慢性散在性甲状腺炎の組織像と甲状腺機能との対比ならびにその経年変化

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To evaluate the relationship between the histological features of the thyroid and its functional state, and also to evaluate the chronological course of those patients with a focal type of chronic thyroiditis according to Woolner's classification, a needle biopsy of the thyroid and an estimation of serum levels of thyroxine (T4) and triiodothyronine (T3), and of thyrotropin (TSH) levels to thyrotropin-releasing-hormone (TRH) administration (500 μg, i.v.) were performed on 100 patients with the disease (97 females, 3 males; average age of 41.6). (1) The patients were subgrouped according to the degree of small round cell infiltration area to total area of the thyroid slide specimen of each case (Factor C); namely : into CI (less than 10%, n=22), CII (10-50%, n=28), CIII (50-75%, n=27) and CIV (75% nearly diffuse, n=23) groups. The serum levels of T4 were in 40 normals (11 females, 29 males; average age of 32.6), CI, CH, CHI and qv subgroups were 9.9 ± 0.3, 8.7 ± 0.9*, 7.5 ± 0.4*, 7.4 ± 0.6* and 7.0±0.5*/μ1g/100ml (mean±SE); those of T3 were 133±3,154±17,195±20*, 156±15 and 166 ± 11* ng/100ml; the levels of basal TSH (b-TSH) were 2.3± 0.3, 4.3 ± 0.9, 6.4 ± 1.1*, 12.4 ± 6.3* and 13.6 ± 8.0*μU/ml; the maximal levels of TSH to TRH (max-TSH) were 18.0 ± 1.6, 34.9 ± 5.7*, 37.7 ± 5.4*, 61.6 ± 13.6* and 60.9 ± 22.7* AU/ml; the incremental TSH to TRH (ATSH) were 15.7 ± 1.6, 30.5 ± 5.3*, 31.3 ± 4.5*, 49.2 ± 8.8* and 47.3 ± 14.9* μU/ml, respectively. (Asterisks indicate significant difference from normals.) There were tendencies to decrease in serum T4 levels, to increase in serum T3 levels, and to increase levels of b-TSH, max-TSH, and _??_TSH in accordance with the increase of cell infiltration area. The significant reverse correlations between the levels of serum T4 and T3 and those of b-TSH (r=- 0.3175 and r=- 0.2715, respectively) were observed, even though the mean levels of serum T4 and T3 of the subgroup were within the normal range (mean ±2SD of normals). (2) The same tendencies of levels of serum T4, T3, b-TSH, max-TSH, and ATSH were observed in subgroups with the advancement of a factor (Factor M) which was classi fied according to the ratio of the microfollicular area to the total follicular one in the slide, and in subgroups with a factor (Factor O) which was determined in accordance with the degree of prevalence of the oxyphilic follicular epithelium. (3) Repeated needle biopsies were performed on 29 of the patients with the disease at an interval of 12 to 31 (mean of 17) months. i) Those cases which had had high b-TSH (more than 10 μU/ml) levels at the first biopsy subsequently showed the aggravation of the histological features expressed as Factors C, M and 0. ii) It appeared likely that the thyroid replacement therapy with desiccated thyroid had not shown any effect on the subsequent histological features of the disease expressed as Factors C, M and O. iii) There was hardly any definitive tendency between the changes of the histological features and those of the thyroid function in the time course of the two biopsies; however, there did exist a small number of cases (3 out of 8) which showed a more exaggerated maxTSH elevation to TRH at the second biopsy than at the first, and in whom no remarkable histological changes were observed during the period. From the above mentioned results, it is suggested that pathohistological thyroid changes have a close correlation with the thyroid functional state in chronic focal thyroidi tis,
一般社団法人日本内分泌学会の論文

著者

川東正範
金沢大学医学部内科学第二講座

慢性散在性甲状腺炎の組織像と甲状腺機能との対比ならびにその経年変化

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