アブストラクト(54巻2号:神奈川歯学)

神奈川歯学

Japanese

Title : 全身麻酔術前検査で診断された機能性甲状腺結節による原発性甲状腺機能亢進症の一例
Subtitle : 症例
Authors : 佐藤温洋1), 酒井龍太郎2), 今泉うの3), 古出智子1), 青木一孝1), 池上匡4)
Authors(kana) :
Organization : 1)神奈川歯科大学大学院歯学研究科全身管理医歯学講座内科学分野, 2)神奈川歯科大学附属病院麻酔科, 3)神奈川歯科大学大学院歯学研究科全身管理医歯学講座麻酔学分野, 4)神奈川歯科大学附属病院画像診断科
Journal : 神奈川歯学
Volume : 54
Number : 2
Page : 117-121
Year/Month : 2019 / 12
Article : 報告
Publisher : 神奈川歯科大学学会
Abstract : 「緒言」甲状腺機能亢進症は原発性甲状腺機能亢進症と続発性甲状腺機能亢進症に分類される. 原発性甲状腺機能亢進症の原因疾患は甲状腺濾胞上皮細胞膜表面上の甲状腺刺激ホルモン(thyroid stimulating hormone:TSH)受容体に対する自己抗体により発症する甲状腺臓器特異的自己免疫疾患の一つであるバセドウ病が大部分を占める. 一方, 甲状腺ホルモンをTSH非依存的, 自律的に産生する機能性甲状腺結節が原発性甲状腺機能亢進症の原因疾患を占める割合は0.15-0.3%と稀である. 甲状腺結節は病理組織学的には甲状腺濾胞上皮細胞の過形成であり, その頻度は甲状腺超音波検査を施行した場合, 67-68%になると報告されている. 甲状腺機能亢進症がコントロール不良の状態で全身麻酔下による手術, 外傷, 抜歯などの侵襲が加わると甲状腺ホルモンの高値に対する生体の代償機構が破綻し多臓器不全に陥り, 死亡率が10%以上ある甲状腺クリーゼになることがある.
Practice : 歯科学
Keywords : 機能性甲状腺結節, 甲状腺機能亢進症, 術前検査

English

Title : Primary hyperthyroidism caused by a toxic thyroid nodule diagnosed before general anesthesia
Subtitle :
Authors : Haruhiro SATO1), Ryutaro SAKAI2), Uno IMAIZUMI3), Tomoko KOIDE1), Kazutaka AOKI1), Tadashi IKEGAMI4)
Authors(kana) :
Organization : 1)Division of Internal Medicine, Department of Critical Care Medicine and Dentistry, Graduate Schoolof Dentistry, Kanagawa Dental University, 2)Department of Anesthesiology, Kanagawa Dental University Hospital, 3)Division of Anesthesiology, Department of Critical Care Medicine and Dentistry, Graduate Schoolof Dentistry, Kanagawa Dental University, 4)Department of Diagnostic Imaging, Kanagawa Dental University Hospital
Journal : Kanagawa Shigaku
Volume : 54
Number : 2
Page : 117-121
Year/Month : 2019 / 12
Article : Report
Publisher : Kanagawa Odontological Society
Abstract : [Abstract] A 71-year-old Japanese woman with hyperthyroidism visited the Department of Internal Medicine in our hospital. She had a medical history of plasmacytoma and had received chemotherapy in another hospital at the age of 65 years. She was administered zoledronic acid hydrate, a bisphosphonate, against hypercalcemia, which was induced by plasmacytoma. She developed pain in the left lower jaw 6 months ago, and was diagnosed with medication-related osteonecrosis of the jaw (MRONJ) caused by zoledronic acid hydrate in our hospital. This medical treatment was continued for 6 months, however, MRONJ did not improved. Thereafter, a surgery was planned for MRONJ. When the Department of Anesthesiology checked her health status, the blood examination revealed primary hyperthyroidism, but the levels of anti-thyroid stimulating hormone receptor antibody (TRAb) and thyroid stimulating antibody (TSAb) were negative. These autoantibodies are known to cause Basedow disease. Computed tomography of the neck revealed a diffusely enlarged thyroid nodule. The most common cause of primary hyperthyroidism is Basedow disease. However, Basedow disease was ruled out, because of the negative findings for TRAb and TSAb. Thereafter, the cause of primary hyperthyroidism was considered to be a toxic thyroid nodule, which autonomously secreted the thyroid hormone. Thiamazole, an anti-thyroid medicine, and potassium iodide were orally administered to decrease the levels of the thyroid hormone. After the levels of the thyroid hormone returned to the normal range, MRONJ surgery was performed under general anesthesia, using sevoflurane and remifentanil. No complications were observed during the surgery. The most severe form of hyperthyroidism is known as thyroid storm that can be induced by any surgery, including tooth extraction. Thus, the findings of the present case suggest that thyroid function should be evaluated prior to any type of surgery.
Practice : Dentistry
Keywords :