Endocrine Abstracts (2010) 22 P766

Deiodinase impairment in the autoimmune thyroid disease: case report

Gianmarco Mezzacapo, Luciano Persico & Giuseppe Lavra

San Giovanni Hospital, Rome, Italy.

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 hypothalamic–pituitary 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.

DateFT3* (μg/ml)FT4 (μg/ml)TSH (μUI/ml)TPOSize (cm)Therapy
02/20072.6 (2.2–4.7)37 (8–20)37 (0.2–4)1:22305
05–10/20073.036.321.755 LT4 75
06/20083.615.40.653TiTre 20×3
06/20092.89.91.1PseudonodularTitre 20×3

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