甲巯咪唑致甲状腺功能亢进症患儿关节炎综合征2例

Arthritis syndrome due to methimazole in 2 girls with hyperthyroidism

2例女性患儿(例1,10岁;例2,13岁)均因甲状腺功能亢进(甲亢)口服甲巯咪唑10 mg/次、2次/d,分别在用药18 d、20 d后出现关节疼痛。实验室检查示类风湿因子及抗核抗体系列均正常,考虑为甲巯咪唑所致关节炎综合征。例1立即停用甲巯咪唑,3 d后关节痛消失,转外科治疗原发疾病。例2逐渐减少甲巯咪唑剂量(5 mg/次、2次/d,用药3 d;5 mg/次、1次/d,用药2 d),但症状缓解不明显,遂停药,4 d后关节疼痛缓解。因甲亢复发,再次应用甲巯咪唑(早2.5 mg,晚1.25 mg)4个月时关节疼痛复现。停用甲巯咪唑,换用丙硫氧嘧啶18.75 mg/次、2次/d,2周后关节疼痛缓解,甲亢控制良好,1个月后关节疼痛完全消失。

Two girls (patient 1, 10 years old;patient 2, 13 years old) received methimazole 10 mg orally twice daily for hyperthyroidism. They developed arthralgia on day 18 and day 20 after medication, respectively. The laboratory tests showed normal rheumatoid factor and negative anti-nuclear antibody. Arthritis syndrome caused by methimazole was considered. Methimazole was stopped in patient 1 immediately. The arthralgia disappeared 3 days after drug withdrawal, and then she was transferred to department of surgery for treatment of primary disease. Patient 2 received gradually reduced dose of methimazole (5 mg twice daily for 3 days, 5 mg daily for 2 days) firstly, but the arthralgia did not improve. Then methimazole was stopped. Four days later, her arthralgia relieved. Patient 2 received methimazole 2.5 mg every morning and 1.25 mg every night again because of recurrence of hyperthyroidism. Four months after remedication, the arthralgia recurred. Methimazole was stopped again and replaced by propylthiouracil 18.75 mg twice daily. Two weeks later, her arthralgia relieved and hyperthyroidism was well controlled. One month later, her arthralgia disappeared.