[Amyloid struma].

Abstract

A 71-year-old woman with a seven-year history of seronegative polyarthritis had to be intubated and ventilated because of acute respiratory failure. The chest radiograph and computed tomography revealed bilateral pleural effusions and massive enlargement of the thyroid which compressed the trachea. Concentration of the thyroid-stimulating hormone was slightly reduced, while that of peripheral thyroid hormone was normal. Histological examination of a goitre specimen after strumectomy showed macrofollicular goitre with massive amyloid deposits. Amyloid was subsequently also demonstrated in the gastrointestinal tract. The patient died 5 months later from respiratory failure. A second patient, 47 years old at hospitalization, had been suffering from arthritic psoriasis since she was a child and had been undergoing haemodialysis for renal failure caused by amyloid. She had undergone angiography because the haemodialysis shunt had become occluded. 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 enlargement with retrosternal extension and a nodule in the thyroid isthmus. After injection of contrast medium for the angiography she developed, on the basis of probably already existing hyperthyroidism with an increased level of thyroid-stimulating immunoglobulin, clinically and biochemically manifest hyperthyroidism, which was treated with thiamazole (15 mg daily) and propranolol (40 mg twice daily). Cytological examination of a fine-needle biopsy of thyroid tissue revealed amyloid deposits. The patient died 4 years later, shortly after bilateral hip replacement for femoral neck fractures. At autopsy a large amyloid goitre and amyloid deposits in the kidneys, gastrointestinal tract and coronary arteries were found.