Few J, Thompson N W, Angelos P, Simeone D, Giordano T, Reeve T
Department of Surgery, University of Michigan, Ann Arbor, USA.
Surgery. 1996 Dec;120(6):993-8; discussion 998-9. doi: 10.1016/s0039-6060(96)80045-6.
Riedel's thyroiditis is an often disabling disease with clinical and histologic similarity to several other fibrous inflammatory disorders. Surgical treatment alone is often unsatisfactory in permanently alleviating airway compression, dysphagia, neck immobility, pain, or chronic fatigue syndrome. Investigation of drugs shown to be of benefit in the treatment of related fibrous disorders in which hormonal factors or inflammatory deregulation appear to be important is indicated. Tamoxifen has not been previously used in the treatment of Riedel's thyroiditis.
Four patients with clinical and histologic diagnoses of Riedel's thyroiditis were evaluated before and after treatment with tamoxifen. Each had progressive symptomatic disease of 3 to 16 years' duration despite one or more surgical procedures and steroid therapy. Subjective improvement was noted in all cases, and objective changes were confirmed by periodic physical and computed tomographic examinations.
Patients have been monitored for 1 to 4 years with subjective improvement in 100% and objective disease regression ranging from 50% to 100% in all patients. One patient had complete regression within 6 months, and another had more than 50% regression within 3 months. All have returned to predisease activity levels. There were no significant side effects of the therapy.
Tamoxifen has proved to be the most effective drug therapy available for managing Riedel's thyroiditis. Our studies suggest that this is unrelated to antiestrogen activity. Tamoxifen's effectiveness may be caused by a mechanism by which it stimulates the release of transforming growth factor-beta, which may inhibit the fibroblastic proliferation characteristic of Riedel's thyroiditis.
里德尔甲状腺炎是一种常导致功能障碍的疾病，在临床和组织学上与其他几种纤维性炎症性疾病相似。仅手术治疗往往无法令人满意地永久缓解气道压迫、吞咽困难、颈部活动受限、疼痛或慢性疲劳综合征。对于在相关纤维性疾病治疗中显示有益的药物进行研究是有必要的，在这些疾病中激素因素或炎症失调似乎很重要。他莫昔芬此前尚未用于里德尔甲状腺炎的治疗。
对4例经临床和组织学诊断为里德尔甲状腺炎的患者在接受他莫昔芬治疗前后进行评估。尽管进行了一次或多次手术及类固醇治疗，但每位患者均患有病程为3至16年的进行性症状性疾病。所有病例均有主观改善，通过定期体格检查和计算机断层扫描检查证实了客观变化。
对患者进行了1至4年的监测，所有患者主观改善率达100%，客观疾病消退率为50%至100%。1例患者在6个月内完全消退，另1例在3个月内消退超过50%。所有患者均恢复到患病前的活动水平。该治疗没有明显副作用。
他莫昔芬已被证明是治疗里德尔甲状腺炎最有效的药物疗法。我们的研究表明，这与抗雌激素活性无关。他莫昔芬的有效性可能是由一种机制引起的，即它刺激转化生长因子-β的释放，这可能抑制里德尔甲状腺炎特有的成纤维细胞增殖。
