A rare case showing subacute thyroiditis-like symptoms with amyloid goiter after anti-tumor necrosis factor therapy

[摘要] Anti-tumor necrosis factor (TNF)-a therapy is established as a new standard for the treatment of various autoimmuneinflammatory diseases. We report the first case showing subacute thyroiditis-like symptoms with an amyloid goiter afteranti-TNF-a therapy. A 56-year-old man with Crohn’s disease presented with fever and a diffuse, tender goiter. To control thediarrhea, anti-TNF therapy (infliximab) was administered 4 weeks before the thyroid symptoms emerged. The patientreported a swollen neck with tenderness on the right side and fever 4 days after the second infliximab injection. An elevatedserum C-reactive protein (CRP) and serum thyroid hormone level with suppressed serum thyrotropin were observed.The thyroid-stimulating antibody was not elevated. An ultrasonograph of the thyroid revealed an enlarged goiter withposterior echogenicity attenuation and a low echoic region that was tender. The thyroid uptake value on technetium-99mscintigraphy was near the lower limit of the normal range. The patient was initially diagnosed with thyrotoxicosis resultingfrom subacute thyroiditis. Administration of oral prednisolone improved the fever, thyroid pain, and thyroid function, but histhyroid remained swollen. The patient developed diarrhea after prednisolone withdrawal; therefore, adalimumab, anotherTNF inhibitor, was administered. After three injections, his abdominal symptoms were alleviated, but the thyroid pain andfever recurred. Elevated serum CRP levels in the absence of thyroid dysfunction were observed. The patient’s symptomsresolved after prednisolone retreatment, but an elastic, firm goiter persisted. A fine-needle biopsy revealed amyloiddeposition in the thyroid.

[学科分类] 血液学

[关键词] Adult;Male;Asian - Japanese;Japan;Thyroid;Thyroid;Thyroiditis;Goitre;Amyloid goitre;Amyloidosis;Crohn's disease;Pyrexia;Goitre;Diarrhoea;Thyrotoxicosis;Anaemia;Hypoalbuminaemia;Hypolipidaemia;Thyroid function;FT3;FT4;TSH;Ultrasound scan;Thyroid scintigraphy;C-reactive protein;Fine needle aspiration biopsy;Thyroglobulin;HLA genotyping;Haemoglobin;White blood cell differential count;Albumin;Infliximab;Adalimumab;Prednisolone;Glucocorticoids;Paracetamol;Genetics;Unique/unexpected symptoms or presentations of a disease;May;2015