AMYLOID GOITER PRESENTED AS A SUBACUTE THYROIDITIS-LIKE SYMPTOM IN A PATIENT WITH HYPERSENSITIVITY VASCULITIS

We present a 25-year-old woman with amyloid goiter due to hypersensiti vity vasculitis, who developed transient thyrotoxicosis resembling sub acute thyroiditis. She received prednisolone (20 mg/ day) for three ye ars for hypersensitivity vasculitis, and was diagnosed as having secon dary amyloidosis by biopsies of the stomach, rectum and kidneys. She n oticed neck swelling with severe right neck tenderness, palpitation, h yperhidrosis and weight loss. An elastic firm diffuse goiter was palpa ble, and the upper pole of the right lobe was extremely tender. Her se rum free T-4 and T-3 levels were high, and the serum TSH was suppresse d to subnormal. She was positive for serum C-reactive protein. Anti-th yroidal autoantibodies were all negative. Her thyrotoxicosis subsided spontaneously within one week. Serum titers of antibodies to various v iruses were unchanged during the clinical course for two weeks, but sh e was positive for HLA B35. Examination of a needle-biopsy specimen of the thyroid gland showed extensive amyloid deposition and no evidence of subacute thyroiditis. We considered her transient thyrotoxicosis t o be associated with amyloid goiter. The clinical course of this case was similar to the subacute thyroiditis-like syndrome, first described by Ikenoue et al. When patients with primary or secondary amyloidosis have symptoms and signs of subacute thyroiditis, but develop an unusu al course, amyloid goiter should be considered.