Iwaoka T, Umeda T, Nakayama M, Shimada T, Fujii Y, Miura F, Sato T
Jpn J Med. 1982 Jan;21(1):29-34. doi: 10.2169/internalmedicine1962.21.29.
A 54-year-old woman who had proteinuria due to stage II membranous nephropathy is reported. She was treated with indomethacin for proteinuria and developed drug-induced hepatitis four months later. Liver dysfunction gradually recovered, but hormonal studies revealed abrupt fall of T3 and T4 and concomitant elevation of TSH levels within a month. Pathological findings of thyroid specimen and positive antithyroglobulin and antimicrosomal antibodies were compatible to chronic thyroiditis. In the second renal biopsy, glomerular deposits of thyroglobulin, thyroid microsomal antigens and IgG were demonstrated by immunofluorescence. Therefore, membranous nephropathy in this patient is presumed to be caused by immune complexes mediated by thyroid constituents. We believe that this is a precious case because continuous changes in T3, T4 and TSH were followed in a course of chronic thyroiditis, especially in the stage of progress to hypothyroidism, and the chronic thyroiditis was shown to be involved in the membranous nephropathy.
报告了一名54岁因II期膜性肾病出现蛋白尿的女性患者。她因蛋白尿接受吲哚美辛治疗，四个月后发生药物性肝炎。肝功能障碍逐渐恢复，但激素检查显示在一个月内T3和T4突然下降，同时促甲状腺激素水平升高。甲状腺标本的病理检查结果以及抗甲状腺球蛋白和抗微粒体抗体阳性与慢性甲状腺炎相符。在第二次肾活检中，通过免疫荧光证实了甲状腺球蛋白、甲状腺微粒体抗原和IgG在肾小球中的沉积。因此，推测该患者的膜性肾病是由甲状腺成分介导的免疫复合物引起的。我们认为这是一个珍贵的病例，因为在慢性甲状腺炎病程中，尤其是在进展为甲状腺功能减退的阶段，T3、T4和促甲状腺激素持续变化，并且显示慢性甲状腺炎与膜性肾病有关。
