Online Journal
IF値: 0.677(2017年)→0.966(2018年)


Journal of Medical Ultrasonics

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2018 - Vol.45

Vol.45 No.01

Case Report(症例報告)

(0069 - 0075)

TSAb・TSBAb の変動を伴う自己免疫性甲状腺疾患において,経時的に施行し た血流評価を中心とした超音波検査が有用であった1 例

A case of autoimmune thyroid disease with fluctuation of TSAb and TSBAb activity followed up by ultrasonography including thyroid blood flow assessment

日髙 尚子1, 2, 南方 瑞穂1, 3, 重田 真幸1, 貴田岡 正史4

Naoko HIDAKA1, 2, Mizuho MINAKATA1, 3, Masayuki SHIGETA1, Masafumi KITAOKA4

1公立昭和病院糖尿病・内分泌内科, 2災害医療センター糖尿病・内分泌内科, 3自衛隊中央病院代謝内科, 4イムス三芳総合病院内分泌・代謝センター

1Department of Diabetes and Endocrinology, Showa General Hospital, 2Department of Diabetes and Endocrinology, National Hospital Organization Disaster Medical Center, 3Department of Endocrinology and Metabolism, Self-Defense Forces Central Hospital, 4Endocrinology and Metabolism Center, IMS Miyoshi General Hospital

キーワード : painless thyroiditis, Graves’ disease, anti-TSH receptor antibody, thyroid blood flow


A 66-year-old female developed chronic thyroiditis with positive conversion of anti-thyroglobulin antibody 17 years after remission of Graves’ disease. She had been euthyroid and did not need hormonal replacement. At a follow-up visit, diffuse goiter and a broad low echoic region were incidentally identified on ultrasonography, and painless thyroiditis (PT) was suspected. She remained hypothyroid for 6 months, and levothyroxine administration was started. Contrary to the general course of PT, her anti-TSH receptor antibody (TRAb) level was exceptionally high. Thyroid-stimulating antibody (TSAb) level decreased during a follow-up period of 14 months (3,930%→127%), and TSH-stimulation blocking antibody (TSBAb) was extremely high (102.7%) at the last examination. Echography showed atypical findings of thyroid blood flow. In PT, the blood flow is generally decelerated during the acute phase and accelerated during the recovery phase, due to the action of thyrotropin. This case presented the opposite pattern; acceleration in the acute phase and deceleration in the recovery phase, probably caused by the change in TSAb and TSBAb levels. There have been some reports in which thyroid autoantibodies changed over time, complicating the disease state. However, there have been no reports of sonographic changes in blood flow. This case demonstrates the importance of echography in conjunction with serologic markers in proper assessment of autoimmune thyroid disease.