病例报告：与亚急性甲状腺炎相关的颅内高压

文献信息

中文摘要

背景： 亚急性甲状腺炎（SAT）是一种自限性炎症性甲状腺疾病，通常产生一过性甲状腺毒症期。颅内高压（IH）是甲状腺毒症的一种罕见但可能威胁视力的并发症，几乎仅报道于甲状腺功能亢进症，此前仅有一篇报告将其与SAT相关联。方法：我们报告一例29岁女性，在亚急性甲状腺炎的甲状腺毒症期发生IH，时间上与牙科操作相关。结果：她表现为头痛、恶心、呕吐和发热，随后出现晕厥发作；临床、实验室和影像学发现导致诊断为亚急性甲状腺炎伴明显甲状腺毒症。她后来出现双侧视力模糊和搏动性耳鸣，眼科评估显示双侧视乳头水肿，视力下降（右眼20/100，左眼20/33）和视野缺损。腰椎穿刺显示开放压力为47.6 cmH2O（35 mmHg），脑脊液成分正常；神经影像学未记录到静脉窦血栓形成或结构性病变。她开始接受乙酰唑胺和皮质类固醇治疗，随后视力恢复，尽管右眼下方视野缺损持续存在。结论：这是第二例报告的与亚急性甲状腺炎相关的IH病例。本病例强调，对于每一位新发或不明原因头痛的患者，都应进行眼底检查，因为视乳头水肿可能在视觉症状出现之前导致不可逆的视神经损伤，并且早期使用乙酰唑胺治疗，同时管理潜在的甲状腺疾病，可以预防永久性视力丧失。

英文摘要

Subacute thyroiditis (SAT) is a self-limited inflammatory thyroid disorder that typically produces a transient thyrotoxic phase. Intracranial hypertension (IH) is a rare but potentially sight-threatening complication of thyrotoxicosis, reported almost exclusively in hyperthyroidism, with only a single previous report linking it to SAT. We report the case of a 29-year-old woman who developed IH during the thyrotoxic phase of subacute thyroiditis, temporally related to dental manipulation. She presented with headache, nausea, vomiting, and fever, followed by a syncopal episode; clinical, laboratory, and imaging findings led to a diagnosis of subacute thyroiditis with overt thyrotoxicosis. She later developed bilateral visual blurring and pulsatile tinnitus, and ophthalmological evaluation showed bilateral papilledema with reduced visual acuity (20/100 right eye, 20/33 left eye) and visual field defects. Lumbar puncture demonstrated an opening pressure of 47.6 cmH2O (35 mmHg) with normal cerebrospinal fluid composition; neuroimaging did not document venous sinus thrombosis or structural lesions. She was started on acetazolamide and corticosteroids, with subsequent recovery of visual acuity, although an inferior visual field defect persisted in the right eye. This is the second reported case of IH associated with subacute thyroiditis. This case underscores that fundus examination should be performed in every patient with a new or unexplained headache, since papilledema may cause irreversible optic nerve damage before visual symptoms appear, and that early treatment with acetazolamide, together with management of the underlying thyroid disorder, can prevent permanent visual loss.