Rubin R A, Guay A T
Section of Endocrinology, Lahey Clinic Medical Center, Burlington, Massachusetts.
Thyroid. 1991;1(2):157-61. doi: 10.1089/thy.1991.1.157.
Subacute thyroiditis is thought to be virally induced in genetically predisposed individuals because a strong association has been suggested recently between HLA-B35 and patients in whom subacute thyroiditis has developed. Two identical twin brothers were seen at our clinic with the same symptoms and date of onset of hyperthyroidism and enlargement and tenderness of the thyroid, which gave us a unique opportunity to study the genetic predisposition and treatment of this thyroid disease. Diagnostic criteria for subacute thyroiditis were met in both twins, including hyperthyroxinemia, suppression of thyroidal 123I uptake, increased erythrocyte sedimentation rate, transient painful goiter, and absence of antimicrosomal antibodies. Twin B was treated with corticosteroids, and a nonsteroidal anti-inflammatory agent was prescribed for Twin A. The mode of treatment used did not make a difference in affecting the course of the disease. The erythrocyte sedimentation rate was normal after 2 months from onset of symptoms. Results of viral studies were inconclusive. The same HLA typing was found in each twin: A3, B18, B35, Cw4, DR2, DRw10, DQw1. Thus, each was heterozygous for HLA-B35. We reviewed the literature and found a strong association between HLA-B35 and subacute thyroiditis in various ethnic groups tested. Our experience with these identical twins provides additional evidence to suggest that HLA-35 and perhaps Cw4 confer genetic susceptibility in acquiring subacute painful thyroiditis in a possible dominant mode of inheritance.
亚急性甲状腺炎被认为是在具有遗传易感性的个体中由病毒诱发的，因为最近有人提出 HLA - B35 与已患亚急性甲状腺炎的患者之间存在很强的关联。我们诊所接待了两名同卵双胞胎兄弟，他们有相同的症状，甲亢的发病日期相同，甲状腺肿大且有压痛，这为我们研究这种甲状腺疾病的遗传易感性和治疗提供了独特的机会。两名双胞胎均符合亚急性甲状腺炎的诊断标准，包括高甲状腺素血症、甲状腺 123I 摄取受抑制、红细胞沉降率升高、短暂性疼痛性甲状腺肿以及无抗微粒体抗体。双胞胎 B 接受了皮质类固醇治疗，双胞胎 A 则开具了一种非甾体抗炎药。所采用的治疗方式对疾病进程并无影响。症状出现 2 个月后红细胞沉降率恢复正常。病毒学研究结果尚无定论。在每个双胞胎中发现了相同的 HLA 分型：A3、B18、B35 和 Cw4、DR2、DRw10、DQw1。因此，两人均为 HLA - B35 杂合子。我们查阅了文献，发现在所检测的各个种族群体中，HLA - B35 与亚急性甲状腺炎之间存在很强的关联。我们对这些同卵双胞胎的经验提供了额外的证据，表明 HLA - 35 或许还有 Cw4 以可能的显性遗传方式赋予了患亚急性疼痛性甲状腺炎的遗传易感性。
