Graves病に合併した巨大胸腺過形成の一例

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  • A Case of Enlarged Thymic Hyperplasia Accompanying Graves' Disease without exophthalmus

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Thymic hyperplasia is commonly associated with Graves' disease. A radiologically visible thymic mass, however, is rare. Herein we describe a huge thymic hyperplasia which is unresponsive to antithyroid drug therapy.<BR>A 16-year-old female was admitted to the Kanazawa Medical University in July 1992, with complaints of finger tremors, hypersweating, palpitation and loss of body weight. Her physical examination was notable for tachycardia and goiter. There was no exophthalmus and no symptoms of blepharoptosis, double vision, dyspnea or muscle weakness, suggesting no evidence of myasthenia gravis. Her thyroid function test showed a serum-free T4 of 9.5ng/dl (normal range is 83-1.45), a serum-free T3 of 26.0pg/ml (normal range is 2.8-6.0), and undetectable serum TSH levels before and after infusion. TSH receptor antibodies (TBII and TSAb) were positive, and antithyroid antibodies (TGHA and MCHA) were negative. A chest roentgenogram showed a right hilar enlargement, suggesting an anterior mediastinal mass. A chest CT scan revealed an unenhanced solid anterior mediastinal mass. Neither a gallium nor an iodide scan showed an abnormal uptake in the mass.<BR>The female was treated with MMI 30mg/day for three months and her thyroid function was gradually normalized. The size of the anterior mediastinal mass on a follow-up chest CT scan remained unchanged. She underwent a thymectomy. The thymus weighed 25 grams and revealed microscopic lymphoid hyperplasia with germinal centers surrounded by Hassall's corpuscles in the medulla.<BR>Thymic hyperplasia accompanying Graves' disease should be surgically treated when its regression does not occur or when there is a clinical suspicion of malignancy in spite of appropriate antithyroid therapy.

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