Zašto bolesnica s Gravesovom bolešću ostaje eutiroidna/blago hipertiroidna nakon totalne tiroidektomije - uloga antitijela na tirotropinske receptore (TRAb) i vestigalnih ostataka tiroglosalnog trakta

Abstract

A young female patient suffering from Graves. disease is presented, who raised some diagnostic and therapeutic dilemmas after being diagnosed with subclinical hyperthyroidism following total thyroidectomy. This 20-year-old female patient, carrier of HLA B8 DR3 genes, was referred to our hospital for total thyroidectomy after developing severe leukopenia on both methimazole and propylthiouracil therapy. A high postoperative titer of thyrotropin receptor antibodies and positive scintigraphy finding of the pyramidal lobe and remnant thyroid tissue in the left thyroid lobe led to the administration of radioiodine. Despite further enlargement of the remnant thyroid tissue on post-radioiodine scintiscanning, the patient is currently euthyroid, with normal thyroid-stimulating hormone levels; however, her long-term prognosis remains uncertain.Opisan je slučaj bolesnice operirane zbog hipertireoze na podlozi Gravesove bolesti, u koje se na početno primijenjenu medikamentnu terapiju razvila granulocitopenija. Iako je kod bolesnice bila planirana totalna tireoidektomija, s obzirom na prijeoperacijski neprepoznat lobus piramidalis učinjena je tek djelomična resekcija štitnjače. Poslijeoperacijski se kao posljedica autoimune aktivacije ostatnog tkiva štitnjače antitijelima na tirotropinske receptore (TRAb) razvila hipertireoza, pa je daljnji tijek bolesti još uvijek nesiguran