- 期刊
自體免疫甲狀腺功能低下合併自體免疫溶血性貧血：病例報告
Autoimmune Hypothyroidism with Autoimmune Hemolytic Anemia: A Case Report
摘要
一位27歲女性，最近幾個月走路容易喘、心悸、全身無力、食慾不佳及頭暈。患者甲狀腺呈瀰漫性腫大，甲狀腺功能則出現TSH高，及高效價anti-TPO抗體，因此診斷爲自體免疫甲狀腺功能低下(autoimmune hypothyroidism)，橋本氏甲狀腺炎(Hashimoto's thyroiditis)是最可能的疾病。此外，還發現嚴重的巨血球性貧血，direct Comb's test強烈陽性而診斷爲自體免疫溶血性貧血。經過類固醇治療後貧血狀況才獲得改善。自體免疫甲狀腺功能低下合併自體免疫溶血性貧血，到目前爲止只有少量的病例報告，尚未被歸類於任何自體免疫症候群中，容易被臨床醫師所忽略。自體免疫溶血性貧血的治療方式和其他貧血截然不同：甲狀腺素補充療法無效，需以類固醇治療，所以及時正確診斷對病患的治療很重要。
並列摘要
A 27-year-old woman had shortness of breath upon walking, palpitation, generalized weakness, poor appetite and dizziness of several months' duration. Clinical examination revealed a diffuse goiter, hyperthyrotropinemia, and a high titer of anti-TPO antibody. She was diagnosed to have autoimmune hypothyroidism compatible with Hashimoto's thyroiditis. In addition, she also had severe macrocytic anemia with a strongly positive direct Coomb's test, which suggested autoimmune hemolytic anemia (AIHA). Her anemia responded to steroid therapy, but not to thyroxine replacement alone. Up to now there have been few reports of autoimmune hypothyroidism associated with AIHA. The two autoimmune disorders have not been grouped together as an autoimmune syndrome. Since the management of AIHA is vastly different from that of the more common hypothyroidism-related anemias, prompt and accurate diagnosis is crucial for treatment.