The
silicone implant controversy wavers between reassuring epidemiological studies and about 300 case reports of patients developing a definite or incomplete/atypical
connective tissue disease (CTD) after receiving a
silicone gel-filled
breast implant (SBI). Since Hashimoto's
thyroiditis (HT) is rarely reported in this context, we report here two new cases of HT associated with a history of bilateral cosmetic SBIs. The first patient was a 45-year-old white woman who had SBIs in 1976. In 1991 she developed HT, evolving to thyroid deficiency which was compensated with
levothyroxine treatment. In addition, the patient complained of
fatigue,
arthralgia, morning stiffness and developed a
sicca syndrome necessitating
artificial tears. The 1995 evaluation disclosed the presence of
antinuclear antibodies at a titre of 1/640, and high level anti-
thyroid microsomal antibodies (1/256,000).
Gamma globulins rose to 22.6%. Thyroid ultrasonography showed an enlarged thyroid gland with a diffusely hypoechogenic pattern. The implants were painful, and in 1996 they were removed. Microscope examination of the fibrous
capsule surrounding the
prostheses showed extremely dense connective tissue with
fibrosis. The second patient was a 55-year-old white woman who had SBIs in 1984. In 1995, she developed HT with clinical
pain and tenderness of the thyroid gland, with mild
hyperthyroidism and positive
antithyroglobulin antibodies, and was given
corticosteroid treatment for 5 months. In 1996, the implants were again painful and the patient developed positive
antinuclear antibodies with a titre of 1/200. Ultrasonography showed a heterogeneous thyroid gland, and implant removal was advised. Hashimoto's
thyroiditis is recognized as a subset of chronic auto-immune
thyroiditis, and its association with SBI is rare. In these 2 observations, an association without relation is possible, but a future survey of similar cases seems warranted.