A case of Sjoegren's syndrome diagnosed on eleventh year after the operation of thyroid tumor.

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Sjögren's Syndrome (SjS) frequently supervenes diseases of other organs such as rheumatoid arthritis, chronic thyroiditis or chronic active hepatitis. Recently, we encountered a case which showed dry mouth seven years after thyroid tumor surgery and diagnosed as SjS at the fourth year of sicca condition. The patient was a 74-year-old Japanese female who was initially examined in our clinic on April 16, 1985 with a chief complaint of xerostomia. In her past history, there were hysterectomy and ovariectomy at age 37. Around that time she noticed a tumor in her neck which was treated by medication. She underwent surgery for volvuls at 43 and for thyroid adenocarcinoma at age 63. However the latter showed local recurrence 3 years later and metastasis (rice grain size) in the right parotid gland another 4 years, both had been successfully resected. Pyeronephritis developed at age 73. She had no experience of radiotherapy. Her familyhistory disclosed cancer, hypertension and allergy. As for the history of present illness, dry mouth appeared at age 70 when she underwent parotid gland operation. Her physique and nutritional status on our initial examination were moderate. There was oligosialia. The tongue surface was slightly smooth and red, and oral mucosa was thin and atrophic. Her residual teeth were 6 incisors and 4 canines in upper and lower jaws with several decays. While the peripheral blood and liver function tests were within normal limits, remarkable sicca syndrome related data were obtained as follows: total protein was 8.7mg/dl; γ-globulin 21.2%; ESR 32mm/h; RA test 2+; and amylase isozime-S 20.8 SU. The result of biopsy of the minor salivary gland was grade 2, with aggregate inflammatory cells. Scintigraphy by TcO4- visualized a defect on right side of the thyroid gland and a flat time activity curve in every salivary gland. Sialography on left parotid gland showed typical globular pattern. The diagnosis of SjS was made. The patient is now under symptomatic therapy with artificial saliva, bromhexin and lysozyme. Considering the well known association of Hashimoto's chronic thyroiditis with SjS, it was speculated that the long term presence of thyroid tumor induced some type of immunological disorder in the host to lead to SjS.
社団法人日本口腔外科学会の論文

A case of Sjoegren's syndrome diagnosed on eleventh year after the operation of thyroid tumor.

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