Ohshima T, Maeda H, Takayasu T, Fujioka Y, Nakaya T, Saito K, Nagano T
Department of Legal Medicine, Kanazawa University School of Medicine, Japan.
Nihon Hoigaku Zasshi. 1990 Aug;44(4):365-70.
A rare autopsy case of death due to thyroid crisis is reported. A 45-year-old lean woman with pigmentation of the skin was found dead at the seaside. The autopsy findings were as follows: The enlarged thyroid gland (35.5 g) had a histological finding of diffuse hyperplastic goiter (hyperthyroidism). The thymus (28.5 g) was enlarged and parenchymatous. The lymphocytes in the thymus and spleen were conspicuously proliferated, probably due to secondary adrenal cortex insufficiency. The adrenal cortex was slightly atrophic. Hemosiderin-laden macrophages in the lung, and centrilobular necrosis, microscopic bleeding, fibrosis, and nodular regenerative hyperplasia of the liver indicated the persisted heart failure. A small pericardial scar was found at the right ventricle of the heart (280 g), and the histological finding of the heart was only congestion. Acetone was detected in a relatively high concentration in the blood (72 micrograms/ml), urine (139 micrograms/ml), bile (32 micrograms/ml) and gastric contents (38 micrograms/g), probably due to metabolic disorder from thyroid crisis. In conclusion, the cause of death was diagnosed as sudden death due to thyroid crisis from hyperthyroidism.
报告了一例罕见的因甲状腺危象死亡的尸检病例。一名45岁、体型消瘦且皮肤有色素沉着的女性被发现死于海边。尸检结果如下：甲状腺肿大（35.5克），组织学检查发现为弥漫性增生性甲状腺肿（甲状腺功能亢进）。胸腺（28.5克）肿大且实质化。胸腺和脾脏中的淋巴细胞明显增殖，可能是由于继发性肾上腺皮质功能不全。肾上腺皮质稍有萎缩。肺内有含铁血黄素巨噬细胞，肝脏有小叶中心坏死、微小出血、纤维化及结节状再生性增生，提示存在持续性心力衰竭。在心脏右心室（280克）发现一个小的心包瘢痕，心脏组织学检查仅见充血。血液（72微克/毫升）、尿液（139微克/毫升）、胆汁（32微克/毫升）和胃内容物（38微克/克）中检测到相对较高浓度的丙酮，可能是由于甲状腺危象导致的代谢紊乱。总之，死因诊断为甲状腺功能亢进引起的甲状腺危象导致的猝死。
