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类固醇反应性脑病变与自身免疫性甲状腺炎相关
Mathew Wells1, Jared Rife2, Samantha Hopkins3
1Department of Family Medicine, Goshen Health, Syracuse, Indiana, USA.
BMJ case reports
|September 25, 2025
概括
与自身免疫性甲状腺炎 (SREAT) 相关的类固醇反应性脑病变可能导致快速痴呆和精神病. 在患有SREAT的老年人中,迅速的类固醇治疗会导致显著的症状改善和恢复.
科学领域:
- 神经学 神经学
- 内分泌学 在内分泌学.
- 免疫学 免疫学 免疫学
背景情况:
- 哈西莫托脑病变,也称为与自身免疫性甲状腺炎 (SREAT) 相关的类固醇反应性脑病变,是一种罕见的神经系统疾病.
- 它的特点是快速进展的痴呆症,类似中风的症状,精神病,以及阳性抗甲状腺抗体.
研究的目的:
- 报告SREAT病例的老年患者呈现急性神经精神病症状.
- 强调在患有新发的神经和精神疾病的老年人群中考虑SREAT的重要性.
主要方法:
- 一个80多岁的患有甲状腺功能低下症的妇女的病例报告,呈现出幻觉,记忆丧失和偏执.
- 诊断工作包括抗体检测 (甲状腺蛋白和甲状腺过氧化酶抗体).
- 治疗涉及高剂量静脉注射甲基普雷尼索隆,然后是口服普雷尼索隆逐渐减少.
主要成果:
- 患者表现出高的抗甲状腺抗体,表明SREAT.
- 最初的高剂量类固醇治疗导致她的神经精神症状明显改善.
- 随后的口服普雷尼松缓和和随访护理有效地管理了这种情况.
结论:
- 在老年人群中,SREAT是新发神经精神病症状的可逆原因.
- 早期诊断和迅速使用全身类固醇治疗对于有利的结果至关重要.
- 在老年患者中,SREAT应被认为是"不可错过"的诊断,这些老年患者有无法解释的神经和精神疾病的变化.
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