张涛静　吴淑馨　谢培凤

[摘要] Graves病为自身免疫性甲状腺病，以甲状腺功能亢进症（简称“甲亢”）为主要表现，常表现为高代谢状态，并影响骨代谢，但临床上由于甲亢影响骨代谢，进而引发继发性甲状旁腺功能亢进症的却非常罕见。本文报道了1例Graves病诊断1个月后发生全身肌肉抽搐，经过详细检查发现甲状旁腺素（PTH）升高，最终明确诊断为继发性甲状旁腺功能亢进症。复习相关文献发现针对甲亢与PTH关系的研究基本都为单中心、非盲法研究，病例数较小，得出的结论也不一致。通过本病例报道，提示对于甲亢患者应提高警惕，常规检查PTH和血清游离钙水平，对于存在游离钙水平低、PTH水平高的患者，应提前补充钙片，预防骨质疏松发生。

[关键词] Graves病；继发性甲状旁腺功能亢进症；甲状旁腺素

[中图分类号] R581.1 [文献标识码] A [文章编号] 1673-7210（2016）10（b）-0165-03

[Abstract] Graves disease is an autoimmune thyroid disease. The hyperthyroidism is its main performance， usually with high metabolic state and affecting bone metabolism. However clinically it is very rare that hyperthyroidism affects bone metabolism and lead to secondary hyperparathyroidism. This paper reports one cases of Graves disease. The patient had the muscles twitch after one month of diagnosis. The final diagnosis is secondary hyperparathyroidism after a detailed examination with elevated PTH. Review of the literature find that researches on the relationship between hyperthyroidism and PTH are basically single center， non-blinded study with a small number of cases. The conclusion is also inconsistent. This this case report prompts that patients with hyperthyroidism should be vigilant， regular inspection of PTH and serum free calcium levels. The patients with the low level of free calcium and high PTH levels should advance calcium supplement to prevent osteoporosis.

[Key words] Graves disease； Secondary hyperparathyroidism； Parathyroid hormone

Graves病属于自身免疫性甲状腺病，临床表现为甲状腺功能亢进症（hyperthyroidism），简称甲亢，如多汗、易激动、烦躁、心悸、怕热、消瘦等[1]。由于Graves病呈现典型的高代谢状态，有不少患者会影响骨代谢，严重者甚至导致骨质疏松的发生，此类患者多为绝经后女性。本研究患者为年轻女性，甲亢症状不重，但发病时全身抽搐等症状明显，现报道并复习国内外相关报道及文献资料如下：

1 临床资料

患者女，33岁。主因心慌、心悸1个月，于2016年2月20日来北京中医药大学东方医院（以下简称“我院”）心血管科门诊就诊，当时无汗出、无怕热、无易饥多食及体重下降。心血管科医师查甲……