桥本脑病伴毒性弥漫性甲状腺肿临床分析.docVIP

桥本脑病伴毒性弥漫性甲状腺肿临床分析 浙江省杭州市第四人民医院 310002 邵森 【摘要】 目的 探讨桥本脑病伴毒性弥漫性甲状腺肿患者的发病机制、临床表现、实验室检查特点及预后。方法 分析4例桥本脑病伴毒性弥漫性甲状腺肿患者的临床资料，观察其临床表现、实验室及影像学检查特点及治疗，并随访3个月。结果 4例患者均为女性，临床表现主要为认知功能障碍、行为异常、抽搐等。实验室检查患者血清抗甲状腺抗体水平增高。对激素治疗敏感。桥本脑病伴毒性弥漫性甲状腺肿患者，从临床表现、血清脑脊液抗体检测、影像学、脑电图、治疗与预后，与桥本甲状腺炎相关性桥本脑病相似。结论 毒性弥漫性甲状腺肿、桥本甲状腺炎都可能与桥本脑病的发生有相关性。对于临床上不明原因的脑病和自身免疫性甲状腺疾病时，不管其临床特点及病因如何，均应考虑桥本脑病可能。 【关键词】桥本脑病 抗甲状腺抗体激素 自身免疫性疾病 毒性弥漫性甲状腺肿 The analysis of the dinical features for Hashimoto’s Encephalopathy with Graves disease SHAO Sen,SHEN Jian ping,XU Da cheng,GUO Li li,CHEN Guan feng,XU Yan.Department of Neurology, Hangzhou Fourth Peoples Hospital,Hangzhou 310002,China 【Abstract】 Objective To investigate the pathogenesis，clinical presentations，laboratory features and prognosis of Hashimoto’s Encephalopathy (HE) with Graves disease(GD)．Methods To analyze the clinical presentations，laboratory findings and treatment in 4 patients with HE with GD. Results 4 cases were all female．They mainly presented with cognitive dysfunctions,abnormal behaviors and seizures．We found that antithyroid antibodies were significantly higher．Most of the patients dramatically responded to corticosteroids. GD and HT patients with HE present with a similar clinical, biological, radiological, and electrophysiological picture. Conclusions GD and HT equally represent the possible background condition for the development of HE. which should be considered in the differential diagnosis of all patients with encephalopathy of unknown origin and an autoimmune thyroid disease, regardless of the nature of the underlying autoimmune thyroid disease. 【Key words】 Hashimoto’s Encephalopathy Antithyroid antibodies Steroids Autoimmune disorders Graves disease 桥本脑病(Hashimotos Encephalopathy，HE)又称为自身免疫性甲状腺炎相关的激素敏感性脑病(steroid-responsive encephalopathy associated with autoimmune thyroiditis，SREAT)，是与桥本甲状腺炎相关的以神经系统症状为主要表现的疾病。在1966年由Brain首先描述[1]。本研究报道4例桥本脑病伴毒性弥漫性甲状腺肿患者，对其临床表现，血清脑脊液抗体检测、影像学、脑电图、预后进行了分析。 临床资料 该4例考虑诊断为桥本脑病的成人患者，均符合以下特点：①急性或亚急性起病的脑病，表现为意