一名垂体手术后中枢性甲状腺功能减退症患者因感染SARS-CoV-2和流感而引发无痛性甲状腺炎。

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM Endocrinology, Diabetes and Metabolism Case Reports Pub Date : 2024-10-24 Print Date: 2024-10-01 DOI:10.1530/EDM-24-0037
Norio Wada, Hajime Sugawara, Ayaka Satoh, Shuhei Baba, Arina Miyoshi, Shinji Obara
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引用次数: 0

摘要

摘要:本病例是一名 50 岁的日本妇女,因发热、咽痛和乏力 2 天后转入我院。9 个月前,她在接受糖尿病酮症酸中毒治疗时被诊断出患有肢端肥大症,并为此接受了垂体手术。术后她被诊断为垂体功能减退,医生给她开了氢化可的松和左甲状腺素。她服用二甲双胍后血糖控制良好。急诊室的严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)和流感检测呈阳性。其他实验室检查结果包括甲状腺毒症(游离 T3:9.13 pg/mL;游离 T4:3.64 ng/dL;促甲状腺激素 (TSH)):学习要点:我们描述了一例与 SARS-CoV-2 和流感感染相关的无痛性甲状腺炎病例。虽然已有一些与 COVID-19 相关的无痛性甲状腺炎病例的报道,但还没有与流感相关的无痛性甲状腺炎病例的报道。在本病例中,病毒感染后立即出现了甲状腺毒症。此外,在发病前,抗甲状腺球蛋白抗体和抗甲状腺过氧化物酶抗体检测均为阴性。前者在出现症状时检测结果呈阳性,而后者在出现症状数周后检测结果呈阳性。病毒感染(如SARS-CoV-2和流感)患者如果没有甲状腺肿大或甲状腺触痛,可能会发展为无痛性甲状腺炎;建议进行甲状腺功能筛查。
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Painless thyroiditis associated with SARS-CoV-2 and influenza infections in a patient with central hypothyroidism after pituitary surgery.

Summary: We present the case of a 50-year-old Japanese woman who was transferred to our hospital with a 2-day history of fever, sore throat, and malaise. She was diagnosed with acromegaly 9 months ago while being treated for diabetic ketoacidosis, for which she underwent pituitary surgery. She was diagnosed with hypopituitarism postoperatively and was prescribed hydrocortisone and levothyroxine. Her glycemic control was good on metformin. Tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza were positive in the emergency room. Other laboratory findings included thyrotoxicosis (free T3: 9.13 pg/mL; free T4: 3.64 ng/dL; and thyroid-stimulating hormone (TSH): <0.01 μIU/mL) and a high C-reactive protein (CRP) level (3.84 mg/dL). The test for the TSH receptor antibody was negative. She had no apparent goiter and reported no tenderness in response to thyroid palpation. 99m-Technetium scintigraphy revealed decreased tracer uptake. Ultrasonography showed no hypoechoic lesions. Her thyrotoxicosis spontaneously resolved after 6 weeks. Although both anti-thyroglobulin antibody (TgAb) and anti-thyroid peroxidase antibody (TPOAb) were negative 9 months ago, TgAb was positive at admission. The test for TPOAb became positive 6 weeks later. These findings were suggestive of painless thyroiditis. In this patient, painless thyroiditis was believed to be caused by SARS-CoV-2 and influenza infections. Screening tests of thyroid function in patients with viral infections such as SARS-CoV-2 or influenza are recommended, even when thyroid gland pain or tenderness is not observed.

Learning points: We describe a case of painless thyroiditis associated with SARS-CoV-2 and influenza infections. Although a few cases of painless thyroiditis associated with COVID-19 have been reported, no cases of painless thyroiditis associated with influenza have been reported. In this case, thyrotoxicosis developed immediately after the viral infection. In addition, tests for anti-thyroglobulin antibody and anti-thyroid peroxidase antibody were negative before the onset of symptoms. Tests for the former became positive at the time of onset of symptoms, whereas tests for the latter became positive several weeks after the onset of symptoms. Patients with viral infections such as SARS-CoV-2 and influenza, who had no goiter or thyroid tenderness, may develop painless thyroiditis; screening tests for thyroid function are recommended.

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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
期刊最新文献
Adrenocortical insufficiency after bilateral adrenal hemorrhage due to anticoagulation and chronic immunothrombocytopenia. A case of severe Covid-19 infection as the first manifestation of Cushing's disease. Atypical thyroid tests in an athlete treated for hypothyroidism as the first symptom of pituitary dysfunction due to relative energy deficiency. Delayed onset arginine vasopressin deficiency after traumatic brain injury. Diabetic ketoacidosis as first presentation of undiagnosed pancreatic cancer in an octogenarian.
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