每日一题_2023.07.28

A 42-year-old woman with a history of pernicious anemia presents to her physician complaining of anxiety and occasional palpitations. She has unexplained weight loss of 10 lb (4.5 kg) and multiple daily bowel movements. She has not had a menstrual period in four months. She has a thyroid bruit and a 10 × 4 cm oval, nontender soft-tissue mass anterior to the thyroid cartilage. Which of the following is the most likely etiology of this patient’s disease?

一名有恶性贫血病史的42岁女性到医师处就诊，主诉焦虑和偶尔心悸。患者不明原因地体重减轻10 lb (4.5 kg)，每天多次排便。她已经四个月没有月经了。患者有甲状腺杂音，甲状软骨前方有一个10 × 4 cm的椭圆形无压痛软组织肿块。下列哪一项是该患者疾病最有可能的病因?

(A)  Autoantibody stimulation of thyroid- stimulating hormone receptors 自身抗体刺激促甲状腺激素受体

(B)  Idiopathic replacement of thyroid tissue with fibrous tissue 特发性甲状腺组织被纤维组织替代

(C)  Papillary thyroid cancer 甲状腺乳头状癌

(D)  Thyroid adenoma 甲状腺腺瘤

(E)  Viral infection leading to destruction of thyroid tissue 病毒感染导致甲状腺组织破坏

答案解析：

这个病人患有Graves病。在Graves病中，促甲状腺激素IgG抗体与甲状腺上的促甲状腺激素(TSH)受体结合，导致甲状腺激素产生过量。这导致腺体增生和增大，导致特征性的甲状腺肿(10 × 4 cm无压痛的软组织肿块就是甲状腺肿，它阻塞了正常的甲状腺解剖结构)。格雷夫斯病是甲状腺毒症最常见的病因。与没有Graves病的患者相比，Graves病患者罹患其他自身免疫性疾病(如恶性贫血或1型糖尿病)的风险更高。格雷夫斯病的临床表现包括焦虑、易怒、震颤、热不耐受伴皮肤出汗、心动过速和心悸、体重减轻、食欲增加、细毛、腹泻、闭经或月经稀发。体征包括弥漫性甲状腺肿、眼球突出、眶周水肿和反射亢进。实验室检查显示甲状腺激素水平升高，TSH水平降低。

正确答案：A