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淀粉样变甲状腺肿:一组秘鲁病例

Amyloid Goiter: A Peruvian Case Series.

作者信息

Paz-Ibarra José, Concepción-Zavaleta Marcio, Quiroz-Aldave Juan Eduardo, Somocurcio-Peralta José, Haro María Belén Tite, Solis-Pazmino Paola

机构信息

Department of Medicine, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru.

Division of Endocrinology, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú.

出版信息

touchREV Endocrinol. 2024 Oct;20(2):124-129. doi: 10.17925/EE.2024.20.2.16. Epub 2024 Apr 2.

Abstract

: Amyloid goiter (AG) is a rare cause of thyroid swelling, characterized by deposits of amyloid protein in the thyroid tissue. It can be associated with primary or secondary amyloidosis. Its prevalence in multinodular goiter cases is 0.17%, with rare clinical detection before surgery. This Peruvian case series comprised three female patients and one male patient, with ages ranging from 28 to 65 years. All individuals had pre-existing inflammatory diseases and reported symptoms including dyspnoea, dysphagia and dysphonia. Upon physical examination, all patients exhibited a grade III goiter. Fine-needle aspiration reported colloid goiter. Three out of the four patients underwent total thyroidectomy and histochemistry revealed AG with positive Congo red staining. AG is an uncommon clinical entity. It has been reported to occur more frequently in males, with an average age of diagnosis of 40 years. In our series, we observed a broad age range of patients receiving diagnoses, spanning from 28 to 65 years, with a predominance in females. The consideration of AG should be extended to every patient with an underlying chronic systemic inflammatory disease, especially end stage renal disease. In this context, AG should be included in the differential diagnosis for patients with multinodular goiter exhibiting progressive growth and causing compressive symptoms at the cervical level without affecting thyroid function, as demonstrated in our series. AG, a rare condition, warrants suspicion in the presence of a giant goiter with an underlying systemic inflammatory disease.

摘要

淀粉样甲状腺肿(AG)是甲状腺肿大的罕见原因,其特征是淀粉样蛋白沉积于甲状腺组织。它可与原发性或继发性淀粉样变性相关。在多结节性甲状腺肿病例中的患病率为0.17%,术前临床检出罕见。该秘鲁病例系列包括3名女性患者和1名男性患者,年龄在28至65岁之间。所有个体均有既往炎症性疾病,报告的症状包括呼吸困难、吞咽困难和声音嘶哑。体格检查时,所有患者均表现为III度甲状腺肿。细针穿刺报告为胶样甲状腺肿。4名患者中有3名接受了全甲状腺切除术,组织化学检查显示为AG,刚果红染色阳性。AG是一种不常见的临床实体。据报道,它在男性中更常见,平均诊断年龄为40岁。在我们的系列中,我们观察到接受诊断的患者年龄范围广泛,从28岁到65岁,女性占主导。对于每一位患有潜在慢性全身性炎症性疾病的患者,尤其是终末期肾病患者,都应考虑AG。在这种情况下,如我们的系列所示,对于表现为进行性生长并在颈部引起压迫症状但不影响甲状腺功能的多结节性甲状腺肿患者,AG应纳入鉴别诊断。AG是一种罕见疾病,在存在伴有潜在全身性炎症性疾病的巨大甲状腺肿时应引起怀疑。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a489/11548356/60616f593c8e/touchendo-20-2-124-g001.jpg

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