司美格鲁肽注射液致甲状腺功能亢进

Hyperthyroidism caused by semaglutide injection

1例31岁女性为减重自行皮下注射司美格鲁肽注射液(司美格鲁肽)。3个月后体检,心电图提示窦性心动过速,实验室检查示三碘甲状腺原氨酸(T3)2.75-nmol/L、甲状腺素(T4)199.86-nmol/L、游离三碘甲状腺原氨酸(FT3)11.31-pmol/L、游离甲状腺素(FT4)46.63-pmol/L、促甲状腺激素(TSH)<0.005 mU/L。考虑为司美格鲁肽导致的窦性心动过速和甲状腺功能亢进,停用该药,给予甲巯咪唑10-mg口服、2次/d和美托洛尔25-mg口服、2次/d。治疗1个月余,患者心电图正常,复查甲状腺功能:T3-1.79-nmol/L、T4-127.33-nmol/L、FT3-4.94-pmol/L、FT4-15.87-pmol/L、TSH<0.005 mU/L。但患者出现肝酶升高:丙氨酸转氨酶327-U/L、天冬氨酸转氨酶148-U/L、γ-谷氨酰转移酶123.4-U/L。停用甲巯咪唑和美托洛尔,给予水飞蓟宾140-mg口服、3次/d和双环醇50-mg、3次/d治疗。1个月余后,患者甲状腺功能和肝功能均恢复正常,停用水飞蓟宾和双环醇。之后多次复查甲状腺功能、肝功能和心电图,均正常。

A 31-year-old woman received semaglutide injection subcutaneously for weight loss.Three months later,the electrocardiogram showed sinus tachycardia,and the laboratory tests showed triiodothyronine(T3)2.75-nmol/L,thyroxine(T4)199.86-nmol/L,free triiodothyronine(FT3)11.31-pmol/L,free thyroxine(FT4)46.63-pmol/L,thyroid-stimulating hormone(TSH)<0.005 mU/L.Considering the sinus tachycardia and hyperthyroidism caused by semaglutide injection,the drug was discontinued,and methimazole 10-mg orally,twice daily and metoprolol 25-mg orally twice daily were given.After treatment for more than 1 month,the electrocardiogram of the patient was normal,and the thyroid function examination showed T3-1.79-nmol/L,T4-127.33-nmol/L,FT3-4.94-pmol/L,FT4-15.87-pmol/L,and TSH<0.005 mU/L.However,there were elevated liver enzymes,showing alanine aminotransferase 327-U/L,aspartate aminotransferase 148-U/L,andγ-glutamyl transpeptidase 123.4-U/L.Then,methimazole and metoprolol were stopped,and silibinin 140-mg orally thrice daily combined with bicyclol 50-mg thrice daily were given.More than 1 month after treatments,the patient′s thyroid function and liver function were normal,and silibinin and bicyclol were stopped.After that,the thyroid function,liver function and electrocardiogram were all normal in repeated examinations.