Amyloid goiter: radiological study in a case presenting hypothyroidism.
We report herein a case of amyloid goiter associated with rheumatoid arthritis in which hypothyroidism was observed. A 52-year-old housewife who had suffeed from rheumatoid arthritis for 15 years was referred to our hospital because of general fatigue. On admission, a large goiter was observed. Laboratory data showed primary hypothyroidism. Renal biopsy and gastric mucosa biopsy showed amyloid deposition of AA-type. Thyroid biopsy showed massive amyloid involvement. Although the findings of iodine-123 scintigraphy, technetium-99m pertechnetate scintigraphy, computed tomography and magnetic resonance image studies were similar to those for goiter associated with chronic thyroiditis, tallium-201 chloride scintigraphy gave a differing result, demonstrating absent uptake at 3 hours in this case. Replacement therapy with levothyroxine relieved the symptoms. This case was unusual in that amyloid goiter presented clinically as hypothyroidism. Absence of tallium-201 chloride uptake at 3 hours may be a diagnostic specificity for amyloid goiter in differentiating its hypothyroidism from that caused by chronic thyroiditis.
Ishimura
E
E
Second Department of Internal Medicine, Osaka City University Medical School, Japan.
Okamura
T
T
Masaki
H
H
Hiura
Y
Y
Kawagishi
T
T
Inaba
M
M
Nishizawa
Y
Y
Ochi
H
H
Morii
H
H
D000682:Amyloid / Q000378:metabolism*; D005260:Female; D006042:Goiter / Q000000981:diagnostic imaging* / Q000378:metabolism*; D006801:Humans; D007037:Hypothyroidism / Q000000981:diagnostic imaging* / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011877:Radionuclide Imaging; D013670:Sodium Pertechnetate Tc 99m; D013794:Thallium Radioisotopes; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D000682:Amyloid; D013794:Thallium Radioisotopes; D013670:Sodium Pertechnetate Tc 99m