{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T20:17:58Z","timestamp":1793218678127,"version":"4.5.0"},"reference-count":26,"publisher":"Bioscientifica","content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2015,5,1]]},"abstract":"Summary<\/jats:title>\n Anti-tumor necrosis factor (TNF)-\u03b1 therapy is established as a new standard for the treatment of various autoimmune inflammatory diseases. We report the first case showing subacute thyroiditis-like symptoms with an amyloid goiter after anti-TNF-\u03b1 therapy. A 56-year-old man with Crohn's disease presented with fever and a diffuse, tender goiter. To control the diarrhea, anti-TNF therapy (infliximab) was administered 4 weeks before the thyroid symptoms emerged. The patient reported a swollen neck with tenderness on the right side and fever 4 days after the second infliximab injection. An elevated serum C-reactive protein (CRP) and serum thyroid hormone level with suppressed serum thyrotropin were observed. The thyroid-stimulating antibody was not elevated. An ultrasonograph of the thyroid revealed an enlarged goiter with posterior echogenicity attenuation and a low echoic region that was tender. The thyroid uptake value on technetium-99m scintigraphy was near the lower limit of the normal range. The patient was initially diagnosed with thyrotoxicosis resulting from subacute thyroiditis. Administration of oral prednisolone improved the fever, thyroid pain, and thyroid function, but his thyroid remained swollen. The patient developed diarrhea after prednisolone withdrawal; therefore, adalimumab, another TNF inhibitor, was administered. After three injections, his abdominal symptoms were alleviated, but the thyroid pain and fever recurred. Elevated serum CRP levels in the absence of thyroid dysfunction were observed. The patient's symptoms resolved after prednisolone retreatment, but an elastic, firm goiter persisted. A fine-needle biopsy revealed amyloid deposition in the thyroid.<\/jats:p>\n \n Learning points<\/jats:title>\n \n \n \n Many cases with thyroid dysfunction accompanied by amyloid goiter have been reported.<\/jats:p>\n <\/jats:list-item>\n \n There are cases that develop amyloid goiter with subacute thyroiditis-like symptoms after anti-TNF therapy.<\/jats:p>\n <\/jats:list-item>\n \n When the thyroid remains swollen after improvement of thyrotoxicosis following treatment with prednisolone, it should be assessed to differentiate between an amyloid goiter and common subacute thyroiditis.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1530\/edm-14-0117","type":"journal-article","created":{"date-parts":[[2015,5,6]],"date-time":"2015-05-06T08:06:18Z","timestamp":1430899578000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":6,"title":["A rare case showing subacute thyroiditis-like symptoms with amyloid goiter after anti-tumor necrosis factor therapy"],"prefix":"10.1530","volume":"2015","author":[{"given":"Junji","family":"Kawashima","sequence":"first","affiliation":[{"name":"1 Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideaki","family":"Naoe","sequence":"additional","affiliation":[{"name":"2 Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Sasaki","sequence":"additional","affiliation":[{"name":"2 Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiichi","family":"Araki","sequence":"additional","affiliation":[{"name":"1 Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref201","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/00005792-199209000-00001","article-title":"Amyloidosis and inflammatory bowel disease. A 50-year experience with 25 patients","volume":"71","year":"1992","journal-title":"Medicine"},{"key":"ref171","doi-asserted-by":"crossref","first-page":"397","DOI":"10.3109\/s10165-012-0670-5","article-title":"Subacute thyroiditis in a patient with juvenile idiopathic arthritis undergoing etanercept treatment: a case report and review of the literature","volume":"23","year":"2013","journal-title":"Modern Rheumatology"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"3653","DOI":"10.1210\/jcem.80.12.8530615","article-title":"Clinical characteristics of subacute thyroiditis classified according to human leukocyte antigen typing","volume":"80","year":"1995","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref121","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1189\/jlb.0606402","article-title":"Decreasing TNF-\u03b1 results in less fibrosis and earlier resolution of granulomatous experimental autoimmune thyroiditis","volume":"81","year":"2007","journal-title":"Journal of Leukocyte Biology"},{"key":"ref101","first-page":"938","article-title":"Graves' disease in a patient with rheumatoid arthritis during treatment with anti-tumor necrosis factor-\u03b1","volume":"35","year":"2008","journal-title":"Journal of Rheumatology"},{"key":"ref221","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1507\/endocrj.45.421","article-title":"Amyloid goiter presented as a subacute thyroiditis-like symptom in a patient with hypersensitivity vasculitis","volume":"45","year":"1998","journal-title":"Endocrine Journal"},{"key":"ref111","first-page":"98","article-title":"Genetic disregulation of gene coding tumor necrosis factor \u03b1 receptors (TNF \u03b1 Rs) in follicular thyroid cancer \u2013 preliminary report","volume":"16","year":"2002","journal-title":"Journal of Biological Regulators and Homeostatic Agents"},{"key":"ref01","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1056\/NEJM199512213332507","article-title":"Drugs and thyroid function","volume":"333","year":"1995","journal-title":"New England Journal of Medicine"},{"key":"ref181","doi-asserted-by":"crossref","first-page":"3653","DOI":"10.1210\/jcem.80.12.8530615","article-title":"Clinical characteristics of subacute thyroiditis classified according to human leukocyte antigen typing","volume":"80","year":"1995","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref251","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1189\/jlb.0606402","article-title":"Decreasing TNF-\u03b1 results in less fibrosis and earlier resolution of granulomatous experimental autoimmune thyroiditis","volume":"81","year":"2007","journal-title":"Journal of Leukocyte Biology"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1056\/NEJM199512213332507","article-title":"Drugs and thyroid function","volume":"333","year":"1995","journal-title":"New England Journal of Medicine"},{"key":"ref241","first-page":"98","article-title":"Genetic disregulation of gene coding tumor necrosis factor \u03b1 receptors (TNF \u03b1 Rs) in follicular thyroid cancer \u2013 preliminary report","volume":"16","year":"2002","journal-title":"Journal of Biological Regulators and Homeostatic Agents"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/00005792-199209000-00001","article-title":"Amyloidosis and inflammatory bowel disease. 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