HASHIMOTOS-THYROIDITIS AND SILICONE BREAS T IMPLANTS - 2 CASE-REPORTS

The silicone implant controversy wavers between reassuring epidemiolog ical studies and about 300 case reports of patients developing a defin ite or incomplete/atypical connective tissue disease (CTD) after recei ving a silicone gel-filled breast implant (SBI). Since Hashimoto's thy roiditis (HT) is rarely reported in this context, we report here two n ew cases of HT associated with a history of bilateral cosmetic SBIs. T he first patient was a 45-year-old white woman who had SBIs in 1976. I n 1991 she developed HT, evolving to thyroid deficiency which was comp ensated with levothyroxine treatment. In addition, the patient complai ned of fatigue, arthralgia, morning stiffness and developed a sicca sy ndrome necessitating artificial tears. The 1995 evaluation disclosed t he presence of antinuclear antibodies at a titre of 1/640, and high le vel anti-thyroid microsomal antibodies (1/256,000). Gamma globulins ro se to 22.6 %. Thyroid ultrasonography showed an enlarged thyroid gland with a diffusely hypoechogenic pattern. The implants were painful, an d in 1996 they were removed. Microscope examination of the fibrous cap sule surrounding the prostheses showed extremely dense connective tiss ue with fibrosis. The second patient was a 55-year-old white woman who had SBIs in 1984. In 1995, she developed HT with clinical pain and te nderness of the thyroid gland, with mild hyperthyroidism and positive antithyroglobulin antibodies, and was given corticosteroid treatment f or 5 months. In 1996, the implants were again painful and the patient developed positive antinuclear antibodies with a titre of 1/200. Ultra sonography showed a heterogeneous thyroid gland, and implant removal w as advised. Hashimoto's thyroiditis is recognized as a subset of chron ic auto-immune thyroiditis, and its association with SBI is rare. In t hese 2 observations, an association without relation is possible, but a future survey of similar cases seems warranted.