腺腫様甲状腺腫における甲状腺機能充進症について

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It has been reported that the occurrence of hyperthyroidism from large adenomatous goiter is high in America. Furthermore, many studies in recent years have demonstrated that the Thyrotropin (TSH) response to Thyrotropin Releasing Hormone (TRH) in clinical euthyroid patients with adenomatous goiter resulted in failure. However, there has been no data on the incidence of hyperthyroidism in patients with adenomatous goiter in Japan. The present paper reports the incidence of hyperthyroidism in a large number of patients with adenomatous goiter in Japan. Three hundred and fourteen patients (29 males and 285 females, aged 12-74) with adenomatous goiter are included in this study. The diagnosis of adenomatous goiter depends on the microscopic criteria described by Meissner and Warren, regardless of the nodularity of goiter. The resected goiter weight of these patients ranged from 2.8 to 280.5 gm. Serum concentrations of T3, T4 and TSH were measured in these patients. Furthermore, a TRH test was performed on 51 (3 males and 48 females, aged 13-64) out of 314 patients, who were supposed to be euthyroid from T3 T4 and clinical findings. 500 μg TRH were injected intravenously. Blood samples for TSH determination were taken before and 15, 30 and 60 min. after injection. Serum T3, T4 and TSH were measured by using commercial kits (T3 RIA kit, T4 RIA kit and TSH RIA kit, Dainabot Japan). One hundred and sixty-four subjects (54 males and 110 females, aged 10-74), who had no clinical suspicion of thyroid disease and were apparently healthy, served as normal controls. Serum T3 T4 and TSH values in the control subjects were 117.1 ± 18.4 ng/dl (mean ± SD), 10.3 ± 1.6μg/dl, and 3.0 ± 2.1μU/ml respectively. Peak increment of serum TSH concentration from baseline after TRH administration (_??_TSH) in 15 control subjects ranged from 5 μU/ml to 30 μU/ml. The serum concentration of T3 in 314 patients was 123.8 ± 50.1 ng/dl (mean ± SD), T4 was 10.4 ± 3.1 μg/dl, and TSH was 2.0 ± 1.4μ.U/ml. While serum concentrations of T3 and T4 were within the normal range in most of the patients, 7 out of 314 patients had overt thyrotoxicosis and were treated with an antithyroid drug. Two out of 9 thyrotoxic patients had a multinodular goiter, and others had a single nodular goiter. The incidence of thyrotoxicosis was higher in elderly patients and patients who had had the condition over a long period. TSH response to TRH was undetectable (_??_TSH≤-1μU/ml) in 3 (5.9%) and low (_??_TSH <5μU/ml) in 6 (11.8%) of 51 patients. These 9 patients had multinodular goiter. The elderly patients with a long duration of goiter had a tendency to be in a state of reduced TSH response to TRH. Furthermore, a significant correlation between _??_TSH value and resected goiter weight was observed (p<0.05). In 9 patients with low or unresponsive TRH, serum concentration of T3 was 13.1 ± 17.8 ng/dl, T4 was 10.0 ± 2.3 μg/dl, and TSH was 2.1 ± 1.0μU/ml. On the other hand, in 7 patients with normal TRH responsiveness, serum concentration of T3 was 124.9 ± 29.6 ng/dl, T4 was 9.1 ± 1.9 μg/dl, and TSH was 2.4 ± 1.0μU/ml. There was no significant difference between the two groups. These results indicated that the occurrence of thyrotoxicosis from adenomatous goiter in Japan is extremely low, but TRH low- or unresponsiveness, which is thought to represent a state of subclinical hyperthyroidism maintained by autonomously functioning tissue, was observed in more than 10% of patients with euthyroid adenomatous goiter.
日本内分泌学会の論文

腺腫様甲状腺腫における甲状腺機能充進症について

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