Deiodinase impairment in the autoimmune thyroid disease: case report
Gianmarco Mezzacapo, Luciano Persico & Giuseppe Lavra
A 63-year-old woman came to our observation. She has been affected by a nodular goiter for 20 years. She was treated with 6 months short L-thyroxine therapy cycle (75 μg/day); the therapy was interrupted on her own initiative 3 months before we saw her. Symptoms: constriction, tachycardia. US: diffusely enlarged and hypoechogenic thyroid, a 5 cm well defined solid nodule on the right lobe. FNAB: poor colloid, numerous follicular cells, some of them showing oxyphil cells aspects, numerous lymphocytes. RMN: normal hypothalamicpituitary axis. The clinical results linked to the anamnestic and actual laboratory data leaded us to the following diagnosis: nodular goiter with aspects of autoimmune thyroiditis in deiodinase impairment from TT4 to TT3; a therapy with triiodothyronine (20γ ×3 time a day) was started. A 18 months follow-up evidenced the normalization of the metabolic picture and a gradual reduction of the nodular pathology as well as the resolution of the compressive symptomatology.