Klein M, Barbé F, Pascal V, Weryha G, Leclère J
Clinique Médicale et Endocrinologique, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre-lès-Nancy, France.
Eur J Endocrinol. 1998 Feb;138(2):185-8. doi: 10.1530/eje.0.1380185.
With long-term exposure to lead, lead accumulates in bone, where it is stored for years. These quiescent lead stores are mobilised when increased bone turnover occurs, and latent lead toxicity may then become symptomatic. Although Graves' disease is a common cause of increased bone turnover, to date hyperthyroidism has been implicated in lead poisoning only twice. We describe herein two cases of hyperthyroidism, one caused by toxic multinodular thyroid enlargement, the second by Graves' disease, leading to lead poisoning. Treatment of hyperthyroidism with radioactive iodine cured both hyperthyroidism and lead poisoning and no chelating agent therapy was necessary. Lead poisoning is an important environmental health problem, and physicians must be aware of the endocrine disorders such as hyperthyroidism and hyperparathyroidism that increase bone turnover, favouring lead mobilisation. Atypical symptoms should draw the physician's attention to the possibility of lead poisoning, particularly in workers with occupational exposure to lead and in areas where lead poisoning is endemic.
长期接触铅会导致铅在骨骼中蓄积，并在骨骼中储存数年。当骨转换增加时，这些静止的铅储存会被动员起来，潜在的铅毒性可能会出现症状。虽然格雷夫斯病是骨转换增加的常见原因，但迄今为止，甲状腺功能亢进仅两次被认为与铅中毒有关。我们在此描述两例甲状腺功能亢进病例，一例由毒性多结节性甲状腺肿大引起，另一例由格雷夫斯病引起，导致铅中毒。用放射性碘治疗甲状腺功能亢进治愈了甲状腺功能亢进和铅中毒，无需螯合剂治疗。铅中毒是一个重要的环境卫生问题，医生必须意识到诸如甲状腺功能亢进和甲状旁腺功能亢进等内分泌紊乱会增加骨转换，有利于铅的动员。非典型症状应引起医生对铅中毒可能性的关注，特别是在职业接触铅的工人以及铅中毒流行的地区。
