Nishikawa M, Yoshimura M, Yoshikawa N, Toyoda N, Yonemoto T, Ogawa Y, Mori S, Tabata S, Tokoro T, Sakaguchi N, Inada M
Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Endocr J. 1997 Aug;44(4):571-4. doi: 10.1507/endocrj.44.571.
A 44-year-old woman developed hyperthyroidism due to the coexistence of Graves' disease and an autonomously functioning thyroid nodule (AFTN). Anti-thyrotropin receptor antibody (TRAb) was strongly positive (83.2%), and a thyroid scan initially showed diffuse uptake of Tc-99m pertechnatate in both lobes and further increased uptake in accordance with the right lobe nodule. The nodule in the right lobe was histologically diagnosed as thyroid follicular adenoma. After she was maintained in a euthyroid state by treatment with Methymazole (MMI), thyroid uptake of Tc-99m in the nodule became lower and was slightly suppressed by T3 administrations probably due to its dependence on TSH. Subtotal thyroidectomy was performed and she subsequently became euthyroid with negative TBII activity. It is concluded that she had a coexisting functioning nodule with Graves' disease (Marine-Lenhart syndrome) and that the nodule changed from hot to cool along with the anti-thyroid treatment, unlike usual cases of this syndrome showing a cold nodule on the initial imaging under the hyperthyroid state. Repeated Tc-99m pertechnatate thyroid scans were helpful in evaluating the reaction of MMI and TSH in both lesions separately in the present case.
一名44岁女性因格雷夫斯病（Graves' disease）与自主功能性甲状腺结节（AFTN）并存而出现甲状腺功能亢进。抗促甲状腺素受体抗体（TRAb）呈强阳性（83.2%），甲状腺扫描最初显示双侧叶均有Tc-99m高锝酸盐弥漫性摄取，且随着右叶结节摄取进一步增加。右叶结节经组织学诊断为甲状腺滤泡性腺瘤。在用甲巯咪唑（MMI）治疗使其维持在甲状腺功能正常状态后，结节中Tc-99m的甲状腺摄取降低，且可能由于其对促甲状腺激素（TSH）的依赖性，T3给药后摄取略有抑制。行甲状腺次全切除术，随后她甲状腺功能恢复正常，促甲状腺素受体刺激性抗体（TBII）活性为阴性。结论是她患有格雷夫斯病合并功能性结节（Marine-Lenhart综合征），且与该综合征通常情况下在甲状腺功能亢进状态下初始影像显示冷结节不同，该结节随着抗甲状腺治疗从热结节变为冷结节。在本病例中，重复进行Tc-99m高锝酸盐甲状腺扫描有助于分别评估MMI和TSH在两个病变中的反应。
