多結節性中毒性甲状腺腫の3症例

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In 1913 Plummer presented the concept of two distinct types of hyperthyroidism : exophthalmic goiter and adenomatous goiter. Thereafter the latter was divided into two; these are multinodular toxic goiter (MTG) and toxic nodular goiter. MTG is known to be somewhat prevalent in foreign countries; however, the incidence of MTG in Japan is extremely low. In this paper, we present three cases of MTG disclosed by clinical and laboratory findings. The main features of these patients are as follows : 1) They were all young females with no apparent exophthalmos-and no history of antecedent non toxic multinodular goiter. 2) On palpation, their goiters were found to be multinodular and soft, and cyst formation was found in two of them. 3) On thyroid scintiscanning, two of them showed diffusely irregular uptake patterns, and one of them had a cold nodule simultaneously; however, the remainder showed uniform accumulation. 4) Serum T4 concentrations were normal or slightly elevated, but serum T3 values were markedly elevated (T33 toxicosis). Positive suppression by oral T3 administration was ob-served in two of them, but TRH tests were negative in all. 5) LATS and HTACS (Human Thyroid Adenyl Cyclase Stimulator) levels were normal in all, but an abnormal TBII (Thyrotropin Binding Inhibitor Immunoglobulin) level was found transiently in one. 6) Histopathologic examinations revealed pictures of adenomatous goiter with hyperplastic epithelium in all. But in one case with transient TBII, chronological observations of a needle biopsied specimen revealed gradual resemblance to that of Graves' disease. 7) From the above findings, we concluded that the patients had MTG, but that it was slightly different in nature from that frequently seen in foreign countries. Furthermore, we would like to propose the possibility that MTG might develop into Graves' disease.
日本内分泌学会の論文

多結節性中毒性甲状腺腫の3症例

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