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Thyroid Amyloidosis With Recurrent Subacute Thyroiditis-Like Syndrome

Second Department of Internal Medicine, Faculty of Medicine Kyushu University, Fukuoka, Japan

Address all correspondence and requests for reprints to: Hiroshi Ikenoue, M.D., Second Department of Internal Medicine, Faculty of Medicine 60, Kyushu University, 3-1-1 Maidashi, Higashi-ku 812, Fukuoka, Japan.

We studied 2 men with a subacute thyroiditislike syndrome (STLS) associated with systemic amyloidosis. Both had very tender, diffuse, firm goiters, low thyroidal radioactive iodine uptake values, and increased erythrocyte sedimentation rates. Glucocorticoid therapy resulted in dramatic improvement. Compared to 18 patients with subacute thyroiditis, these 2 men had 1) persistence of goiter even in remission, 2) repeated exacerbation of STLS, 3) pain always localized in the same site, and 4) gastrointestinal, renal, and cardiac abnormalities. Histological examination of the patients’ thyroid glands revealed amyloid deposition and no evidence of subacute thyroiditis. In addition, 1 man had low T₃ thyrotoxicosis with an elevated rT₃/T₃ ratio, suggesting impaired peripheral conversion of T₄ to T₃, and immunological and histological evidence of Hashimoto’s thyroiditis. These findings suggest that thyroid amyloidosis may be associated with STLS. When patients with clinical features of subacute thyroiditis have an unusual course, the possibility of thyroid amyloidosis should be considered.

Received November 10, 1987.

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