Myxoedema Tuberosumおよび甲状腺機能低下症を伴ったEMO症候群の1例

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In the present case of hypothyroidism with exophthalmos, pretibial myxedema, clubbed fingers and toes, and myxoedema tuberosum, serum LATS levels were very high, and the values of serum T3, T4 and TSH produce interesting changes. A 58-year old farmer was admitted to Tohoku University Hospital in September, 1972, with the chief complaint of swellings on his legs and on the right shoulder. He complained of a sensation of cold, fatiguability and constipation, as well. Pulse rate was 52/min, regular. His face was slightly edematous, his voice was slightly hoarse, and the skin was dry. Exophthalmos and clubbed fingers and toes were observed. The thyroid gland was not palpable. The Achilles tendon reflex was absent. ECG showed sinus bradycardia, but no low voltage. Serum total cholesterol was 240 mg/dl. Serum total protein was 6.6 g/dl, of which 12.6% was γ-globulin. BMR was -10%. Resin sponge 131I-T3 uptake was 25%. Serum T4 was low, but T3 was normal, 4.8 μg/dl and 85 ng/dl, respectively. Thyroidal 24-hr 131I-uptake was 4% and failed to respond to stimulation by bovine TSH. Serum TSH was 2.5 μU/ml. Serum LATS was strongly positive (1261±598%). The tanned-red-cell hemagglutination test was 1 : 5. Histological changes of the thyroid gland obtained by open biopsy revealed chronic thyroiditis. Both swellings on his legs and shoulder were revealed to be myxedema by histological examinations. Three months after admission, serum T3 and T4 decreased to 15 μg/dl and 3.3 μg/dl, respectively. At that time serum TSH, BMR and serum cholesterol values were 125 μU/ml, -15 and 310 mg/dl, respectively. The injection of hyaluronidase to myxoedema tuberosum on his right shoulder and topical application of concentrated corticosteroid creams under an occlusive dressing to the pretibial myxedema were both very effective. At first, he was treated with 25 μg of l-T3 per day. But when treated with 50 μg, his condition of hypothyroidism disappeared and serum TSH became undetectable.
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Myxoedema Tuberosumおよび甲状腺機能低下症を伴ったEMO症候群の1例

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