冠状病毒引起的桥本脑病

M. Guerra, G. Alvaro, Roa-Gomez Gabriella, M. Nicu, Khaja Misbahuddini
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摘要

背景:多种因素可诱发甲状腺疾病。这种机制并不精确;甲状腺组织的模仿效应可能是原因。脑病可能是这种甲状腺疾病的一种表现,但其机制尚不清楚。目前还没有数据表明冠状病毒是桥本脑病的可能病因。病例报告:一名34岁肥胖西班牙裔女性因急性“行为改变”被带到我们的急诊科。她的家人注意到她的焦虑,反复的头部运动。患者表现出精神病行为,报告家庭成员被杀(与她被杀的家庭成员相同),出现幻听;家人无法准确预测这种行为的持续时间。病史包括哮喘(从未插管,未使用类固醇)、病态肥胖、溢乳、广泛HTN和DM。她否认胸痛、心悸、恶心、呕吐、发烧、不适、近期流感样症状。体格检查除头部重复运动外未见异常;因急性精神状态改变及乳酸性酸中毒,住院接受重症监护。入院时TSH/T3/ T4: 47.10/34/0.15,抗微生物体Ab和冠状病毒PCR阳性(表1);CT:头部:不明显,颈部超声显示甲状腺肿大异质,限制了对潜在实质的评估;未见实性、囊性或复杂结节(图1)。MRI头部未见垂体腺瘤。患者开始使用左旋甲状腺素,最初IV,然后过渡到200 mcg PO,并接受头孢曲松,地塞米松,依诺肝素(作为预防)C19;甲状腺置换开始后;患者精神状态开始急剧改善,转至医务室,后好转至基线,出院。作为门诊患者,反复甲状腺检查显示正常,精神状态与入院前基线相同。结论:本病例报告1例由SARS-CoV2病毒引起的桥本脑病。除了将这种甲状腺炎与其他病毒性实体联系起来的报道外,在2020年的大流行中没有关于这种甲状腺疾病的数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hashimoto encephalopathy induced by coronavirus
Background: Multiple factors can induce thyroid disease. The mechanism is not precise; a possible mimicry effect in the thyroid tissue could be the cause. Encephalopathy could be one manifestation of this thyroid disorder, but its mechanism is not well understood. There is a lack of data showing coronavirus as a possible cause of Hashimoto encephalopathy. Case Report: A 34-year-old obese Hispanic female was brought to our emergency department due to acute “Behavioral changes”. Her family noted her anxiety with repetitive head movement.; the patient presented with psychotic behavior, reporting family members were killed (The same that brought her), having auditory hallucinations; the family could not precisely predict the duration of this behavior. Her history includes asthma (never intubated, not on steroids), morbid obesity, galactorrhea, and extensive HTN and DM. She denied chest pain, palpitations, nausea, vomit, fever, malaise, recent flu-like symptoms. No abnormality in the physical examination was noted except for repetitive head movement; due to her acute mental status changes and lactic acidosis, she was admitted under critical care service. During her admission, the TSH/T3/ T4: 47.10/34/0.15, Antimicrosomal Ab and Coronavirus PCR were positive (Table1); CXR: No acute pathology, CT Head: Unremarkable, ultrasound neck showed Enlarged heterogeneous thyroid gland, which limits evaluation of underlying parenchyma; no measurable demonstrated solid, cystic or complex nodule (Figure 1). MRI head showed no pituitary adenoma. The patient was started on levothyroxine initially IV then transitioned to 200 mcg PO, and received ceftriaxone, dexamethasone, enoxaparin (As prophylaxis) for C19; after thyroid replacement was initiated; the patient started improving mental status drastically, she was transferred to the medical floor, later improved to baseline, and then was discharged. As an outpatient, the repeated thyroid panel showed normal values, and mental status was status as her baseline previous to her admission. Conclusion: Our case report describes a case of Hashimoto encephalopathy induced by SARS-CoV2 virus. Besides reports relating this thyroiditis with viral other viral entities, there is no data about this thyroid disorder in the 2020 pandemic.
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