メルゼブルク三徴
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- 《まれ》三つ組,三人組 / 三和音/中国（人）の秘密結社
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English Journal
- [Carl Adolph von Basedow on the on the occasion of the 150th anniversary of the day he died].
- Göring HD.Author information hd.goering@klinikum-dessau.deAbstractIn 2004 we commemorate the 150th day of death of Carl Adolph von Basedow, who takes a lasting place in the history of medicine for his description of the Merseburg triad (exophthalmos, goitre, tachycardia) with hyperthyroidism. There has been a long-lasting dispute over who first described these diagnostic features. In Germany, the dermatologically-relevant features of hyperthyroidism are known as Basedow disease. In the Anglo-American literature the name "Graves' disease" is predominately used, but also authors such as Parry or Flajani are also recognised. More than 60 other publications concerning arsenic poisoning, gonorrhoeal arthritis, anthrax, thrombophlebitis as well as a variety of surgical and gynaecological problems reflect the vast field of activity and broad scientific interests of the family doctor Basedow, who reached brilliant and lasting achievements on his own and without considerable resources.
- Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG.J Dtsch Dermatol Ges.2004 Nov;2(11):963-7.
- In 2004 we commemorate the 150th day of death of Carl Adolph von Basedow, who takes a lasting place in the history of medicine for his description of the Merseburg triad (exophthalmos, goitre, tachycardia) with hyperthyroidism. There has been a long-lasting dispute over who first described these dia
- PMID 16281617
- [Carl Adolph von Basedow--150th anniversary of his death].
- Meng W.Author information Bereich Endokrinologieder Abteilung für Gastroenterologie, Endokrinologie und Ernährungsmedizin der Klinik und Poliklinik für Innere Medizin A der Ernst-Moritz-Arndt Universität Greifwald. meng@uni-greifswald.deAbstractCarl Adolph von Basedow was the son of an aristocratic family and was born 1799 in Dessau. He was the grandson of the famous pedagogue Johann Bernhard Basedow. He studied medicine at the university of Halle and spent two years in the surgical service of Paris hospitals--the Charité and the Hôtel Dieu. In 1822, he settled in Merseburg as a physician. He was soon acclaimed as a genial and skilled helper in all branches of medical practice. He performed his own post-mortem examinations and published findings on a number of different diseases. His famous contribution in the thyroid field appeared in 1840 entitled "Exophthalmos due to hypertrophy of the cellular tissue in the orbit". Exophthalmos, goiter and palpitation of the heart have become known as the Merseburg Triad. In 1848, he published the autopsy findings on a patient who died from "exophthalmic cachexia". In Germany and some other countries, the disease was named as Morbus Basedow since 1858. In 1854 he pricked in his finger in the postmortem room when examining a patient who had died of typhus and he succumbed to septicemia at the early age of fifty-five. The date of his death was April 11, 1854. On April 14, he was laid in the Sixtus Cemetery in Merseburg. Basedow postulated that a wrong mixing of the blood manifested in cell tissue congestion and glandular vegetation cause the manifestations of disease. If we abstract our modern knowledge and accept circulating antibodies and disturbance of the immune balance as a dyscrasia as well as the proliferation of lymphocytic clones and local cellulary infiltration in terms of immune thyroiditis and autoimmune orbitopathy as cell tissue congestion and glandular vegetations, then doubt arise whether we have indeed made much progress in the last 150 years. At least, respect for the genius of the general physician Carl Adolph von Basedow is becoming greater. We may all hope that in the contributions and the discussions, we shall learn where we stand at the end of the century and what new avenues of research are appearing on the horizon.
- Zeitschrift für ärztliche Fortbildung und Qualitätssicherung.Z Arztl Fortbild Qualitatssich.2004 May;98 Suppl 5:7-12.
- Carl Adolph von Basedow was the son of an aristocratic family and was born 1799 in Dessau. He was the grandson of the famous pedagogue Johann Bernhard Basedow. He studied medicine at the university of Halle and spent two years in the surgical service of Paris hospitals--the Charité and the Hôtel D
- PMID 15255307
- [Carl Adolph von Basedow--on the 200th anniversary of his birth].
- Meng W.Author information Abteilung für Endokrinologie und Stoffwechselerkrankungen, Ernst-Moritz-Arndt Universität Greifswald. meng@rz.uni-greifswald.deAbstractCarl Adolph von Basedow was the son of an aristocratic family and was born 1799 in Dessau. He was the grandson of the famous pedagogue Johann Bernhard Basedow. He studied medicine at the university of Halle and spent two years in the surgical service of Paris hospitals--the Charité and the Hôtel Dieu. In 1822, he settled in Merseburg as a physician. He was soon acclaimed as a genial and skilled helper in all branches of medical practice. He performed his own post-mortem examinations and published findings on a number of different diseases. His famous contribution in the thyroid field appeared in 1840 entitled "Exophthalmos due to hypertrophy of the cellular tissue in the orbit". Exophthalmos, goiter and palpitation of the heart have become known as the Merseburg Triad. In 1848, he published the autopsy findings on a patient who died from "exophthalmic cachexia". In Germany and some other countries, the disease was named as Morbus Basedow since 1858. In 1854 he pricked in his finger in the postmortem room when examining a patient who had died of typhus and he succumbed to septicemia at the early age of fifty-five. The date of his death was April 11, 1854. On April 14, he was laid in the Sixtus Cemetery in Merseburg. Basedow postulated that a wrong mixing of the blood manifested in cell tissue congestion and glandular vegetation cause the manifestations of disease. If we abstract our modern knowledge and accept circulating antibodies and disturbance of the immune balance as a dyscrasia as well as the proliferation of lymphocytic clones and local cellulary infiltration in terms of immune thyroiditis and autoimmune orbitopathy as cell tissue congestion and glandular vegetations, then doubt arise whether we have indeed made much progress in the last 150 years. At least, respect for the genius of the general physician Carl Adolph von Basedow is becoming greater. We may all hope that in the contributions and the discussions, we shall learn where we stand at the end of the century and what new avenues of research are appearing on the horizon.
- Zeitschrift für ärztliche Fortbildung und Qualitätssicherung.Z Arztl Fortbild Qualitatssich.1999 Apr;93 Suppl 1:5-10.
- Carl Adolph von Basedow was the son of an aristocratic family and was born 1799 in Dessau. He was the grandson of the famous pedagogue Johann Bernhard Basedow. He studied medicine at the university of Halle and spent two years in the surgical service of Paris hospitals--the Charité and the Hôtel D
- PMID 10355042
Japanese Journal
- Surgical Treatment for Graves' Disease.
- 栗原 英夫
- 日本臨床外科学会雑誌 63(7), 1593-1606, 2002
- … Since 1940 when Karl Adorf von Basedow had first stated the Merseburg's triad, namely hyperthyroidism, exophthalmos, and goiter, we surgeons have struggled with the triad in the treatment of Graves disease. …
- NAID 130003603121
Related Links
- In 1840, Basedow first described the association of pretibial myxedema with orbital abnormalities and features of hyperthyroidism. [4] The term Graves' disease triad is currently used to describe this constellation of ...
- The three main signs of hyperthyroidism, namely exophthalmos, goiter, and tachycardia are still called the Merseburg triad in German medicine. Topics ...
★リンクテーブル★
[★]
- 英
- Graves' disease, Graves disease
- 同
- バセドー病 バセドウ病 (国試)Basedow病 Basedow disease Basedow's disease、グレーヴス病 Graves病、exophthalmic goitre、中毒性びまん性甲状腺腫 toxic diffuse goiter、パリー病 Parry disease
- ラ
- morbus Basedowii
- 関
- 甲状腺中毒症
概念
病因
- 甲状腺刺激免疫グロブリン thyroid stimulating immunoglobulin
- 甲状腺増殖刺激免疫グロブリン thyroid re-growth-stimulating immunoglobulin (TGI)
- TSH結合阻害免疫グロブリン TSH-binding inhibitor immunoglobulin (TBIIs)
- 自己抗体であるTSH受容体抗体の産生 → 甲状腺濾胞上皮細胞のTSH受容体に結合して活性化 → 甲状腺ホルモン分泌↑
- 抗TSH受容体抗体は95-98%の症例で出現する。
疫学
頻度
- 住民検診などで見つかる Basedow病は、1,000人に対し 1-6人と報告されている。
- 男女比は1:4で女性に多い。特に、20-50歳の女性に多い。
- 家族内集積が高い。
病変形成＆病理
- 自己抗体により、濾胞のホルモン産生が刺激され、甲状腺は瀰漫性に腫大（正常の数倍から200gまで）。
症状
- 頻脈、体重減少、手指振戦、発汗増加等
- 心臓肥大、リンパ組織過形成、真皮の肥厚
- 2. びまん性甲状腺腫大（表面は平滑で柔らかい、血管雑音）
- 3. 眼球突出または特有の眼症状
- 未治療or適切な治療が行なわれていなかった状態、感染、外傷などの誘因が加わった時に機能亢進症が急速に増悪する状態。頻脈、ショック。
合併症
検査
- 1. FT4、FT3のいずれか一方または両方高値
- 2. TSH低値
- 3. TSH受容体抗体陽性、または甲状腺刺激抗体陽性
- 4. 放射線ヨード甲状腺摂取率高値 ← 甲状腺ホルモンの生合成が亢進
エコー
診断
(Basedow病の診断ガイドライン(日本甲状腺学会 第7次案))
- 所見
- 1. 頻脈、体重減少、手指振戦、発汗増加等の甲状腺中毒症所見
- 2. びまん性甲状腺腫大
- 3. 眼球突出または特有の眼症状
- 1. 遊離T4、遊離T3のいずれか一方または両方高値
- 2. TSH低値(0.1μU/ml以下)
- 3. 抗TSH受容体抗体(TRAb,TBII) 陽性、または刺激抗体(TSAb) 陽性
- 4. 放射線ヨード(またはテクネシウム) 甲状腺摂取率高値、シンチグラフィでびまん性
- 診断
- a) の1つ以上に加えて、b) の4つを有するもの
- a) の1つ以上に加えて、b) の1、2、3を有するもの
3) Basedow病の疑い
- a) の1つ以上に加えて、b) の1と2を有し、遊離T4、遊離T3高値が3カ月以上続くもの
- 付記
- 1. コレステロール低値、アルカリフォスターゼ高値を示すことが多い.
- 2. 遊離T4正常で遊離T3のみが高値の場合が稀にある.
- 3. 眼症状がありTRAbまたはTSAb陽性であるが、遊離T4およびTSHが正常の例はeuthyroid
Graves’diseaseまたはeuthyroidophthalmopathyといわれる.
- 4. 高齢者の場合、臨床症状が乏しく、甲状腺腫が明らかでないことが多いので注意をする.
- 5. 小児では学力低下、身長促進、落ち着きの無さ等を認める.
- 6. 遊離T3(pg/ml) /遊離T4(ng/dl) 比は無痛性甲状腺炎の除外に参考となる
治療
の二種類である。薬効の高さや作用持続時間の長さの利点からMMIを第一選択とするが、胎盤移行や乳汁移行、副作用の出現頻度を考慮しPTUを用いることもある。治療中止の時期は甲状腺機能の正常化はもちろんのこと、抗TSH受容体抗体が陰性であることも必要である。
- 治療期間：長い。1-2年維持量でコントロールし、TSH受容体抗体が陰性化したら減量し、さらに6ヶ月したら休薬(YN.D-31)
治療の中止
- 4点がそろえば中止。中止後、10-25%が再発する。
- 1. メルカゾール1錠/日-1錠/隔日で甲状腺機能が正常 (TSH, FT4の両方が正常)
- 2. 投薬継続期間が2年以上
- 3. 甲状腺腫が小さくなった
- 4. TSH受容体抗体が陰性
βブロッカー
- 脈拍、動悸、振戦を軽減 ← 甲状腺ホルモンの「心筋細胞のカテコールアミン受容体を増加させる作用」に対して
放射性ヨード療法
- 131Iのβ線により甲状腺組織を破壊
- 効果は2-3週後に出現し、最大効果は6-12週後。
外科的治療法
比較
|
|
放射性ヨード療法
131療法
|
外科的治療法
|
抗甲状腺薬
|
| 長所
|
治療法が簡単
|
|
どの年代の患者でも可能(妊娠・妊娠中も可能)
|
| 成人合併例でも治療可能
|
|
通院での治療可能
|
| 比較的短期間で寛解
|
短期間に治癒
|
|
| 永続寛解率が高い
|
高い寛解率
|
|
| 侵襲が少ない
|
|
不可逆的な甲状腺機能低下は稀
|
| 短所
|
特別な施設が必要
|
手術侵襲
|
副作用(無顆粒球症・肝障害)
|
| 永続的甲状腺機能低下症が年ごとに増加
|
永続的甲状腺機能低下症
|
|
| 妊娠、授乳期では禁忌
|
瘢痕
|
治療期間が長い
|
|
|
術後合併症(反回神経麻痺、テタニー)
|
永続寛解率が低い
|
|
|
術後再発
|
|
| 回避・禁忌
|
30歳以下は避ける
|
|
|
| 妊娠予定、妊娠中、授乳中は禁忌
|
|
|
| 適応
|
欧米の第一選択
|
|
日本の第一選択
|
| 老人で早期治療を望む場合
|
早期治癒を望む場合(社会的・妊娠希望)
|
小児、妊婦
|
| 抗甲状腺薬で副作用の例
|
抗甲状腺薬で副作用の例
|
外科的療法、放射性ヨード療法の明らかな適応外
|
| 抗甲状腺薬で永続治癒の可能性低
|
抗甲状腺薬で永続治癒の可能性低
|
FT4軽度上昇例
|
| 服薬・治療コンプライアンス低
|
服薬・治療コンプライアンス低
|
|
| 手術適応だが合併症、患者の意志により回避される場合
|
通院が困難
|
|
| 手術後再発例
|
甲状腺腫が大
|
甲状腺腫が小
|
病理
- 濾胞上皮の著明な過形成、上皮細胞の丈が増して円柱上となる、濾胞上皮が乳頭状に濾胞腔に突出する、間質の軽度の線維化、リンパ球集簇、リンパ濾胞、腫大した上皮細胞は濾胞中央部のコロイドを活発に吸収するため、コロイドの辺縁部に空泡が見える。
グレーブス病、亜急性甲状腺炎、無痛性甲状腺炎の比較
- YN.D-40改変
参考
- 1. D．産科疾患の診断・治療・管理 8．合併症妊娠の管理と治療 - 日産婦誌60巻3 号
- http://www.jsog.or.jp/PDF/60/6003-041.pdf
[★]
- 英
- Merseburg triad
- 同
- Merseburg三徴
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- バセドウ病の代表的な臨床症状
- 甲状腺腫，頻脈，眼球突出
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