HYPOTHYROIDISM IN ASSOCIATION WITH SYSTEMIC AMYLOIDOSIS
blocking antibodies; goiter; Otorhinolaryngology; Surgery; thyroiditis
Background. Systemic amyloidosis reads to functional compromise of various organs through infiltration of these tissues by amyloid protein. The majority of affected patients develop infiltration of the thyroid gland; yet thyroid dysfunction rarely occurs. Methods and Results. Described herein is a case of hypothyroidism occurring in a patient with amyloid goiter. An alternative explanation for her hypothyroidism could not be determined by histologic or serologic evaluation. Hormonal assays were consistent with progressive hypothyroidism in spite of oral and, finally, parenteral replacement therapy. A review of the literature describes other cases of thyroid dysfunction reported in patients with systemic amyloidosis. Conclusions. This case illustrates how amyloid infiltration may be a cause of hypothyroidism in patients with systemic amyloidosis. Therefore, all patients who develop a goiter, including those with systemic amyloidosis, must be screened for thyroid dysfunction. When a physician diagnoses the patient with hypothyroidism, that physician must be aware of potential pitfalls in the administration of thyroxine replacement as outlined below.
Rich M W
Head and Neck-Journal for the Sciences and Specialties of the Head and Neck
1995
1995-07
Journal Article
<a href="http://doi.org/10.1002/hed.2880170412" target="_blank" rel="noreferrer noopener">10.1002/hed.2880170412</a>
Total thyroidectomy: is morbidity higher for Graves' disease than nontoxic goiter?
Adult; Aged; Female; Goiter; Graves Disease/pathology/*surgery; Humans; Hypocalcemia/epidemiology; Male; Middle Aged; Morbidity; Nodular/pathology/*surgery; Postoperative Complications/epidemiology; Retrospective Studies; Thyroidectomy/*adverse effects
BACKGROUND: Total thyroidectomy for treatment of Graves' disease is controversial and much of the debate centers on the concern for complications. The purpose of this study was to evaluate the morbidity of total thyroidectomy for Graves' disease and determine if it is different than for patients with nontoxic nodular goiter. METHODS: The rates of life threatening neck hematoma, recurrent laryngeal nerve (RLN) injury, transient hypocalcemia, and hypoparathyroidism were determined for consecutive patients with Graves' disease treated with total thyroidectomy from 1996 to 2010. Results were compared with patients who underwent total thyroidectomy for nontoxic nodular goiter during the same period, matched for the weight of the excised thyroid gland. RESULTS: Total thyroidectomy was performed in 111 patients with Graves' disease (group I) and 283 patients with nontoxic nodular goiter (group II). Parathyroid autotransplantation was performed in 31(28%) patients in group I and 98 (35%) patients in group II (P = NS). Comparative analysis of morbidity revealed no significant difference in neck hematoma, 0(0%) (I) versus 3(1%) (II); permanent RLN injury, 0(0%) (I) versus 2(1%) (II); and permanent hypoparathyroidism in 1(1%) (I) versus 1 (0.4%) (II) (P = NS). Transient hypocalcemia was more common in patients with Graves' disease, 80(72%) (I) versus 170 (60%) (II) (P \textless 0.05), but not when matched for thyroid weight. CONCLUSIONS: Total thyroidectomy can be performed with low morbidity in patients with Graves' disease; only transient hypocalcemia occurred more often than in patients with nodular goiter. Total thyroidectomy should be presented as a therapeutic option for all patients with Graves' disease.
Welch Kellen C; McHenry Christopher R
The Journal of surgical research
2011
2011-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jss.2011.03.054" target="_blank" rel="noreferrer noopener">10.1016/j.jss.2011.03.054</a>