Kinney J S, Hurwitz E S, Fishbein D B, Woolf P D, Pinsky P F, Lawrence D N, Anderson L J, Holmes G P, Wilson C K, Loschen D J
Division of Viral Diseases, Centers for Disease Control, Atlanta, Georgia 30333.
Am J Med. 1988 Jan;84(1):10-8. doi: 10.1016/0002-9343(88)90002-2.
Between January and March 1984, the first community outbreak of transient thyrotoxicosis in the United States was documented in a seven-county area of southeastern Nebraska; 36 of the total 49 patients resided in York County (2.4 cases per 1,000 population). The median age of patients was 36 years, range six to 82 years; 51 percent were women. By definition, all patients were symptomatic, visited a physician, and had a newly identified elevated serum concentration of thyroxine or triiodothyronine of unknown cause. None had a goiter or a painful thyroid gland. Low 131I uptake measurements were found in all nine patients studied. Six patients were hospitalized; none died. Investigation of all 12 household contacts of eight selected patients revealed five additional persons with thyrotoxicosis and four with asymptomatic hyperthyroxinemia. A case-control study revealed that illness was associated with a significantly higher frequency of a reported recent respiratory viral-like condition. In another case-control study, the HLA-DR3 antigen was present in more case subjects (39 percent) than control subjects (14 percent). In addition, a significantly higher proportion of patients than control subjects purchased beef from one of the three supermarkets in York Country. Concomitant with the outbreak, the supermarket implicated in the outbreak purchased an unusually large quantity of beef (7,000 pounds) from a nonregular supplier in Nebraska, which had reportedly instituted the practice of trimming gullets (a procedure that removes the muscles from bovine larynx for beef) about three months earlier. Thus, it is concluded that the Nebraska outbreak, like one in Minnesota that occurred 18 months later, probably resulted from patients having eaten ground beef that was contaminated with bovine thyroid gland. This form of thyrotoxicosis, perhaps misdiagnosed as painless thyroiditis in the past, probably represents a previously under-recognized public health problem.
1984年1月至3月间，美国首次记录到社区爆发短暂性甲状腺毒症，地点在内布拉斯加州东南部的一个七县地区；49名患者中有36名居住在约克县（每1000人口中有2.4例）。患者的年龄中位数为36岁，范围为6至82岁；51%为女性。根据定义，所有患者均有症状，看过医生，且血清甲状腺素或三碘甲状腺原氨酸浓度新发现升高，病因不明。无一例有甲状腺肿或甲状腺疼痛。在所有9名接受研究的患者中，均发现碘-131摄取量低。6名患者住院；无一例死亡。对8名选定患者的所有12名家庭接触者进行调查发现，另外有5人患有甲状腺毒症，4人患有无症状性甲状腺素血症。一项病例对照研究显示，患病与近期报告的类似呼吸道病毒感染的频率显著较高有关。在另一项病例对照研究中，病例组中HLA-DR3抗原的出现频率（39%）高于对照组（14%）。此外，与对照组相比，购买约克县三家超市之一牛肉的患者比例显著更高。在疫情爆发的同时，涉事超市从内布拉斯加州的一个非正规供应商那里购买了异常大量的牛肉（7000磅），据报道该供应商大约在三个月前开始实施修剪牛喉（一种从牛喉去除肌肉用于牛肉的程序）的做法。因此，得出结论，内布拉斯加州的这次疫情，就像18个月后在明尼苏达州发生的那次疫情一样，可能是由于患者食用了被牛甲状腺污染的绞碎牛肉所致。这种形式的甲状腺毒症，过去可能被误诊为无痛性甲状腺炎，可能代表了一个以前未被充分认识的公共卫生问题。
