Bando Y, Ushiogi Y, Toya D, Tanaka N, Fujisawa M
Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Japan.
Endocr J. 2001 Jun;48(3):323-9. doi: 10.1507/endocrj.48.323.
We report the case of a 64-year-old woman with rheumatoid arthritis (RA) associated with high grade fever, malaise, and painless swelling of thyroid gland. Laboratory findings showed severe systemic inflammatory reactions, including increases in various cytokines such as IL-6. Gallium-67 citrate imaging revealed intense uptake in the painlessly enlarged thyroid gland. Histologically, biopsied specimens of thyroid showed diffuse amyloid infiltrations, which included amyloid A (AA) protein. Biopsies of rectum and stomach revealed similar amyloid depositions, indicating that the amyloid had a secondary origin, potentially due to RA. All clinical symptoms were relieved by intravenous pulsatile administration of methylprednisolone followed by oral prednisone, resulting in prolonged hypothyroid status. To our knowledge, this is the first case report in Japan describing painless thyroiditis with severe inflammatory reactions in amyloid goiter.
我们报告了一例64岁患有类风湿性关节炎（RA）的女性病例，该患者伴有高热、全身不适以及甲状腺无痛性肿大。实验室检查结果显示存在严重的全身炎症反应，包括多种细胞因子如IL - 6升高。枸橼酸镓 - 67显像显示无痛性肿大的甲状腺摄取增强。组织学检查显示，甲状腺活检标本有弥漫性淀粉样物质浸润，其中包括淀粉样蛋白A（AA）。直肠和胃的活检显示有类似的淀粉样物质沉积，表明该淀粉样物质为继发性，可能与类风湿性关节炎有关。静脉注射甲泼尼龙冲击治疗后口服泼尼松，所有临床症状均得到缓解，但导致了甲状腺功能减退状态的延长。据我们所知，这是日本首例描述淀粉样甲状腺肿伴严重炎症反应的无痛性甲状腺炎的病例报告。
