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The
th Annual Meeting of April 8-9, 2017 The Endocrine Society and The Diabetes Association of the R.O.C. (Taiwan)
PE-01
COCURRENT GRAVES’ DISEASE AND BILATERAL CAROTID ARTERY STENOSES (MOYAMOYA DISEASE): A CASE REPORT 1
SHIH-CHE HUA, 2PO-YEN YEH
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan; 2Division of Neurology, Department of Internal Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan
Background: Moyamoya disease is a cerebrovascular disorder characterized by bilateral stenoses or occlusion of the terminal portions of the internal carotid arteries accompanied by typical netlike collateral vessels at the base of the brain. Although higher incidence in Asians, it is very rare to report patients suffering Moyamoya disease and Graves’ disease simultaneously. We present a young lady with the diagnosis of concurrent Moyamoya disease and Graves’ disease. Case report: A 28-year-old lady with past history of Graves’ disease visited our hospital complaining of bilateral frontal headache followed by progressive weakness of his left arm, which had been getting worse for 3 days. An emergent head computed tomography showed one small acute infarction in the right parietal lobe; old infarction in the right frontal lobe, right corona radiata and left parietal lobe. /DERUDWRU\ GDWD VKRZHG ORZ 76+ ȝ,8 PO UHIHUHQFH DQG HOHYDWLRQ RI 7 reference: 84.6-201.8) and T4 (14.3 ng/ dl, reference: 4.6-12.0), abnormal AMIA: 1:6400(+). He was admitted to Neurology ward. A brain magnetic resonance imaging (MRI) scan showed acute infarct over right middle cerebral artery (MCA) territory. Computed tomography angiography (CTA) and magnetic resonance angiogram (MRA) all revealed bilateral carotid stenosis and the presence of collaterals. Laboratory screening tests for young stroke including protein C, protein S, and Rheumatologic exams all showed negative. As to treatment, antiplatelet therapy (Aspirin 300mg/day) and antithyroid therapy (methimazole 20mg/day combined with propranolol) were performed. After her neurological symptoms/signs improved, she was discharged and followed up at the clinic with the above mentioned drugs. Discussions: Although it has previously been reported, coexistence of Moyamoya disease and Graves’ disease is very rare. Moyamoya disease and Graves’ disease are with implicated genetic factors because one gene locus of Moyamoya disease (chromosome 8q23, MYMY3) is very close to that of autoimmune thyroid disease (8q23-24). There has not been available for optimal treatment yet. It has been suggested to use antiplatelet, antithyroid therapy, or revascularization surgery in some literatures.
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