Watanobe H, Kawabe H
Third Department of Internal Medicine, Hirosaki University School of Medicine, Japan.
J Endocrinol Invest. 1997 Jun;20(6):335-7. doi: 10.1007/BF03350313.
We experienced an unusual combination of painless thyroiditis and Sheehan's syndrome in a single patient. A 29-year-old postpartum woman was referred to us for suspected Sheehan's syndrome. Endocrine tests confirmed the diagnosis, but, unexpectedly, her thyroid hormone levels in the plasma were elevated. Based on the data from various examinations on her thyroid including an extremely low uptake of radioactive iodine and spontaneous alterations of the thyroid function without any therapy for the thyroid, we diagnosed the patient as suffering from Sheehan's syndrome and painless thyroiditis simultaneously. Underlying mechanism(s) whereby painless thyroiditis occurred in our patient may be an immunological rebound after parturition, an immunological alteration induced by secondary hypoadrenocorticism, or a combination of these. The simultaneous occurrence of Sheehan's syndrome and painless thyroiditis is rare, as evidenced by the existence of only one similar case report in the literature. However, since neither Sheehan's syndrome nor painless thyroiditis is a rare endocrine disorder, the thyroid function of patients with postpartum hypopituitarism and previously diagnosed chronic thyroiditis should be carefully evaluated.
我们遇到一位患者同时患有无痛性甲状腺炎和席汉综合征这一不寻常的情况。一名29岁的产后女性因疑似席汉综合征转诊至我们这里。内分泌检查确诊了该诊断，但出乎意料的是，她血浆中的甲状腺激素水平升高。基于对其甲状腺进行的各种检查数据，包括放射性碘摄取极低以及甲状腺功能在未接受任何甲状腺治疗的情况下自发改变，我们诊断该患者同时患有席汉综合征和无痛性甲状腺炎。我们的患者发生无痛性甲状腺炎的潜在机制可能是产后的免疫反弹、继发性肾上腺皮质功能减退引起的免疫改变，或者是这些因素的组合。正如文献中仅有一例类似病例报告所证明的那样，席汉综合征和无痛性甲状腺炎同时发生的情况很罕见。然而，由于席汉综合征和无痛性甲状腺炎都不是罕见的内分泌疾病，对于产后垂体功能减退且先前诊断为慢性甲状腺炎的患者，其甲状腺功能应仔细评估。
