表现为难治性恐慌发作的格雷夫斯病：甲状腺闪烁扫描的诊断澄清
Graves' Disease Presenting as Refractory Panic Attacks: Diagnostic Clarification Through Thyroid Scintigraphy.
摘要(中文译文)
Graves病罕见地以突出的神经精神症状为主要表现，如严重的、难治性惊恐发作，从而导致被误诊为原发性精神障碍。我们描述了一位30岁女性患者，表现为难治性惊恐发作和夜惊，最初接受抗焦虑药和抗抑郁药治疗。尽管甲状腺功能检查结果波动，使诊断在进展中的甲状腺功能亢进症与甲状腺炎之间存在不确定性，但眼病和自主神经功能亢进的存在促使进一步评估。甲状腺闪烁显像显示弥漫性摄取，符合Graves病，并有效排除了甲状腺炎，从而使抗甲状腺治疗和普萘洛尔得以迅速启动。治疗后，患者临床显著改善，自主神经症状消失。本病例凸显了不典型Graves病表现的诊断挑战，并强调在对难治性神经精神症状的评估中考虑内分泌病因的重要性。功能影像学检查结合细致的临床评估，可能有助于解决临床与生化结果之间的不一致，并在部分表现不典型的患者中支持及时诊断。
Abstract
Graves' disease may rarely present with predominant neuropsychiatric symptoms, such as severe, treatment-resistant panic attacks, leading to misdiagnosis as a primary psychiatric disorder. We describe a 30-year-old woman with refractory panic attacks and night terrors who was initially treated with anxiolytics and antidepressants. Despite fluctuating thyroid function test results, which raised diagnostic uncertainty between evolving hyperthyroidism and thyroiditis, the presence of ophthalmopathy and autonomic hyperactivity prompted further evaluation. Thyroid scintigraphy demonstrated diffuse uptake consistent with Graves' disease and effectively excluded thyroiditis, allowing prompt initiation of antithyroid therapy and propranolol. Following treatment, the patient showed significant clinical improvement with resolution of autonomic symptoms. This case highlights the diagnostic challenge of atypical Graves' disease presentations and emphasizes the importance of considering endocrine causes in refractory neuropsychiatric symptoms. Functional imaging, alongside careful clinical assessment, may help resolve clinical-biochemical discrepancies and support timely diagnosis in selected patients with atypical presentations.
如何引用
AMA
Mahsa Satari Gholami. Graves' Disease Presenting as Refractory Panic Attacks: Diagnostic Clarification Through Thyroid Scintigraphy.. Clinical case reports. 2026; doi:10.1002/ccr3.73055.
APA
Mahsa Satari Gholami (2026). Graves' Disease Presenting as Refractory Panic Attacks: Diagnostic Clarification Through Thyroid Scintigraphy.. Clinical case reports. https://doi.org/10.1002/ccr3.73055
GB/T 7714
Mahsa Satari Gholami. Graves' Disease Presenting as Refractory Panic Attacks: Diagnostic Clarification Through Thyroid Scintigraphy.[J]. Clinical case reports, 2026 doi:10.1002/ccr3.73055.
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