dell'Aquila Massimiliano, De Matteis Alessandra, Bolino Giorgio, Urciuoli Paolo, Fineschi Vittorio, Maiese Aniello
Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Viale Regina Elena 336, 00161, Rome, Italy.
Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
Forensic Sci Med Pathol. 2019 Sep;15(3):509-512. doi: 10.1007/s12024-019-00094-6. Epub 2019 Feb 28.
In this paper we describe the case of an 81-year-old Caucasian female (142 cm tall, weighing 45 kg) who suffered from a multinodular goiter for approximately 40 years. Following the onset of a clinical condition characterized by acute respiratory failure, she was transported to the emergency room by ambulance, where she died within a few hours after admission. A recent cardiac examination showed the absence of risk factors for cardiovascular disease, sinus tachycardia with a heart rate of 131 bpm, negative objectivity for signs of cardiocirculatory failure, a blood pressure of 120/80 mmHg and modest exertional dyspnea. A recent hemochemical laboratory analysis showed a TSH value of 0.01microUI/mL, FT3 value of 4.76 pg/mL and FT4 value of 2.33 ng/mL, pointing to a pattern of hyperthyroidism, attributable to Basedow's goiter. Autopsy showed some peculiarities, and we came across two extremely rare findings; the thyroid gland had reached a very large size in relation to the patient's body mass (1510 g, in a patient of 142 cm and 45 kg), and the death of the patient was due to the development of a massive intra-thyroid hemorrhage that had caused acute external compression of the trachea. To the best of our knowledge this very rare event has not previously been reported in the international scientific literature.
在本文中，我们描述了一名81岁的白种女性（身高142厘米，体重45千克）的病例，她患有多结节性甲状腺肿约40年。在出现以急性呼吸衰竭为特征的临床症状后，她被救护车送往急诊室，入院后数小时内死亡。近期的心脏检查显示无心血管疾病风险因素，窦性心动过速，心率为131次/分钟，无心循环衰竭体征，血压为120/80 mmHg，有轻度劳力性呼吸困难。近期的血液生化实验室分析显示促甲状腺激素（TSH）值为0.01微国际单位/毫升，游离三碘甲状腺原氨酸（FT3）值为4.76皮克/毫升，游离甲状腺素（FT4）值为2.33纳克/毫升，表明存在甲状腺功能亢进模式，归因于突眼性甲状腺肿。尸检显示了一些特殊情况，我们发现了两个极其罕见的结果；甲状腺相对于患者体重已达到非常大的尺寸（在一名身高142厘米、体重45千克的患者中为1510克），患者死亡是由于甲状腺内大量出血的发生，导致气管急性外部受压。据我们所知，这一极为罕见的事件此前在国际科学文献中尚未有报道。
