54 IU/L），甲状腺过氧化物酶抗体（TPO）7.66 IU/mL（参考范围：<5.61 IU/mL），确诊为格雷夫斯病所致甲状腺功能亢进。碘 - 123（I - 123）甲状腺摄取和扫描显示4小时时碘摄取均匀增加（68%）（正常范围：3 - 16%），24小时时为（60%）（正常范围：8 - 25%）。患者起初被开了甲巯咪唑抗甲状腺药物治疗，但因担心副作用而未服用。她采取了生活方式干预措施，在三个月的时间里，临床和生化指标均有所改善（TSH：0.824 mcIU/mL，游离T4：0.77 ng/dL，总T3：0.73 ng/mL，TRAb：2.93 IU/L，TSI：0.26 IU/L，TPO抗体：检测不到）。她采取的生活方式干预措施包括不吃乳制品和麸质食品，每天食用一到两颗巴西坚果，定期锻炼，基于正念的压力管理以及冷水浸泡疗法。我们回顾了这些干预措施背后的证据，并讨论了这些措施在格雷夫斯病管理中的效用。
