Moyamoya Disease and Thyrotoxic Painless Thyroiditis: A Case Report
摘要
A few cases of the coexistence of Moyamoya disease and Graves' disease have been reported. But there was no reported case of Moyamoya disease with thyrotoxic painless thyroiditis. A 55-year-old man experienced headache and loss of right temporal vision for one month. He did not have neck pain. Brain MRI showed acute infarct with cortical lamina necrosis at left occipital lobe. Invisible bilateral middle cerebral artery and adjacent collateral vessels were noted. Cerebral angiography was performed and the result was compatible with Moyamoya disease. Thyroid function test showed suppressed TSH and elevated free T4 level. Thyroid autoantibodies were initially negative. Anti-thyroid medication was started for concern of thyroid crisis during acute stroke. Thyroid scintigraphy with Technetium-99 was performed. Thyroid scan uptake was very low. A diagnosis of thyrotoxic painless thyroiditis was confirmed. Two weeks later, patient's thyroid function returned to normal. His anti-thyroid peroxidase antibody became slightly elevated but TSH receptor antibody was still negative. Anti-thyroid treatment was discontinued. Hyperthyroid state was thought to increase cerebral metabolic demand, altered cerebral perfusion and may thus precipitate cerebral ischemia. Development of Graves' disease after painless thyroiditis has been reported. Long term follow up of thyroid function and autoantibodies is necessary for this patient. (J Intern Med Taiwan 2014; 25: 20-24)