背景:在COVID-19大流行期间,一例罕见且难以处理的由2019年冠状病毒病(COVID-19)引起的严重肝肾损害的失感格雷夫斯病(GD)病例具有一定的漏诊和延迟治疗风险。
方法:一名60岁女性患者出现厌食症,疲惫,黄疸,恶心,并在COVID-19感染后10天呕吐。由于症状反复出现,她被送往传染病科超过一个月。
方法:根据患者的流行病学史,临床症状,和先前的历史,她被初步诊断为COVID-19诱导的GD,伴有严重的甲状腺功能亢进相关性肝损伤和慢性肾脏疾病4期。药物诱导和辐射诱导的肝损伤在整个治疗过程中依次发生。
方法:给予甲基咪唑(MMI)(10mg/d)1周,和病人的症状,甲状腺功能,肝肾功能改善。然而,增加MMI剂量(20mg/d)后20天,上述症状和肝肾功能恶化。因此,在人工肝存在的情况下,血液透析,和其他医疗条件,治疗方案被调整为个体化131I抗甲状腺功能亢进治疗.
结果:131I治疗后,患者的肝功能在一个月后恢复到几乎正常的水平,但在停用保肝药物后情况恶化.肾功能没有明显恶化,3个月后恢复到基线水平。大约4个月后甲状腺功能恢复正常。
结论:COVID-19可能诱发GD。可以尽早启动多学科合作。可考虑个体化131I治疗或长期低剂量MMI(10mg/d)治疗合并肝肾功能不全的GD患者的甲状腺功能亢进,并适当延长肝保护治疗时间。
BACKGROUND: A rare and intractable case of apathetic Graves\' disease (GD) with severe liver and kidney damage induced by coronavirus disease 2019 (COVID-19) carries a certain risk of missing diagnosis and delayed treatment during the COVID-19 pandemic.
METHODS: A 60-year-old female patient developed anorexia, exhaustion, jaundice, nausea, and vomiting 10 days after COVID-19 infection. She was admitted to the Infectious Diseases Department because of recurring symptoms for more than a month.
METHODS: Based on the patient\'s epidemiological history, clinical symptoms, and prior history, she was preliminarily diagnosed with GD induced by COVID-19 with severe hyperthyroid-related liver injury and chronic kidney disease stage 4. Drug-induced and radiation-induced liver injuries occurred sequentially throughout the therapy.
METHODS: Methimazole (MMI) (10 mg/d) was administered for 1 week, and the patient\'s symptoms, thyroid function, and liver and kidney function improved. Nevertheless, the aforementioned symptoms and liver and kidney function deteriorated 20 days after increasing the MMI dose (20 mg/d). Therefore, in the presence of an artificial liver, hemodialysis, and other medical conditions, the treatment schedule was adjusted to individualized 131I anti-hyperthyroidism therapy.
RESULTS: After 131I treatment, the patient\'s liver function returned to almost normal levels after a month, but worsened when the hepatoprotective drugs were stopped. Renal function did not deteriorate significantly and returned to baseline after 3 months. Thyroid function was restored to normal approximately 4 months later.
CONCLUSIONS: COVID-19 may induce GD. Multidisciplinary collaboration can be initiated as early as possible. Individualized 131I therapy or long-term low-dose MMI (10 mg/d) can be considered to manage hyperthyroidism in GD patients with liver and kidney dysfunction and to prolong liver protection therapy appropriately.