真性红细胞增多症患者干扰素治疗中合并亚急性甲状腺炎一例报告并文献复习

Abstract

目的：报道真性红细胞增多症(PV)患者干扰素α(IFNα)治疗中合并亚急性甲状腺炎1例，初步探讨该类干扰素诱导的甲状腺炎(IIT)的临床特征，加深对IFNα不良反应的认识。方法：对本例患者的临床资料进行分析，并复习相关文献。结果：本例IIT的临床特征：1) 年轻女性，治疗前甲状腺自身抗体阴性，属于非自身免疫性IIT；2) 第一次亚甲炎发生于IFNα治疗2月时，第二次发生于IFNα治疗4月时；3) IIT的发生似乎与干扰素的剂型无关；4) IIT症状有轻有重，但是可控的，多数可以完成疗程；5) 中断后重新应用IFNα治疗时可再次发生甲状腺炎。结论：IFNα治疗中可出现甲状腺炎或甲状腺功能异常的不良反应。在血液系统疾病应用IFNα治疗时应严密监测甲状腺功能和甲状腺自身抗体。根据临床症状轻重决定是否停用IFNα，多数可继续使用，若停用后再次开始治疗时一定要严密监测甲状腺功能。 Object: A case of subacute thyroiditis associated with interferon therapy of polycythemia vera is reported. To explore the clinical features of interferon induced thyroiditis and to deepen the understanding of IFNα’s side effects. Methods: The clinical data of this patient were analyzed and related literatures were reviewed. Results: 1) The patient is a young woman.IIT manifested as non-autoimmune thyroiditis without TAb’s. 2) The first course of subacute thyroiditis was diagnosed in treatment 2 months and the second course was diagnosed in treatment 4 months. 3) It seems that there’s no association between different forms of interferon and IIT. 4) The symptoms of IIT were mild or severe, but they could be controlled. Most of them can complete the course of treatment. 5) Patients frequently developed recurrent thyroiditis when re-treating with IFNα. Conclusions: One of the side-effects of IFNα therapy is thyroiditis or thyroid dysfunction. IFNα therapy of hematological diseases should undergo routine thyroid screening. IFNα therapy should be treated based on the clinical presentation. IFNα therapy can be continued in most cases. Thyroid functions should be carefully monitored if treatment is resumed.