在全身性紅斑狼瘡併發的自體免疫性甲狀腺功能低下症可被類固醇及奎寧類藥物導至正常化

Autoimmune-mediated Hypothyroidism in Systemic Lupus Erythematosus Can Be Normalized by Glucocorticoids and Hydroxychloroquine

病理性自體抗體在全身性紅斑狼瘡及自體免疫性甲狀腺疾病都扮演重要角色。自體免疫性甲狀腺疾病與很多非器官性的風濕免疫疾病有關，這包括全身性紅斑狼瘡、修格蘭氏症候群、巨細胞性動脈炎、類風濕性關節炎。在這裡我們報告三個甲狀腺功能低下症與全身性紅斑狼瘡共存的病例。在第一個病例中，我們注意到皮質類固醇或氫氧奎寧可能可幫助全身性紅斑狼瘡合併甲狀腺功能低下症的病人控制自體免疫性甲狀腺發炎及將不正常的甲狀腺功能轉變為正常。在第二個病例中，在原先就存在的甲狀腺功能低下症的病人所新發生的全身性紅斑狼瘡可能與自體免疫的情況惡化有關，而自體免疫的情況惡化包含了甲狀腺功能低下症的再發與新發生的全身性紅斑狼瘡。口服甲狀腺素在此病人已使用十年而在治療紅斑狼瘡一年後其劑量減為每兩天0.05毫克。在第三個病例中，甲狀腺功能低下症的發生是在全身性紅斑狼瘡診斷前不久。而甲狀腺功能自亢進轉變為低下發生在治療全身性紅斑狼瘡而使用類固醇及氫氧奎寧的時候。此外，皮質類固醇劑量的降低可能與自體免疫性甲狀腺功能低下症的甲狀腺功能惡化有關。總之，治療全身性紅斑狼瘡而使用的皮質類固醇及氫氧奎寧可能可幫助控制甲狀腺發炎及甲狀腺功能低下症。雖然這樣的假說有待更大型的研究來證賞。

Systemic lupus erythematosus (SLE) and autoimmune thyroid diseases are both marked by pathogenic autoantibodies. Autoimmune thyroid diseases have associated with a number of nonorgan-specific rheumatological disorders, including SLE, Sjögren's syndrome, giant cell arteritis, and rheumatoid arthritis. Here, we reported three cases of hypothyroidism co-existed with SLE. In case I, we noticed that corticosteroids or hydroxychloroquine may help to control autoimmune thyroid inflammation in SLE patients with hypothyroidism, and may turn abnormal thyroid function back to normal. In case II, emergence of SLE in pre-existing hypothyroidism exacerbated the autoimmune condition with thyroid hypofunction and lupus activity. Oral thyroxine supplement gradually decreased to 0.05 mg qod one year after treatment for SLE. In case III, hypothyroid function was diagnosed immediately before SLE. In addition, the transition of hyperthyroidism to hypothyroidism occurred in the medication of SLE with steroids and hydroxychloroquine. Unfortunately, we noted that along with the decreased dose of prednisolone, hypothyroidism seemed to be aggravated. Putting together, we suggest that corticosteroids and hydroxychloroquine for treating SLE activity are able to control thyroid inflammation and hypothyroid function. However, further investigation with a larger study is needed to confirm it.