Hyperthyroidism from autoimmune thyroiditis in a man with type 1 diabetes mellitus: a case report

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• 作者：John K Amory (1) <br> Irl B Hirsch (2) <br>
• 刊名：Journal of Medical Case Reports
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：5
• 期：1
• 全文大小：251KB
• 参考文献：1. Leong KS, Wallymahmed M, Wilding J, MacFarlane I: Clinical presentation of thyroid dysfunction and Addison's disease in young adults with type 1 diabetes. / Postgrad Med J 1999, 75:467鈥?70. <br> 2. Umpierrez GE, Latif KA, Murphy MB, Lambeth HC, Stentz F, Bush A, Kitabchi AE: Thyroid dysfunction in patients with type 1 diabetes: a longitudinal study. / Diabetes Care 2003, 28:850鈥?55. <br> 3. Mariotti S, Martino E, Cupini C, Lari R, Giani C, Baschieri L, Pinchera A: Low serum thyroglobulin as a clue to the diagnosis of thyrotoxicosis factitia. / N Engl J Med 1982, 307:410鈥?12. 10.1056/NEJM198208123070705">CrossRef <br> 4. Vondra K, Vrb铆kov谩 J, Sterzl L, B铆lek R, Vondrova M, Zamrazil V: Thyroid autoantibodies and their clinical relevance in young adults with type 1 diabetes during the first 12 years after diabetes onset. / J Endocrinol Invest 2004, 27:728鈥?32. <br> 5. Karavanaki K, Kakleas K, Pashali E: Screening for associated autoimmunity in children and adolescents with type 1 diabetes mellitus. / Horm Res 2009, 71:201鈥?06. 10.1159/000201108">CrossRef <br> 6. Michels AW, Gottlieb PA: Autoimmune polyglandular syndromes. / Nat Rev Endocrinol 2010, 6:270鈥?77. 10.1038/nrendo.2010.40">CrossRef <br> 7. Chidakel A, Mentuccia D, Celi FS: Peripheral metabolism of thyroid hormone and glucose homeostasis. / Thyroid 2005, 15:899鈥?03. 10.1089/thy.2005.15.899">CrossRef <br> 8. Mitrou P, Raptis SA, Dimitriadis G: Insulin action in hyperthyroidism: a focus on muscle and adipose tissue. / Endocr Rev 2010, 31:663鈥?79. 10.1210/er.2009-0046">CrossRef <br> 9. Dimitriadis G, Mitrou P, Lambadiari V, Boutati E, Maratou E, Panagiotakos DB, Koukkou E, Tzanela M, Thalassinos N, Raptis SA: Insulin action in adipose tissue and muscle in hypothyroidism. / J Clin Endocrinol Metab 2006, 91:4930鈥?937. 10.1210/jc.2006-0478">CrossRef <br> 10. Crunkhorn S, Patti ME: Links between thyroid hormone action, oxidative metabolism and diabetes risk. / Thyroid 2008, 18:227鈥?37. 10.1089/thy.2007.0249">CrossRef <br> 11. Mohn A, Di Michele S, Di Luzio R, Tumini S, Chiarelli F: The effect of subclinical hypothyroidism on metabolic control in children and adolescents with type 1 diabetes mellitus. / Diabet Med 2002, 19:70鈥?3. 10.1046/j.1464-5491.2002.00635.x">CrossRef <br>
• 作者单位：John K Amory (1) <br> Irl B Hirsch (2) <br><br>1. Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA <br> 2. Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA <br>

文摘

Introduction The presentation, diagnosis, clinical course and treatment of a man with hyperthyroidism secondary to autoimmune thyroiditis in the setting of type 1 diabetes mellitus has not previously been described. Case presentation A 32-year-old European-American man with an eight-year history of type 1 diabetes mellitus presented with an unintentional 22-pound weight loss but an otherwise normal physical examination. Laboratory studies revealed a suppressed thyroid-stimulating hormone concentration and an elevated thyroxine level, which are consistent with hyperthyroidism. His anti-thyroid peroxidase antibodies were positive, and his thyroid-stimulating immunoglobulin test was negative. Uptake of radioactive iodine by scanning was 0.5% at 24 hours. The patient was diagnosed with autoimmune thyroiditis. Six weeks following his initial presentation he became clinically and biochemically hypothyroid and was treated with thyroxine. Conclusion This report demonstrates that autoimmune thyroiditis presenting as hyperthyroidism can occur in a man with type 1 diabetes mellitus. Autoimmune thyroiditis may be an isolated manifestation of autoimmunity or may be part of an autoimmune polyglandular syndrome. Among patients with type 1 diabetes mellitus who present with hyperthyroidism, Graves' disease and other forms of hyperthyroidism need to be excluded as autoimmune thyroiditis can progress quickly to hypothyroidism, requiring thyroid hormone replacement therapy.