每日一题_2023.12.14

A 49-year-old woman with a history of Graves’ disease presented to the endocrinology clinic with a 3-year history of skin changes on her arms and legs and a 1-year history of thyrotoxicosis symptoms. She had intermittently adhered to carbimazole therapy since her diagnosis 10 years earlier. On physical examination, violaceous, nonpitting, indurated nodules were observed on the dorsa of her hands, distal forearms, and shins (left). A goiter (right, arrow), proptosis, and lid lag were also noted. Laboratory testing showed an undetectable thyrotropin level and elevated total and free thyroxine and triiodothyronine levels. Testing for which value would you most expect to be positive in this patient?

一名有Graves病病史的49岁女性到内分泌科门诊就诊，她的手臂和腿部皮肤改变3年，甲状腺毒症症状1年。自10年前确诊以来，患者间歇性地坚持卡咪唑治疗。体格检查时，在她的手背、前臂远端和小腿(左)观察到紫红色、无凹陷、坚硬的结节。还注意到甲状腺肿大(右，箭头)、眼球突出和眼睑滞后。实验室检查显示促甲状腺素水平不可测，总甲状腺素和游离甲状腺素以及三碘甲状腺原氨酸水平升高。在该患者中，你最期望检测出哪种值为阳性?

A. C-peptide c -肽

B. Glutamic acid decarboxylase antibodies 谷氨酸脱羧酶抗体

C. Thyroglobulin antibodies 甲状腺球蛋白抗体

D. Thyroid peroxidase antibodies  甲状腺过氧化物酶抗体

E. Thyrotropin receptor antibodies 促甲状腺素受体抗体

答案解析：

在格雷夫斯病(Graves ‘ Disease)患者中，促甲状腺素受体抗体约有80-95%的时间呈阳性，而抗甲状腺过氧化物酶抗体约有50-80%的时间呈阳性。该患者的促甲状腺素受体和抗甲状腺过氧化物酶抗体检测结果为阳性。胫前皮肤活检显示黏蛋白结节性沉积伴弹性变性。诊断为Graves病甲状腺皮肤病。行甲状腺全切除术，术后给予左甲状腺素治疗。皮损给予局部和皮损内糖皮质激素治疗。

正确答案：E