Fever in the debute of the diffuse toxic goiter
Tamara Kamynina, Valeria Gubkina & Alexander Dreval
Aim: To pay attention to the so rare symptom of diffuse toxic goiter (DTG) as fever.
Materials and methods: We report about 5 patients (all females, aged 1838, mean 31). Before, all patients were examined for fever of unknown origin of long duration. After the others reasons of the febrile body temperature were excluded, DTG was diagnosed. DTG was confirmed by the results of the clinical, hormonal and immunological investigations (T- and B-cell immunity were assessed).
Results: Mediana TSH was 0.09 μU/ml and fT4 26.9 pmol/l. Thyroid volume was exceeded normal (varied from 21 to 35 sm2, mediana 22.4 sm3). The immunological disturbances were revealed: decreased suppressor (6.1%, 15% in control) and helper T-cells (6.1%, 15% in control) count, decreased phagocytosis activity in NST test (9.7%, 79% in control), increased β-cells count (33%, <23% in control) and high level of immunoglobulin IgG class (16.4%, 11.5% in control). The TSH-r antibodies titre (Radioassay RAST, Germany) was studied in 3 patients and achieved 36.5%, 56% and 76% respectively (in comparison with <13% in controls). Antithyroid therapy (adequate methimazole daily doses) was used. Febrile temperature decreased to normal after euthyroism was achieved.
Conclusion: The hyperthyroidism must be taken into account among the different reasons of fever of unknown origin. That rare clinical symptom mirrored the impaired termoregulation due to increased thermogenesis and due to possible immunological disorders in DTG patients with hyperproduction of the thyroid hormones and may be the consequence of the negative influence of the pyrogenic cytokines (IL1, IL6) on the PgE2 production.