- 期刊
Development of Hyperthyroidism Following Primary Hypothyroidism: A Case Report
原發性甲狀腺低下轉變為甲狀腺亢進－病例報告
摘要
原發性甲狀腺低下轉變為甲狀腺亢進是相當罕見的現象，而且回顧文獻也只有少數診斷確定的案例報告。目前認為其病理機轉是因為甲促素受體抗體轉變所引起，但是真正的原因目前仍然不明。我們報告一個病例，病人是一名六十歲男性，因為低血鈉而導致意識不清，所以進一步接受甲狀腺功能檢驗而被診斷有原發性甲狀腺低下並接受甲狀腺治療。但是在六年後病人開始出現體重減輕以及凸眼的症狀，甲狀腺功能檢驗顯示為甲狀腺亢進。但是即使在停止甲狀腺素治療後兩個月所做的甲狀腺功能檢驗依然是甲狀腺亢進，同時所做的碘131甲狀腺掃描為兩側廣泛性顯影，且24小時攝取率為40.9%。經過六個月的追蹤後，病人仍然是甲狀腺亢進，所以他開始接受抗甲狀腺藥物治療，目前甲狀腺功能控制在正常範圍內。
並列摘要
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. I 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.
延伸閱讀
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