Lohwasser S, Wagner H M, Arndt H, Bross K, Andreesen R
Abteilung für Hämatologie und Internistische Onkologie, Universität Regensburg.
Dtsch Med Wochenschr. 1997 Sep 5;122(36):1070-4. doi: 10.1055/s-2008-1047730.
A 24-year-old woman with osteosarcoma of the right thigh, diagnosed 12 years ago, complained at a follow-up examination of decreased exercise tolerance, increased nervous tension, heat intolerance, weight loss, hair loss and irregular stools. Examination revealed tachycardia (100/min), mild exophthalmus and a small goitre.
A decreased basal TSH level (0.002 mU/ml), raised peripheral thyroid hormone (fT4 6.7 ng/dl, total T3 7.8 micrograms/l) and a TSH receptor antibody titre of 33.4 U/l) were compatible with immune type Graves' disease. Radiology revealed an upper mediastinal space-occupying lesion which scintigraphically was separate from thyroid tissue. A metastasis of the osteosarcoma or thymus hyperplasia were considered the most likely cause.
The mediastinal lesion regressed under thyrostatic treatment with carbimazole (20 mg daily by mouth). But the clinical picture, localization and negative scintigraphy provided the diagnosis of transitory thymus hyperplasia in the course of Graves' disease.
In immune type Graves' disease with a mediastinal space-occupying lesion, not only intrathoracic goitre but also thymus hyperplasia should be considered in the differential diagnosis.
一名24岁女性，12年前被诊断为右大腿骨肉瘤，在一次随访检查中诉运动耐量下降、神经紧张加剧、不耐热、体重减轻、脱发及大便不规律。检查发现心动过速（100次/分钟）、轻度突眼及小甲状腺肿。
基础促甲状腺激素水平降低（0.002 mU/ml）、外周甲状腺激素升高（游离甲状腺素4 6.7 ng/dl，总三碘甲状腺原氨酸7.8微克/升）以及促甲状腺激素受体抗体滴度为33.4 U/l，符合免疫性格雷夫斯病。放射学检查显示上纵隔占位性病变，闪烁扫描显示该病变与甲状腺组织分离。骨肉瘤转移或胸腺增生被认为是最可能的病因。
在使用卡比马唑（每日口服20毫克）进行甲状腺抑制治疗后，纵隔病变消退。但临床表现、病变定位及闪烁扫描阴性结果提示为格雷夫斯病过程中的暂时性胸腺增生。
在患有纵隔占位性病变的免疫性格雷夫斯病中，鉴别诊断时不仅应考虑胸内甲状腺肿，还应考虑胸腺增生。
