Vayssairat M, Mimoun M, Houot B, Abuaf N, Rouquette A M, Chaouat M
Hôpital Tenon, Paris.
J Mal Vasc. 1997 Jul;22(3):198-9.
The silicone implant controversy wavers between reassuring epidemiological studies and about 300 case reports of patients developing a definite or incomplete/atypical connective tissue disease (CTD) after receiving a silicone gel-filled breast implant (SBI). Since Hashimoto's thyroiditis (HT) is rarely reported in this context, we report here two new cases of HT associated with a history of bilateral cosmetic SBIs. The first patient was a 45-year-old white woman who had SBIs in 1976. In 1991 she developed HT, evolving to thyroid deficiency which was compensated with levothyroxine treatment. In addition, the patient complained of fatigue, arthralgia, morning stiffness and developed a sicca syndrome necessitating artificial tears. The 1995 evaluation disclosed the presence of antinuclear antibodies at a titre of 1/640, and high level anti-thyroid microsomal antibodies (1/256,000). Gamma globulins rose to 22.6%. Thyroid ultrasonography showed an enlarged thyroid gland with a diffusely hypoechogenic pattern. The implants were painful, and in 1996 they were removed. Microscope examination of the fibrous capsule surrounding the prostheses showed extremely dense connective tissue with fibrosis. The second patient was a 55-year-old white woman who had SBIs in 1984. In 1995, she developed HT with clinical pain and tenderness of the thyroid gland, with mild hyperthyroidism and positive antithyroglobulin antibodies, and was given corticosteroid treatment for 5 months. In 1996, the implants were again painful and the patient developed positive antinuclear antibodies with a titre of 1/200. Ultrasonography showed a heterogeneous thyroid gland, and implant removal was advised. Hashimoto's thyroiditis is recognized as a subset of chronic auto-immune thyroiditis, and its association with SBI is rare. In these 2 observations, an association without relation is possible, but a future survey of similar cases seems warranted.
硅胶植入物的争议在令人安心的流行病学研究和大约300例患者在接受硅胶填充乳房植入物（SBI）后出现明确或不完全/非典型结缔组织病（CTD）的病例报告之间摇摆不定。由于桥本甲状腺炎（HT）在这种情况下很少被报道，我们在此报告两例与双侧美容性SBI病史相关的HT新病例。首例患者是一名45岁的白人女性，她于1976年接受了SBI。1991年她患上了HT，发展为甲状腺功能减退，通过左甲状腺素治疗得到了补偿。此外，患者抱怨疲劳、关节痛、晨僵，并出现了干眼症综合征，需要使用人工泪液。1995年的评估显示抗核抗体滴度为1/640，抗甲状腺微粒体抗体水平很高（1/256,000）。γ球蛋白升至22.6%。甲状腺超声显示甲状腺肿大，呈弥漫性低回声模式。植入物疼痛，1996年将其取出。对假体周围纤维囊的显微镜检查显示结缔组织极度致密并伴有纤维化。第二例患者是一名55岁的白人女性，她于1984年接受了SBI。1995年，她患上了HT，甲状腺出现临床疼痛和压痛，伴有轻度甲状腺功能亢进和抗甲状腺球蛋白抗体阳性，并接受了5个月的皮质类固醇治疗。1996年，植入物再次疼痛，患者抗核抗体阳性，滴度为1/200。超声显示甲状腺不均匀，建议取出植入物。桥本甲状腺炎被认为是慢性自身免疫性甲状腺炎的一个亚型，它与SBI的关联很少见。在这两例观察中，有可能存在无关联的关联，但未来对类似病例进行调查似乎是有必要的。
