ヨード粘液水腫の1例:3年間に亘る低ヨード食下の観察

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A 47-year-old housewife was admitted to our hospital because of general fatigue and constipation suggesting hypothyroidism. For 3 years before admission, general fatigue, arrhythmia, dry skin, drowsiness, cold intolerance and hypermenorrhea occurred insidiously. She had habitually taken considerable amounts of seaweed every day, e.g. more than 50 g of "Kombu" for more than 5 years and at least 1 g of "Wakame" for 6 months. On admission, serum thyroxine (T4) was 1.3 μg/dl, serum triiodothyronine (T3) was 47 ng/dl, TSH was 132 μU/ml, and 123I thyroidal uptake was 60% at 3 hr. and 75% at 24 hr. Anti-thyro-globulin hemagglutination antibodies and anti-thyroid microsomal hemagglutination anti-bodies were both negative. When seaweed was omitted from her diet, T4 rose to 6.3 μg/dl and T3 rose to 113 ng/dl, whereas TSH lowered to 11 μU/ml in 2 weeks. The seaweed-free diet was continued and 4 months later, when she had become euthyroid, an open biopsy of the thyroid gland was carried out. Histological examination of the specimen revealed a marked colloid deposition without characteristic features of Hashimoto's disease. Five months after admission, with the daily administration of 100 mg potassium iodide (KI), the effects of inorganic iodide on thyroid function had begun to be seen. On the 16th day of the KI regimen, palpitation and tachycardia (pulse rate 160/min.) with multifocal ventricular premature beat appeared, and T4 on the 11th day was 5.9 μg/di, which was clearly lower than the pretreatment level of 8.4 μg/dl. KI was discontinued on the 16th day, and one week after the withdrawal, T4 T3 and TSH all returned to the pretreatment level. For more than 3 years on a seaweed-free diet, she remained euthyroid without any thyroid regimen. To see the effects of inorganic iodide on thyroid function after this long period on a seaweed-free diet, KI was again administered. One hundred mg/day KI for 14 days followed by 200 mg/day for 21 days had virtually no effect on T4, T3 and free T4 and she remained well. None of the perchlorate discharge tests performed on 3 occasions during the 6 month period after the initiation of the seaweed-free diet showed a discharge. However, when a more sensitive iodide-perchlorate discharge test was performed at the end of the 3 year seaweed-free diet, it gave a positive result of 22% discharge, indicating that there was a mild organification defect. After 3 years and 5 months on a seaweed-free diet, she was allowed to take seaweed as found in the ordinary Japanese diet. Four months later, T4, T3, free T4 and TSH remained unchanged and she has been well up to the present time of writing. Although the precise mechanism why her thyroid became less sensitive to an inorganic iodide load after a long-term seaweed-free diet are not explainable by this type of clinical observation, the mildness of the organification defect might be the cause for the restoration of the escape mechanism from the Wolff-Chaikoff effect. In view of the above findings, it can be said that iodide myxedema with a mild organification defect is reversible not only functionally but also etiologically by inorganic iodide restriction alone.
一般社団法人日本内分泌学会の論文

ヨード粘液水腫の1例:3年間に亘る低ヨード食下の観察

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