Hedberg C W, Fishbein D B, Janssen R S, Meyers B, McMillen J M, MacDonald K L, White K E, Huss L J, Hurwitz E S, Farhie J R
N Engl J Med. 1987 Apr 16;316(16):993-8. doi: 10.1056/NEJM198704163161605.
We report an outbreak of thyrotoxicosis without true hyperthyroidism that occurred between April 1984 and August 1985 among residents of southwestern Minnesota and adjacent areas of South Dakota and Iowa. One hundred twenty-one cases were identified through surveillance of medical clinics, laboratories, hospitals, and physicians' offices. Investigation of the outbreak demonstrated an association between the occurrence of thyrotoxicosis and the consumption of ground beef prepared from neck trimmings processed by a single slaughtering plant (odds ratio, 19.0; P = 0.0001). The cause was confirmed by the findings of bovine thyroid tissue in samples of these trimmings and high concentrations of thyroid hormone in implicated samples of ground beef and the demonstration of prompt increases in serum thyroid hormone concentrations in volunteers who ate the implicated ground beef. Bovine thyroid tissue had been introduced into the neck trimmings inadvertently during the process of "gullet trimming," a procedure that harvests muscles from the bovine larynx. The outbreak resolved after this procedure was discontinued at the plant. The clinical features of the illness suggested the diagnosis of silent thyroiditis, and it is possible that sporadic cases--or even outbreaks--of thyrotoxicosis factitia caused by this mechanism may have occurred in the past but were not recognized.
我们报告了1984年4月至1985年8月期间在明尼苏达州西南部以及南达科他州和爱荷华州相邻地区居民中发生的一次无真正甲状腺功能亢进的甲状腺毒症暴发。通过对医疗诊所、实验室、医院和医生办公室的监测，共确认了121例病例。对此次暴发的调查表明，甲状腺毒症的发生与食用由一家屠宰厂加工的颈部碎肉制成的绞碎牛肉之间存在关联（优势比为19.0；P = 0.0001）。在这些碎肉样本中发现牛甲状腺组织，在受牵连的绞碎牛肉样本中发现高浓度甲状腺激素，并且食用受牵连绞碎牛肉的志愿者血清甲状腺激素浓度迅速升高，这些发现证实了病因。在“食管修剪”过程中，牛甲状腺组织在无意中被引入颈部碎肉，“食管修剪”是一种从牛喉部采集肌肉的操作。该工厂停止此操作后，疫情得到解决。该疾病的临床特征提示为寂静性甲状腺炎的诊断，过去可能发生过由这种机制引起的人为甲状腺毒症的散发病例甚至暴发，但未被识别。
