Onset of Graves' disease during long-term immunosuppressive therapy in a patient with membranous nephropathy.

摘要: A 67-year-old man was referred to our department for thyrotoxicosis with intermittent palpitation and 4-kg weight loss during the previous month. At first visit, patient treated cyclosporine (CyA) membranous nephropathy last 3 years 8 months. Laboratory studies revealed that serum TSH level <0.005 μU/ml, free thyroxine (fT4) triiodothyronine (fT3) levels were elevated at 2.76 ng/dl 5.96 pg/ml respectively. Anti-TSH receptor antibody (TRAb) increased 26.4%. clinical diagnosis of Graves' hyperthyroidism given, then thyrostatic treatment thiamazole (MMI) a dose 10 mg daily initiated after CyA withdrawal. After initiation MMI therapy, fT4 fT3 attained normal within 1.5 months, relief symptoms followed by remarkable decrease in urinary protein excretion from 2.0–5.2 g/day ≤0.03 g/day. The maintained euthyroid low titre TRAb succeeding 2 finally stopped. Neither relapse nor flare-up nephrotic syndrome observed discontinuation. has conflicting effects on immunologic self-tolerance modulation self-reactive T cells natural CD4+CD25+Foxp3+ regulatory cell (Treg) functions, possibly becomes triggering factor development autoimmune disorders. This case may be interesting when considering effect each subset disease. Learning points The balance between intrathyroidal Treg functions determine thyroid. CyA not only halts expansion but also impairs function Treg, which can provoke an unwanted immune response. A change thyroid autoimmunity result diseases (AITD). Renal involvement AITD frequently manifests as syndrome, effective excessive proteinuria.