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产后甲状腺炎和淋巴细胞性垂体炎并发甲状腺风暴:一例罕见病例

Concurrent Thyroid Storm From Postpartum Thyroiditis and Lymphocytic Hypophysitis: A Rare Case.

作者信息

Wannaphut Chalothorn, Saowapa Sakditad, Prasitsumrit Vitchapong, Wirunsawanya Kamonkiat

机构信息

Department of Medicine, John A. Burns School of Medicine University of Hawaii Honolulu Hawaii USA.

Department of Medicine Texas Tech University Health Sciences Center Lubbock Texas USA.

出版信息

Clin Case Rep. 2025 Apr 26;13(5):e9629. doi: 10.1002/ccr3.9629. eCollection 2025 May.

Abstract

Postpartum autoimmune thyroiditis (PAT) and lymphocytic hypophysitis (LH) are rare autoimmune conditions occurring during or after pregnancy. We present a case of a 35-year-old woman who developed thyroid storm because of PAT followed by LH, resulting in panhypopituitarism. Initial presentation included hemodynamic instability, altered consciousness, and hyperthyroid symptoms. She was treated for thyroid storm and subsequently developed hypernatremia, suggestive of diabetes insipidus. MRI revealed features consistent with LH. This case highlights the complex interplay between immune dysregulation and pregnancy-related hormonal changes, leading to concurrent autoimmune thyroiditis and hypophysitis. Prompt recognition and multidisciplinary management involving endocrinology, obstetrics, and critical care are essential for optimizing outcomes in such cases. Further research is needed to elucidate the underlying mechanisms and refine management strategies for these rare but potentially serious endocrine complications in the postpartum period.

摘要

产后自身免疫性甲状腺炎(PAT)和淋巴细胞性垂体炎(LH)是妊娠期间或产后发生的罕见自身免疫性疾病。我们报告一例35岁女性病例,该患者因PAT继发LH而发生甲状腺风暴,进而导致全垂体功能减退。最初表现包括血流动力学不稳定、意识改变和甲状腺功能亢进症状。她接受了甲状腺风暴治疗,随后出现高钠血症,提示尿崩症。磁共振成像(MRI)显示的特征与LH一致。该病例突出了免疫失调与妊娠相关激素变化之间的复杂相互作用,导致并发自身免疫性甲状腺炎和垂体炎。对于此类病例,迅速识别并由内分泌科、妇产科和重症监护科进行多学科管理对于优化治疗结果至关重要。需要进一步研究以阐明潜在机制,并完善产后这些罕见但可能严重的内分泌并发症的管理策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dfb1/12032449/d09d33913cf8/CCR3-13-e9629-g001.jpg

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