Heufelder A E, Hay I D
Medizinische Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Germany.
Clin Investig. 1994 Oct;72(10):788-93. doi: 10.1007/BF00180548.
The etiology of Riedel's invasive fibrous thyroiditis, a rare disorder confused in the past with the more common fibrous variant of Hashimoto's disease, has remained obscure. However, the presence of mononuclear cells in the fibrosclerotic process and the detection of autoantibodies directed against thyroid-specific antigens in a large proportion of patients with invasive fibrous thyroiditis favor an autoimmune pathogenesis of invasive fibrous thyroiditis. Further, an association between invasive fibrous thyroiditis and Hashimoto's thyroiditis has been suggested. Here we report the first two patients in whom invasive fibrous thyroiditis evolved from antecedent Graves' disease, documented by the presence of thyroid dysfunction, bilateral ophthalmopathy, and thyrotropin receptor stimulating autoantibodies. The diagnosis of invasive fibrous thyroiditis was established in both instances on the basis of the established histopathological criteria. The presence of extensive mononuclear cell infiltration within the invasive fibrosclerotic process in these two patients, the close relationship between thyroid-specific autoantibodies, inflammatory parameters, and disease activity, and the response to glucocorticoid therapy all suggest the existence of a link between Graves' disease and invasive fibrous thyroiditis. These findings support the notion of autoimmune mechanisms playing a role in the pathogenesis of Riedel's invasive fibrous thyroiditis.
里德尔侵袭性纤维性甲状腺炎是一种过去常与更常见的桥本氏病纤维变体相混淆的罕见疾病，其病因一直不明。然而，在纤维硬化过程中存在单核细胞，并且在大部分侵袭性纤维性甲状腺炎患者中检测到针对甲状腺特异性抗原的自身抗体，这支持侵袭性纤维性甲状腺炎的自身免疫发病机制。此外，有人提出侵袭性纤维性甲状腺炎与桥本氏甲状腺炎之间存在关联。在此，我们报告了首例由先前的格雷夫斯病发展而来的侵袭性纤维性甲状腺炎患者，这一情况通过甲状腺功能障碍、双侧眼病以及促甲状腺素受体刺激自身抗体的存在得以证实。在这两例患者中，均根据既定的组织病理学标准确诊为侵袭性纤维性甲状腺炎。这两名患者的侵袭性纤维硬化过程中存在广泛的单核细胞浸润、甲状腺特异性自身抗体、炎症参数与疾病活动之间的密切关系以及对糖皮质激素治疗的反应，所有这些都表明格雷夫斯病与侵袭性纤维性甲状腺炎之间存在联系。这些发现支持自身免疫机制在里德尔侵袭性纤维性甲状腺炎发病机制中起作用这一观点。
