Development of Hyperthyroidism Following Primary Hypothyroidism: A Case Report
Development of Hyperthyroidism Following Primary Hypothyroidism: A Case Report
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原发性甲状腺功能减退症继发甲状腺功能亢进：病例报告
DOI：
10.1016/s1607-551x(09)70105-6
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Ta‐Jen Wu
中科院分区：
文献类型：
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作者：
Yueh‐Hua Chung;H. Ou;Ta‐Jen Wu
原发性甲状腺功能减退症后发生甲状腺功能亢进症并不常见，仅有少数文献报道。目前认为血清促甲状腺激素受体抗体的改变在其病理生理机制中起主要作用，但其确切机制尚不清楚。在此，我们报告一位60岁男性因低钠血症而意识障碍的病例。甲状腺功能检查显示原发性甲状腺功能减退，抗微粒体抗体效价高(1：6,400)。患者6年后出现体重减轻和眼球突出。患者血清甲状腺激素水平升高，停用甲状腺素治疗，但2个月后患者仍有甲状腺功能亢进。24小时131I摄取率为40.9%，双侧甲状腺叶未见弥漫性放射性。6个月后，患者仍有甲状腺功能亢进，开始服用他巴唑10 mg/d。他现在正在服用他巴唑，甲状腺功能正常。
Development of hyperthyroidism following primary hypothyroidism is uncommon, and only a few documented cases have been reported. Alterations in thyroid-stimulating hormone receptor antibodies in serum are currently considered to play the main role in the pathophysiology, but the exact mechanism is still unknown. Here, we report the case of a 60-year-old man with disturbed consciousness due to hyponatremia. Thyroid function tests showed primary hypothyroidism with a high anti-microsomal antibody titer (1:6,400). The patient experienced weight loss and exophthalmos 6 years later. Serum thyroid hormone levels were increased and thyroxine treatment was discontinued, but the patient remained thyrotoxic 2 months later.131I thyroid uptake was 40.9% at 24 hours, and bilateral thyroid lobes were not enlarged with diffuse radioactivity. Six months later, the patient was still thyrotoxic and therapy with methimazole 10 mg/day was started. He is now taking methimazole and is euthyroid.