Tamagno G, De Carlo E, Murialdo G, Scandellari C
Department of Medical and Surgical Sciences, Internal Medicine III, University of Padua, Padua, Italy.
Minerva Med. 2007 Dec;98(6):769-72.
The systemic involvement that often characterizes genetic hemochromatosis is well known. Although evidence of iron storage in endocrine glands has been reported, the possible functional changes due to altered thyroid in course of hemochromatosis have been not clearly defined so far. Thyroid may be directly affected by iron storage in the gland as well as functionally altered due to iron accumulation occurring in the pituitary. The prevalence and the pathogenetic mechanisms of primary thyroid illness in patients with genetic hemochromatosis are still largely unknown. Hereby, we describe two patients affected by genetic hemochromatosis who developed Hashimoto's thyroiditis. Taking into consideration the possible links occurring among iron overload, thyroid gland damage and thyroid dysfunction, we hypothesize that hemochromatosis could have been an enhancing factor for the development of primary thyroid disease in these patients. Potentially, this process might also determine new onset anti-thyroid autoimmunity or overlap it. We conclude that systematic studies in large and heterogeneous populations will be necessary in order to assess the risk of development of primary thyroid disorders in course of genetic hemochromatosis and, more generally, chronic iron overload conditions. In our mind, thyroid function should be periodically checked in all patients with chronic iron overload conditions.
遗传性血色素沉着症常具有的全身受累情况是众所周知的。尽管已有报道显示内分泌腺存在铁储存证据，但迄今为止，血色素沉着症病程中甲状腺改变所致的可能功能变化尚未明确界定。甲状腺可能会因腺体内的铁储存而直接受到影响，也可能因垂体中铁蓄积而发生功能改变。遗传性血色素沉着症患者原发性甲状腺疾病的患病率及发病机制在很大程度上仍不为人知。在此，我们描述了两名患有遗传性血色素沉着症并发展为桥本甲状腺炎的患者。考虑到铁过载、甲状腺损伤和甲状腺功能障碍之间可能存在的联系，我们推测血色素沉着症可能是这些患者原发性甲状腺疾病发生发展的一个促进因素。潜在地，这个过程也可能决定新发抗甲状腺自身免疫或与之重叠。我们得出结论，有必要在大量异质性人群中进行系统研究，以评估遗传性血色素沉着症病程中以及更普遍的慢性铁过载情况下原发性甲状腺疾病发生发展的风险。我们认为，所有慢性铁过载患者都应定期检查甲状腺功能。
