Ikenoue H, Okamura K, Kuroda T, Sato K, Yoshinari M, Fujishima M
Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Clin Endocrinol Metab. 1988 Jul;67(1):41-5. doi: 10.1210/jcem-67-1-41.
We studied 2 men with a subacute thyroiditis-like syndrome (STLS) associated with systemic amyloidosis. Both had very tender, diffuse, firm goiters, low thyroidal radioactive iodine uptake values, and increased erythrocyte sedimentation rates. Glucocorticoid therapy resulted in dramatic improvement. Compared to 18 patients with subacute thyroiditis, these 2 men had 1) persistence of goiter even in remission, 2) repeated exacerbation of STLS, 3) pain always localized in the same site, and 4) gastrointestinal, renal, and cardiac abnormalities. Histological examination of the patients' thyroid glands revealed amyloid deposition and no evidence of subacute thyroiditis. In addition, 1 man had low T3 thyrotoxicosis with an elevated rT3/T3 ratio, suggesting impaired peripheral conversion of T4 to T3, and immunological and histological evidence of Hashimoto's thyroiditis. These findings suggest that thyroid amyloidosis may be associated with STLS. When patients with clinical features of subacute thyroiditis have an unusual course, the possibility of thyroid amyloidosis should be considered.
我们研究了2名患有与系统性淀粉样变性相关的亚急性甲状腺炎样综合征（STLS）的男性。两人均有非常疼痛、弥漫性、质地坚硬的甲状腺肿大，甲状腺放射性碘摄取值低，红细胞沉降率升高。糖皮质激素治疗带来显著改善。与18例亚急性甲状腺炎患者相比，这2名男性有以下情况：1）即使在缓解期甲状腺肿大仍持续存在；2）STLS反复加重；3）疼痛始终局限于同一部位；4）存在胃肠道、肾脏和心脏异常。对患者甲状腺进行组织学检查发现有淀粉样沉积，无亚急性甲状腺炎的证据。此外，1名男性存在低T3甲状腺毒症，rT3/T3比值升高，提示外周T4向T3的转化受损，并有桥本甲状腺炎的免疫学和组织学证据。这些发现表明甲状腺淀粉样变性可能与STLS有关。当具有亚急性甲状腺炎临床特征的患者病程异常时，应考虑甲状腺淀粉样变性的可能性。
