AMYLOID GOITER

A 71-year-old woman with a seven-year history of seronegative polyarth ritis had to be intubated and ventilated because of acute respiratory failure. The chest radiograph and computed tomography revealed bilater al pleural effusions and massive enlargement of the thyroid which comp ressed the trachea. Concentration of the thyroid-stimulating hormone w as slightly reduced, while that of peripheral thyroid hormone was norm al. Histological examination of a goitre specimen after strumectomy sh owed macrofollicular goitre with massive amyloid deposits. Amyloid was subsequently also demonstrated in the gastrointestinal tract. The pat ient died 5 months later from respiratory failure. - A second patient, 47 years old at hospitalization, had been suffering from arthritic ps oriasis since she was a child and had been undergoing haemodialysis fo r renal failure caused by amyloid. She had undergone angiography becau se the haemodialysis shunt hall become cccluded. She had been admitted because of an increase in goitre size during the last 6 months and a malignancy was suspected. Computed tomography showed the thyroid enlar gement with retrosternal extension and a nodule in the thyroid isthmus . After injection of contrast medium for the angiography she dct elope d, on the basis of probably already existing hyperthyroidism with an i ncreased level of thyroid-stimulating immunoglobulin, clinically and b iochemically manifest hyperthyroidism, which was treated with thiamazo le (15 mg daily) and propranolol (40 mg twice daily). Cytological exam ination of a fine-needle biopsy of thyroid tissue revealed amyloid dep osits. The patient died 4 years later, shortly after bilateral hip rep lacement for femoral neck fractures, At autopsy a large amyloid goitre and amyloid deposits in the kidneys, gastrointestinal tract and coron ary arteries were found.