慢性甲状腺炎の長期観察例について:その組織所見を中心に

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It is generally believed that in the long-term observation of chronic thyroiditis, the goiter decreases in size with thyroid hormone therapy and the thyroid function drops gradually. On the other hand, the histological changes in so-called Hashimoto's thyroiditis have been recognized to show progressive loss of epithelium and increased fibrosis. In this study, goiter size, thyroid function, thyroid microsomal and thyroglobulin antibodies and histology in needle biopsy were investigated in 75 patients with chronic thyroiditis during an interval of more than ten years. Among 75 cases, 8 (11%) were hypothyroid at the first medical examination : Among 21 cases who received no treatment, 7 (33%) became hypothyroid during the period of more than ten years. Among 54 cases with thyroid hormone therapy, 16 (30%) showed a remark-able reduction in size of goiter, but among 21 cases without thyroid hormone therapy only 3 (14%) showed a remarkable reduction. This paper discusses changes in titers of thyroidal antibodies in 47 cases. Among these 47 cases, 21 increased titer of thyroglobulin antibody during the period of more than ten years. 10 (48%) out of these 21 cases showed a remarkable reduction in size of goiter. But among 11 cases with a decrease of titer of thyroglobulin antibody, only one (9%) showed a remarkable reduction in size of goiter. On the other hand, titer of thyroid microsomal antibody increased in 33 cases. 9 (27%) out of these 33 cases showed a remarkable reduction in size of goiter. Only one (13%) of 8 cases, which decreased titer of thyroid microsomal antibody, showed a remarkable reduction in size of goiter. Of the cases with less change in size of goiter during the period of more than ten years, we made comparative investigations of the histological changes between the cases with thyroid hormone therapy and the cases without therapy. The results revealed that there were no significant changes in histological pictures between the cases with treatment and those without it, and that histological pictures showed no marked change during the period of more than 10 years in both cases. In the cases whose goiter was diffusely enlarged at the initial diagnosis and showed a marked decrease in size by thyroid hormone therapy during the period of more than 10 years, the histological picture showed "typical Hashimoto's disease" with diffuse infiltration of lymphocytes and diffuse epithelial change. These data indicate that Hashimoto's disease does not always progress to fibrosis whether thyroid hormone is administered or not.
一般社団法人日本内分泌学会の論文

慢性甲状腺炎の長期観察例について:その組織所見を中心に

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