Abstract
Three cases of sudden death associated with undiagnosed chronic thyroiditis are described. All were young or middle-aged men who were found dead, and death appeared to have occurred suddenly. Two of them had not previously experienced any serious medical problems, the third suffered from well-controlled Addison's disease. None had been investigated or treated for thyroid disease previously. Microscopically all showed a severe chronic thyroiditis with parenchymal destruction and reactive hyperplasia of the acinar epithelium. In the first case elevated triiodothyronin (T3), thyroxin (T4) and low thyroid stimulating hormone (TSH) were present, in the second case low T3 and T4 and normal TSH, and in the third an isolated elevation of T3 were found. Anti-thyroid antibodies were found in two cases. The possible causal relationship between silent chronic autoimmune thyroiditis and sudden death is discussed.
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References
Singer PA (1991) Thyroiditis. Acute, subacute and chronic. Med Clin North Am 75(1):61–77
Papapetrou PD, Jackson IMD (1975) Thyrotoxicosis due to “silent” thyroiditis. Lancet 1:361–363
Woolf PD, Daly R (1976) Thyrotoxicosis with painless thyroiditis. Am J Med 60:73–79
Dorfman SG, Cooperman MT, Nelson RL, Depuy H, Peake RL, Young RL (1977) Painless thyroiditis and transient hyperthyroidism without goiter. Ann Intern Med 86:24–28
Gorman CA, Duick CS, Woolner LB, Wahner HW (1978) Transient hyperthyroidism in patients with lymphocytic thyroiditis. Mayo Clin Proc 53:359–366
Woolf PD (1980) Transient painless thyroiditis with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev 1(4):411–420
Nikolai TF, Brosseau J, Kettrick MA, Roberts R, Beltaos E (1980) Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism (silent thyroiditis). Arch Intern Med 140:478–482
Mizukami Y, Michigishi T, Hashimoto T, Tonami N, Hisada K, Matsubara F et al. (1988) Silent thyroiditis: a histologic and immunohistochemical study. Hum Pathol 19:423–431
Woeber KA (1992) Thyrotoxicosis and the heart. N Eng] J Med 327(2):94–97
Burch HB, Wartofsky L (1993) Life-threatening thyrotoxicosis. Endocrinol Metab Clin North Am 22(2):263–277
Nickerson JF, Hill SR jr, McNeal JH, Barker SB (1960) Fatal myxedema, with and without coma. Ann Intern Med 53:475–493
Guthrie GP, Hunsaker III JC, O'Connor WN (1987) Sudden death in hypothyroidism. N Engl J Med 317(2):1291
Autelitano F, Santensanio G, Mauriello A, Palmieri G, Orlandi A, Spagnioli LG (1992) Patologia latente della tiroide: studio epidemiologico e statistico di tiroide prelevate in torso di 507 autopsie consecutive (in Italian). Ann Ital Chir 63(6):761–781
Byard RW, Cohle SD (eds) (1994) Sudden death in infancy, childhood and adolescence. Cambridge University Press, Cambridge
Coe JI (1993) Postmortem chemistry update. Emphasis on forensic application. Am J Forensic Med Pathol 14(2):91–117
Coe J (1973) Postmortem values of thyroxine and thyroid stimulating hormone J Forensic Sci 18:20–24
Rachut E, Rynbrandt DJ, Doutt TW (1980). Postmortem behaviour of serum thyroxine, triiodothyronin, and parathormone. J Forensic Sci 25(1):67–71
Bonnell HJ (1983) Antemortem chemical hypothyroxinemia. J Forensic Sci 28(1):242–248
Herman GE, Kanluen S, Monforte J, Husain M, Spitz WU (1986) Fatal thyrotoxic crises. Am J Forensic Med Pathol 7(2):174–176
Smith BR, McLachlan SM, Furmaniak J (1988) Autoantibodies to the thyrotropin receptor. Endocr Rev 9(1):106–121
Karch SB, Billingham ME (1984) Morphologic effects of defibrillation: a preliminary report. Crit Care Med 12:920–921
Bhasin S, Wallace W, Lawrence JB, Lesch M (1981) Sudden death associated with thyroid hormone abuse. Am J Med 71:887–890
Buchanan WW, Alexander WD, Crooks J, Koutras DA, Wayne EJ, Anderson JR et al. (1961) Association of thyrotoxicosis and autoimmune thyroiditis. BMJ 1:843–847
Schmidt MB (1926) Eine beiglanduldre Erkrankung (Nebennieren und Schilddrüse) bei Morbus Addisonii. Verh Dtsch Ges Pathol 21:212
Volpé R (1977) The role of autoimmunity in hypoendocrine and hyperendocrine function. With special emphasis on autoimmune thyroid disease. Ann Int Med 87:86–99
Simson LR (1976) Thyrotoxicosis: postmortem diagnosis in an unexpected death. J Forensic Sci 21:831–832
Randall BB (1992) Fatal hypokalemic thyrotoxic periodic paralysis presenting as sudden unexplained death of a cambodian refugee. Am J Forensic Med Pathol 13(3):204–206
Parker JLW, Lawson DH (1973) Death from thyrotoxicosis. Lancet 2:894–895
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Edston, E. Three sudden deaths in men associated with undiagnosed chronic thyroiditis. Int J Leg Med 109, 94–97 (1996). https://doi.org/10.1007/BF01355524
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DOI: https://doi.org/10.1007/BF01355524