Yamakita N, Sakata S, Hayashi H, Maekawa H, Miura K
Third Department of Internal Medicine, Gifu University School of Medicine, Japan.
Am J Med Sci. 1993 May;305(5):304-6. doi: 10.1097/00000441-199305000-00007.
A case of silent thyroiditis after unilateral adrenalectomy for treatment of Cushing's syndrome is reported. The left adrenocortical adenoma was resected. Glucocorticoid was replaced after the operation and was gradually tapered. Thyrotoxic symptoms with painless goiter occurred 9 months after the adrenalectomy when a replacement dose of prednisolone was tapered to 5 mg/d. Plasma-free thyroid hormones increased and thyrotropin was suppressed. Thyroidal uptake of radioactive iodine was extremely low. Both titers of antimicrosomal and antithyroglobulin antibodies stayed at high levels throughout the observation period from the preoperative stage. Normalization of thyroid functions was obtained 3 months after the onset of thyrotoxicosis with beta-adrenergic blocker alone. It was speculated that exposure to a large amount of endogenous and supplementary exogenous glucocorticoid protected the patient's immune system from autoimmune attack of thyroid antigens and that tapering of the supplementary glucocorticoid caused exacerbation of immune responses, resulting in overt thyroid dysfunction even 9 months after adrenalectomy.
报告了1例因库欣综合征行单侧肾上腺切除术后发生的寂静性甲状腺炎。切除了左侧肾上腺皮质腺瘤。术后给予糖皮质激素替代治疗，并逐渐减量。肾上腺切除术后9个月，当泼尼松龙替代剂量减至5mg/d时，出现甲状腺毒症症状伴无痛性甲状腺肿大。游离甲状腺激素水平升高，促甲状腺激素受到抑制。甲状腺对放射性碘的摄取极低。术前阶段至整个观察期，抗微粒体抗体和抗甲状腺球蛋白抗体滴度均维持在高水平。甲状腺毒症发作3个月后，仅用β-肾上腺素能阻滞剂甲状腺功能恢复正常。推测大量内源性和补充性外源性糖皮质激素的暴露保护了患者的免疫系统免受甲状腺抗原的自身免疫攻击，补充性糖皮质激素的减量导致免疫反应加剧，甚至在肾上腺切除术后9个月导致明显的甲状腺功能障碍。
