Yamaguchi K, Fukushima H, Uzawa H, Iseki T, Shiroozu A, Inoue K
Nihon Naibunpi Gakkai Zasshi. 1984 Jan 20;60(1):79-88. doi: 10.1507/endocrine1927.60.1_79.
A 47-year-old housewife was admitted to our hospital because of general fatigue and constipation suggesting hypothyroidism. For 3 years before admission, general fatigue, arrhythmia, dry skin, drowsiness, cold intolerance and hypermenorrhea occurred insidiously. She had habitually taken considerable amounts of seaweed every day, e.g. more than 50 g of " Kombu " for more than 5 years and at least 1 g of " Wakame " for 6 months. On admission, serum thyroxine (T4) was 1.3 micrograms/dl, serum triiodothyronine (T3) was 47 ng/dl, TSH was 132 microunits/ml, and 123I thyroidal uptake was 60% at 3 hr. and 75% at 24 hr. Anti-thyroglobulin hemagglutination antibodies and anti-thyroid microsomal hemagglutination antibodies were both negative. When seaweed was omitted from her diet, T4 rose to 6.3 micrograms/dl and T3 rose to 113 ng/dl, whereas TSH lowered to 11 microunits/ml in 2 weeks. The seaweed-free diet was continued and 4 months later, when she had become euthyroid, an open biopsy of the thyroid gland was carried out. Histological examination of the specimen revealed a marked colloid deposition without characteristic features of Hashimoto's disease. Five months after admission, with the daily administration of 100 mg potassium iodide (KI), the effects of inorganic iodide on thyroid function had begun to be seen. On the 16th day of the KI regimen, palpitation and tachycardia (pulse rate 160/min.) with multifocal ventricular premature beat appeared, and T4 on the 11th day was 5.9 micrograms/dl, which was clearly lower than the pretreatment level of 8.4 micrograms/dl. KI was discontinued on the 16th day, and one week after the withdrawal, T4, T3 and TSH all returned to the pretreatment level. For more than 3 years on a seaweed-free diet, she remained euthyroid without any thyroid regimen. To see the effects of inorganic iodide on thyroid function after this long period on a seaweed-free diet, KI was again administered. One hundred mg/day KI for 14 days followed by 200 mg/day for 21 days had virtually no effect on T4, T3 and free T4 and she remained well. None of the perchlorate discharge tests performed on 3 occasions during the 6 month period after the initiation of the seaweed-free diet showed a discharge.(ABSTRACT TRUNCATED AT 400 WORDS)
一名47岁的家庭主妇因全身乏力和便秘被收治入院，这些症状提示甲状腺功能减退。入院前3年，她逐渐出现全身乏力、心律失常、皮肤干燥、嗜睡、不耐寒及月经过多。她习惯每天食用大量海藻，例如5年多来每天食用超过50克“昆布”，6个月来每天至少食用1克“裙带菜”。入院时，血清甲状腺素（T4）为1.3微克/分升，血清三碘甲状腺原氨酸（T3）为47纳克/分升，促甲状腺激素（TSH）为132微单位/毫升，甲状腺摄碘123率3小时为60%，24小时为75%。抗甲状腺球蛋白血凝抗体和抗甲状腺微粒体血凝抗体均为阴性。当她的饮食中不再食用海藻时，2周内T4升至6.3微克/分升，T3升至113纳克/分升，而TSH降至11微单位/毫升。继续无海藻饮食，4个月后，当她甲状腺功能恢复正常时，进行了甲状腺开放活检。标本的组织学检查显示有明显的胶体沉积，无桥本氏病的特征性表现。入院5个月后，每天给予100毫克碘化钾（KI），开始出现无机碘对甲状腺功能的影响。在KI治疗方案的第16天，出现心悸和心动过速（心率160次/分钟），伴有多灶性室性早搏，第11天的T4为5.9微克/分升，明显低于治疗前水平8.4微克/分升。第16天停用KI，停药1周后，T4、T3和TSH均恢复到治疗前水平。在无海藻饮食3年多的时间里，她甲状腺功能正常，未接受任何甲状腺治疗。为观察在长期无海藻饮食后无机碘对甲状腺功能的影响，再次给予KI。每天100毫克KI，持续14天，随后每天200毫克，持续21天，对T4、T3和游离T4几乎没有影响，她状况良好。在开始无海藻饮食后的6个月期间，3次进行的过氯酸盐释放试验均未显示释放。（摘要截选至400字）
