Shigemasa C, Ueta Y, Mitani Y, Taniguchi S, Urabe K, Tanaka T, Yoshida A, Mashiba H
First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.
J Clin Endocrinol Metab. 1990 Feb;70(2):385-90. doi: 10.1210/jcem-70-2-385.
Clinical and laboratory findings and long term outcome (1.5-9 yr) in 7 women and 1 man with chronic thyroiditis (CT) who had painful tender thyroid enlargement were evaluated and compared with those in 11 women with subacute thyroiditis (SAT). Histological features consistent with SAT were not demonstrable, and various forms of CT (fibrous variant, diffuse, or focal lymphocytic thyroiditis) were observed. There were no differences in mean age, duration of symptoms, erythrocyte sedimentation rate, and C-reactive protein values in the 2 diseases. Seven patients had a history of goiter, and none had a history of a preceding upper respiratory tract infection. The mean white blood cell count was significantly lower in CT than in SAT patients. Six CT patients had transient thyrotoxicosis with a marked depression of radioactive iodine uptake. Mean serum T4 and T3 levels and T3 to T4 ratio in these 6 patients did not differ from those in the SAT patients. Five (all with high antimicrosomal antibody titers) of 8 CT patients developed persistent hypothyroidism. In contrast, none of the SAT patients became permanently hypothyroid. TSH binding inhibitory immunoglobulins and thyroid stimulation-blocking antibody at recent examination were negative in these 5 patients. Patients with this disorder present with transient thyrotoxicosis, with a marked depression of the thyroid radioactive iodine uptake, and often develop goitrous or atropic persistent hypothyroidism. This disorder may represent acute exacerbation of an underlying immunological process during the course of CT. To differentiate this syndrome from SAT, thyroid biopsy is necessary.
对7名女性和1名男性慢性甲状腺炎（CT）患者进行了评估，这些患者有甲状腺疼痛性肿大，并与11名亚急性甲状腺炎（SAT）女性患者的临床和实验室检查结果及长期预后（1.5 - 9年）进行了比较。未发现与SAT一致的组织学特征，观察到了各种形式的CT（纤维变体、弥漫性或局灶性淋巴细胞性甲状腺炎）。两种疾病在平均年龄、症状持续时间、红细胞沉降率和C反应蛋白值方面没有差异。7名患者有甲状腺肿病史，无一例有上呼吸道感染史。CT患者的平均白细胞计数显著低于SAT患者。6名CT患者出现短暂性甲状腺毒症，放射性碘摄取明显降低。这6名患者的平均血清T4和T3水平以及T3与T4比值与SAT患者无差异。8名CT患者中有5名（均有高抗微粒体抗体滴度）发生了持续性甲状腺功能减退。相比之下，SAT患者无一例永久性甲状腺功能减退。这5名患者近期检查时促甲状腺激素结合抑制性免疫球蛋白和甲状腺刺激阻断抗体均为阴性。患有这种疾病的患者表现为短暂性甲状腺毒症，甲状腺放射性碘摄取明显降低，且常发展为甲状腺肿性或萎缩性持续性甲状腺功能减退。这种疾病可能代表CT病程中潜在免疫过程的急性加重。为了将这种综合征与SAT区分开来，甲状腺活检是必要的。
