Saito Takatoshi, Tojo Katsuyoshi, Tajima Naoko
Division of Diabetes, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo.
Intern Med. 2010;49(2):167-70. doi: 10.2169/internalmedicine.49.2782. Epub 2010 Jan 15.
The serum thyroid stimulating hormone (TSH) level is decreased in acromegalic patients. Although this phenomenon is thought to be caused by the enhanced secretion of somatostatin which suppresses TSH production, it has not yet been proven. We describe a 60-year-old woman with acromegaly who showed a low concentration of TSH. We diagnosed her as painless thyroiditis based on an increased level of thyroglobulin, depressed radioactive iodine uptake (RAIU), normal vascularity and mild swelling of the thyroid, and normal T3, T4, free T3 and free T4 levels. To our knowledge, this is the second reported case of acromegaly complicated by painless thyroiditis. The differential diagnosis between central hypothyroidism and painless thyroiditis is so important. Since it is difficult to diagnose precisely based on only the data of a low level of TSH and normal levels of thyroid hormones, we consider that measurement of thyroglobulin and RAIU is necessary when the complication of painless thyroiditis is suspected.
肢端肥大症患者的血清促甲状腺激素（TSH）水平降低。尽管这种现象被认为是由抑制TSH产生的生长抑素分泌增加所致，但尚未得到证实。我们描述了一名60岁的肢端肥大症女性，其TSH浓度较低。基于甲状腺球蛋白水平升高、放射性碘摄取（RAIU）降低、甲状腺血管正常及轻度肿大，以及T3、T4、游离T3和游离T4水平正常，我们将她诊断为无痛性甲状腺炎。据我们所知，这是第二例报道的肢端肥大症合并无痛性甲状腺炎的病例。中枢性甲状腺功能减退与无痛性甲状腺炎之间的鉴别诊断非常重要。由于仅根据TSH水平低和甲状腺激素水平正常的数据难以准确诊断，我们认为当怀疑有无痛性甲状腺炎并发症时，有必要检测甲状腺球蛋白和RAIU。
