Kawano Atsuko, Kohno Hitoshi
Department of Endocrinology and Metabolism, Fukuoka Children's Hospital, Fukuoka, Japan.
Clin Pediatr Endocrinol. 2011 Jul;20(3):61-4. doi: 10.1297/cpe.20.61. Epub 2011 Oct 7.
Thymic hyperplasia associated with Graves' disease is rarely reported in children, although it is not uncommon in adults. Occasionally, an enlarged thymus presents as an anterior mediastinal mass on a radiographic examination. Such patients often undergo invasive procedures such as a thymus biopsy or thymectomy because of suspected malignancy. However, an enlarged thymus with Graves' disease is known to shrink after treatment with antithyroid drugs. Therefore, recognition of this benign course would avoid unnecessary surgical resection. This report presents the case of a 10-yr-old boy with Graves' disease complicated with an anterior mediastinal mass. Computed tomography showed a homogenous mass with no invasion into the surrounding tissue. A gallium-67 scintigraphy showed no abnormal uptake. Shrinkage of the mass after treatment with an antithyroid drug (methyl-mercaptoimidazole) supported the diagnosis of thymic hyperplasia with Graves' disease. This case report illustrates two important points. First, pediatricians should be aware that thymic hyperplasia can coexist with Graves' disease, even in children. Second, close radiographic assessment would support a diagnosis of thymic hyperplasia and eliminate invasive diagnostic procedures.
与格雷夫斯病相关的胸腺增生在儿童中鲜有报道，尽管在成人中并不罕见。偶尔，胸腺肿大在影像学检查中表现为前纵隔肿块。由于怀疑为恶性肿瘤，此类患者常接受胸腺活检或胸腺切除术等侵入性检查。然而，已知格雷夫斯病伴胸腺肿大的患者在接受抗甲状腺药物治疗后胸腺会缩小。因此，认识到这种良性病程可避免不必要的手术切除。本报告介绍了一名10岁患格雷夫斯病并伴有前纵隔肿块的男孩病例。计算机断层扫描显示为均匀肿块，未侵犯周围组织。镓-67闪烁扫描未显示异常摄取。使用抗甲状腺药物（甲巯咪唑）治疗后肿块缩小，支持格雷夫斯病伴胸腺增生的诊断。本病例报告说明了两个要点。第一，儿科医生应意识到胸腺增生可与格雷夫斯病共存，即使在儿童中也是如此。第二，密切的影像学评估有助于胸腺增生的诊断，并可避免侵入性诊断检查。
