[Thyrotoxicosis in a patient with Turner syndrome: radioactive iodine therapy]

Abstract

Turner syndrome (TS) is a chromosomal disorder affecting female and characterized by complete or partial monosomy of the X chromosome. These genetic changes lead to the abnormalities in growth and development and increase the risk of autoimmune diseases, including those affecting the thyroid. Thyroid pathology in TS may include autoimmune thyroiditis, hypothyroidism, thyrotoxicosis (Graves disease, AIT in the hyperthyroid state).Thyrotoxicosis is the clinical syndrome of excess circulating thyroid hormones. One of the main causes of thyrotoxicosis is Graves' disease (GD), an organ-specific autoimmune disease caused by the production of stimulating thyrotropin receptor antibodies. There are three treatment options for thyrotoxicosis: anti-thyroid drugs, radioactive iodine and thyroidectomy. A personalized approach to disease management is especially important in cases of genetic diseases.We present a clinical case of a patient with TS and GD, who has been referred to a radiologist at the Department of Radionuclide Therapy of Endocrinology Research Center. The patient was diagnosed with congenital hypothyroidism at neonatal screening, but thyroid hormones therapy was initiated aged three. Based on the survey, GD was diagnosed aged twenty one. Anti-thyroid drug therapy was started, which resulted in toxic hepatitis. Taking into account intolerance to anti-thyroid drugs, radioiodine therapy has been recommended, which led to hypothyroidism.

Рисунок 1. Алгоритм ведения пациента: от диагностики до лечения и наблюдения (адаптированный вариант) [28].Figure 1. Patient management algorithm: from diagnosis to treatment and observation (adapted version) [28].

Рисунок 2. Сцинтиграфия ЩЖ с 99mТс-пертехнетатом после внутривенного введения РФП (29.11.2021). Признаки диффузного усиления захвата РФП.Figure 2. Thyroid scintigraphy with 99mTc-pertechnetate after intravenous administration of radiopharmaceuticals (11/29/2021). Signs of diffuse enhancement of radiopharmaceutical capture.