de Bruin T W, Riekhoff F P, de Boer J J
Department of Endocrinology, University Hospital, Utrecht, The Netherlands.
J Clin Endocrinol Metab. 1990 Feb;70(2):396-402. doi: 10.1210/jcem-70-2-396.
We describe an epidemic of self-limited (6 weeks) thyrotoxicosis which affected 12 index cases, 5 household contacts, and 6 retrospectively identified cases in July, August, and September, 1987 in the town of Winterswijk (28,011 inhabitants), The Netherlands. A small goiter was present in 9 of the 12 index patients, tender upon palpation in only 2. Signs and symptoms of thyrotoxicosis were accompanied by a low grade fever in combination with fatigue, headache, myalgia, and a fine desquamation of the palms and soles. The apparent incubation time between family members was 6 days. Thyroid technetium uptake was decreased in 10 of 11 tested patients. Laboratory findings included elevated sedimentation rates (up to 68 mm/h), increased liver enzymes, lymphopenia in 2 patients, and absence of thyroid autoantibodies. HLA-B35, associated with classical subacute thyroiditis, was found in 1 patient only. An etiological agent was not identified. No evidence was found for thyrotoxicosis factitia. After 10 months, all patients were euthyroid, without a goiter or thyroid autoantibodies. Thus, a new variant of thyroiditis, atypical subacute thyroiditis, was probably the cause of this unusual outbreak. It is unclear at present if this variant of thyroiditis is common in communities and represents a separate disease entity.
我们描述了一场自限性（6周）甲状腺毒症的流行，该流行于1987年7月、8月和9月在荷兰温特斯韦克镇（有28,011名居民）发生，累及12例索引病例、5名家庭接触者以及6例回顾性确诊病例。12例索引患者中有9例存在小甲状腺肿，仅2例触诊时有压痛。甲状腺毒症的体征和症状伴有低热，并伴有疲劳、头痛、肌痛以及手掌和脚底的细小脱屑。家庭成员之间的明显潜伏期为6天。11例接受检测的患者中有10例甲状腺锝摄取减少。实验室检查结果包括血沉升高（最高达68毫米/小时）、肝酶升高、2例患者淋巴细胞减少以及无甲状腺自身抗体。仅1例患者发现与经典亚急性甲状腺炎相关的HLA - B35。未鉴定出病原体。未发现人为甲状腺毒症的证据。10个月后，所有患者甲状腺功能恢复正常，无甲状腺肿或甲状腺自身抗体。因此，一种新的甲状腺炎变体，非典型亚急性甲状腺炎，可能是此次异常暴发的原因。目前尚不清楚这种甲状腺炎变体在社区中是否常见以及是否代表一种独立的疾病实体。
