亚急性甲状腺炎表现为甲状腺肿块、声带麻痹和高钙血症。

Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019, USA.

Endocr Pract. 2012 Mar-Apr;18(2):e17-20. doi: 10.4158/EP11201.CR.

OBJECTIVE

To report a case of subacute thyroiditis manifesting as a thyroid mass, vocal cord paralysis, and hypercalcemia.

METHODS

We describe the clinical, laboratory, and radiologic findings in a patient with an unusual clinical course of subacute thyroiditis.

RESULTS

A 65-year-old woman presented with a hoarse voice and an enlarging tender mass in the right side of the neck. On admission, thyroid function was consistent with thyrotoxicosis from subacute thyroiditis. Laboratory studies showed a corrected serum calcium concentration of 11.4 mg/dL, intact parathyroid hormone of 125 pg/mL, 25-hydroxyvitamin D of 12 ng/mL, and creatinine of 1.8 mg/dL. Computed tomography of the neck without use of a contrast agent showed a heterogeneous mass in the right side of the neck in conjunction with deviation of the trachea from right to left but without invasion of the trachea. Thyroid ultrasonography disclosed a heterogeneous mass in the right thyroid lobe measuring 4.7 cm by 5.5 cm by 4.5 cm. Flexible laryngoscopy revealed right vocal cord paralysis. Treatment with a course of prednisone yielded normalization of the serum calcium level, improvement in her voice, and a decrease in size of the thyroid mass. Four months after initial presentation of the patient, thyroid hormone levels became normal, she was clinically euthyroid, and she had a full recovery of her voice. Her serum calcium concentration was normal (9.8 mg/dL) in association with a near-normal parathyroid hormone level of 90 pg/mL. The 25-hydroxyvitamin D and creatinine values were also normal. Repeated thyroid ultrasonography showed a smaller right thyroid lobe with a dominant nodule measuring 2.0 cm by 1.3 cm by 1.4 cm in the right upper pole.

CONCLUSION

This case illustrates that subacute thyroiditis can have the unusual initial manifestations of a thyroid mass, vocal cord paralysis, and hypercalcemia. In similar patients, a trial of corticosteroid therapy may be warranted in an effort to improve clinical symptoms and thus avoid unnecessary surgical treatment.

目的

报告一例表现为甲状腺肿块、声带麻痹和高钙血症的亚急性甲状腺炎病例。

方法

我们描述了一例亚急性甲状腺炎患者不寻常临床过程的临床、实验室和影像学发现。

结果

一名 65 岁女性因声音嘶哑和右侧颈部长出触痛肿块就诊。入院时，甲状腺功能符合亚急性甲状腺炎引起的甲状腺毒症。实验室研究显示校正血清钙浓度为 11.4mg/dL，完整甲状旁腺激素为 125pg/mL，25-羟维生素 D 为 12ng/mL，肌酐为 1.8mg/dL。未使用造影剂的颈部计算机断层扫描显示右侧颈部存在不均匀肿块，同时气管向左侧偏斜，但未侵犯气管。甲状腺超声显示右侧甲状腺叶内有一个不均匀肿块，大小为 4.7cm×5.5cm×4.5cm。软式喉镜检查显示右侧声带麻痹。皮质类固醇治疗后，血清钙水平正常，声音改善，甲状腺肿块缩小。患者就诊后 4 个月，甲状腺激素水平恢复正常，临床甲状腺功能正常，声音完全恢复。她的血清钙浓度正常（9.8mg/dL），甲状旁腺激素水平接近正常（90pg/mL）。25-羟维生素 D 和肌酐值也正常。重复甲状腺超声显示右侧甲状腺上极有一个较小的右甲状腺叶，其中一个优势结节大小为 2.0cm×1.3cm×1.4cm。