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Biomedical subjects

H Niepomniszcze

Publications and source records attributed to H Niepomniszcze.

At least 19 recordsLinked to original sources
PubMed2004

Treatment of thyroid associated ophthalmopathy with periocular injections of triamcinolone.

AIM: To evaluate the efficacy of periocular triamcinolone acetonide for the treatment of thyroid associated ophthalmopathy (TAO), and the presence of ocular or systemic adverse effects. METHODS: A multicentre prospective pilot study was performed on patients diagnosed with Graves' ophthalmopathy less than 6 months before entry to the study. Patients were admitted to the study and were randomised into two groups: treatment and control. The treatment group received four doses of 20 mg of triamcinolone acetate 40 mg/ml in a peribulbar injection to the inferolateral orbital quadrant. Both groups were evaluated by measuring the area of binocular vision without diplopia on a Goldmann perimeter and the size of the extraocular muscles on computed tomography (CT) scans. Ophthalmological and systemic examinations were done to rule out ocular and systemic adverse effects. Follow up was 6 months for both groups. RESULTS: 50 patients were eligible for the study. 41 patients completed the study. There was an increase in the area of binocular vision without diplopia in the treatment group (Sigma initial: mean 231.1 (SD 99.9) and final absolute change, mean 107.1 (SD 129.0)) compared to the control group (Sigma initial: mean 350.7 (SD 86.5) and final absolute change, mean -4.5 (SD 67.6)). The sizes of the extraocular muscles were reduced in the treatment group (mean (inferior rectus initial values): 1.3 (0.7), final percentage change: -13.2 (25.7), medial rectus initial values: 1.2 (0.6), final percentage change: -8.2 (20.7), superior rectus-levator palpebrae initial values: 1.2 (0.6), final percentage change: -9.5 (29.1), lateral rectus initial values: 1.0 (0.4), final percentage change: -11.5 (20.6)) compared to the control group (inferior rectus initial values: 0.9 (0.3), final percentage change: -4.0 (21.5), medial rectus initial values: 0.9 (0.3), final percentage change: 0.6 (22.4), superior rectus-levator palpebrae initial values: 0.9 (0.3), final percentage change: 12.5 (37.5), lateral rectus initial values: 0.9 (0.4), final percentage change: -0.5 (31.6)). Both measurements (degree of diplopia and muscle thickness) were statistically significant between groups (initial - final). No systemic or ocular adverse effects were found. CONCLUSIONS: Triamcinolone administered as a periocular injection is effective in reducing diplopia and the sizes of extraocular muscles in TAO ophthalmopathy of recent onset. This form of treatment is not associated with systemic or ocular side effects.

Adult↗
PubMed2004

Ultrasound parameters and markers of bone turnover in hyperthyroidism: a longitudinal study.

Hyperthyroid patients are characterized by accelerated bone turnover leading to bone mass loss. The aim of this study was to assess changes in quantitative ultrasound [QUS] parameters, bone mineral density (BMD), and biochemical markers of bone turnover in patients prior to and after the onset of hyperthyroid treatment. A 2-yr longitudinal study was performed on 10 women recently diagnosed with Grave's disease after starting antithyroid therapy. Six patients were postmenopausal. All patients showed evidence of thyrotoxicosis as indicated by suppressed serum TSH and high levels of total serum thyroxine. They received antithyroid therapy (methimazole and/or 131I radiodine). QUS parameters were measured using an Achilles ultrasound unit and BMD was assessed by dual-energy X-ray absorptiometry (DXA). Thyroid hormones and markers of bone turnover were determined at baseline and 6, 12, and 24 mo after the onset of treatment.Stiffness, broadband ultrasound attenuation (BUA), and speed of sound (SOS) were low at baseline compared to normal values for the same age range and increased after 2 yr of treatment. A significant increase in BMD of the lumbar spine, total skeleton, and skeletal regions (legs) was also observed after treatment. Recovery of stiffness was almost complete at 12 mo. No significant elevation was observed between 12 and 24 mo. Stiffness increased 7.6%, 10.4%, and 10.4% after 6 mo (p < 0.02), after 1 yr (p < 0.02), and after 2 yr, respectively. No significant increase in SOS and BUA was observed between 12 and 24 mo. Furthermore, recovery of total skeleton and lumbar spine BMD continued throughout the study. Successful antithyroid therapy produced a rapid increase in QUS parameters (Stiffness) and spine BMD and femoral neck during the first year of treatment and a slower increment in total skeleton (up to 24 mo). Overall, ad integrum restitution was not observed in QUS or BMD.

Adult↗
PubMed2002

Estimating body fat and lean tissue distribution in hyperthyroidism by dual-energy X-ray absorptiometry.

Body composition (fat mass, lean tissue, and bone mineral content), was determined by dual-energy X-ray absorptiometry (DEXA) at baseline and 6, 12, and 24 mo after treatment of hyperthyroidism. Ten women with Graves' disease were included in this study. Suppressed serum TSH and high total serum thyroxine levels were found in all patients. The patients received antithyroid therapy (methimazol and/or (131) I radioiodine). Lean tissue, bone mass, and body weight increased after 2 yr of euthyroidism. Total body lean mass increased from 32.3+/-3.9 kg to 35.2+/-4.1 kg (p < 0.005). Total lean mass increased from 10.6 +/- 1.8 kg to 11.6 +/- 1.9 kg (p < 0.01) in the legs, from 3.6 +/- 0.8 kg to 4.0 +/- 0.7 kg (p < 0.02) in the arms, and 16.0 +/- 1.6 kg to 17.4+/-1.8 kg (p < 0.005) in the trunk. Total-body fat mass increased from 19.9 +/- 6.6 kg to 21.2 +/- 7.6 kg (ns). At 1-yr, regional analysis disclosed that fat mass had increased in the trunk from 8.9 +/- 2.9 kg to 10.9 +/- 3.9 kg (p < 0.04) and from 2.3 +/- 0.9 kg to 3.2 +/- 1.2 kg in the arms (p < 0.04). After 2 yr of treatment, fat tissue remained unchanged in all of the studied regions. The results obtained herein suggest that, compared to initial values, the treatment of hyperthyroidism restore body weight. This increase is mainly the result of recovery of lean mass, predominantly in the limbs and trunk. This study provides new data on the patterns of change in body composition occurring in hyperthyroid patients during a 24-mo follow-up after attaining euthyroidism.

Absorptiometry, Photon↗
PubMed2001

Skin disorders and thyroid diseases.

Thyroid disorders have a high prevalence in medical practice; they are associated with a wide range of diseases with which they may or may not share etiological factors. One of the organs which best show this wide range of clinical signs is the skin. This review is an attempt to approach most of the dermopathies reflecting several degrees of harmfulness, coming directly or indirectly from thyroid abnormalities, as well as to update current knowledge on the relationship between the thyroid and skin. We have proposed a primary classification of skin disorders, regarding thyroid involvement, into two main groups: 1) dermopathies associated with thyroid abnormalities, mainly with autoimmune thyroid diseases, like melasma, vitiligo, Sjogren's syndrome, alopecia, idiopathic hirsutism, pre-menstrual acne, bullous diseases, connective tissue diseases, hamartoma syndrome, atopy, leprosy and DiGeorge anomaly; and 2) dermopathies depending on the nature of the thyroid disorder, in which the evolution and outcome of the skin disorder depend on the thyroidal treatment in most cases, such as trophism and skin blood flow, myxedema, alopecia, onychodystrophy, hypo- and hyperhidrosis, xanthomas, intraepidermal bullae, carotenodermia, pruritus, flushing, pyodermitis, palmoplantar keratoderma, ecchymosis, etc. In some other cases, the skin disease which developed as a consequence of the thyroid abnormality can remain unaltered despite functional treatment of the thyroid problem, such as pretibial myxedema, thyroid acropachy and some cutaneous manifestations of multiple endocrine neoplasia types 2A and 2B.

Humans↗
PubMed2001

Long-term follow-up of contralateral lobe in patients hemithyroidectomized for solitary follicular adenoma.

OBJECTIVES: Since there are no available conclusive studies on the long-term evolution of remnant thyroid tissue after hemithyroidectomy in patients who undergo surgery for solitary follicular adenomas, we searched for such cases in our records to elucidate this issue. DESIGN: Search criteria were as follows: (i) presence of a single palpable thyroid nodule with the remainder of the gland normal on palpation; (ii) clinically euthyroid status at the time of surgery; (iii) histological diagnosis of nodule as follicular adenoma; (iv) a hemithyroidectomy operation, sparing the contralateral lobe; (v) normal macroscopic aspect of the contralateral lobe at the time of surgery; and (vi) at least 4 years of postoperative follow-up. PATIENTS: Only 47 female cases were found to meet above criteria, with a mean age of 45.9 years (range: 23-79) at the time of surgery and a mean follow-up of 7.2 years (range: 4-32). Besides evaluating the presence or absence of antithyroid antibodies and the extranodular histology of tissue removed during surgery, a preoperative TRH test also allowed patients to be classified into two groups: normal extranodular thyroid (NET) (n = 32) and abnormal extranodular thyroid (AET) (n = 15). RESULTS: Eleven of the 15 patients with AET had thyroid autoimmunity, with or without overt histological thyroiditis, and the remaining four had subclinical hypothyroidism with negative antithyroid antibody titres. In the entire study population, only 28 patients received treatment with L-T4 immediately after surgery, none of whom had any alterations in the contralateral lobe. However, six of the nineteen patients not treated with T4 (31.6%) developed overt abnormalities in the contralateral lobe, including the only three with AET who had not received L-T4 treatment. The remaining three were two patients with NET, who showed postoperative TSH hyper-responsiveness to TRH (peak TSH > 25 mU/l), and one who developed a new follicular adenoma 32 years later. To date, none of the patients with NET, who had a normal TRH test after surgery, have developed any kind of alterations in the contralateral lobe, even those who received no L-T4 prophylactic treatment. CONCLUSIONS: The findings of this study suggest that: (i) there is a higher risk of follicular adenomas developing in a gland affected by thyroid autoimmunity than in a previously normal gland; (ii) L-T4 therapy may prevent the formation of new nodules or the development of goitre in the contralateral lobe; and (iii) in the absence of prophylactic treatment after surgery, the contralateral lobe of subjects with thyroid autoimmunity and/or previous subclinical hypothyroidism develops morphological abnormalities.

Adenoma↗
PubMed1998

Hyperthyroidism influences ultrasound bone measurement on the Os calcis.

The objective of our study was to compare bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound (QUS) parameters in women with hyperthyroidism and controls. In this cross-sectional study, QUS parameters and BMD values observed in untreated hyperthyroid patients were compared with data obtained from age-matched controls. Twenty-four women with Graves' disease were studied. Eight patients were postmenopausal. All patients had evidence of thyrotoxicosis as indicated by a raised total serum thyroxine and a suppressed serum thyroid stimulating hormone. BMD of the hip, lumbar spine and whole body, and body composition, were measured by DXA. Ultrasound evaluation on the os calcis was performed with an Achilles device. All measurements were performed before antithyroid therapy. The QUS parameters of BUA, SOS and Stiffness were significantly lower in hyperthyroid patients than in controls. Similar results were observed for the BMD of lumbar spine, femoral neck and total skeleton. Lean tissue and fat mass were also significantly decreased in hyperthyroid patients. In conclusion, these findings suggest that hyperthyroidism affects cortical and trabecular bone equally, as well as bone quality. QUS measurements may be helpful for assessing, using a simple and non-irradiating method, the bone effects of thyrotoxicosis.

Absorptiometry, Photon↗
PubMed1997

Development of Graves' disease nine years after total thyroidectomy due to follicular carcinoma of the thyroid.

We report a 49-year-old woman with Marfan syndrome who underwent total thyroidectomy for follicular carcinoma. The patient was given 100 mCi of radioactive iodine (131I) followed by levothyroxine (LT4) 0.2 mg/day after surgery. The subsequent five total body scans were negative and thyroglobulin (TG) measurements ranged between undetectable levels to 12 ng/mL. Nine years after thyroidectomy the patient developed bilateral exophthalmos with markedly positive thyroid-stimulating immunoglobulins (TSI), indicating the presence of Graves' disease. TG levels increased and concurrently pulmonary metastases that did not concentrate radioiodine at tracer doses, were diagnosed. Due to these metastatic lesions, the patient received a therapeutic dose of 150 mCi of 131I 1 month after LT4 withdrawal, and a total body scan was made 10 days later. Slight uptake of 131I was found in the right side of the neck, whereas predominant uptake occurred in the right lung base. We suggest that the elevated TSI played a role in the growth of metastases.

Adenocarcinoma, Follicular↗
PubMed1995

Peripheral neuropathy in subclinical hypothyroidism.

Alterations in peripheral nerves are well documented in overt myxedema but not in subclinical hypothyroidism. We performed electrophysiologic studies to investigate such abnormalities in patients with normal serum total T4 and hyperresponsiveness of TSH to TRH, either with normal or high levels of basal circulating TSH. Subjects were divided in three groups: (i) Hypothyroidism Stage I (group () (n = 17, mean age = 39 +/- 34 years), T4 = 9 +/- 0.7 micrograms/dL, TSH = 4.3 +/- 0.4 microU/mL, sTSH post-TRH (peak value) = 37.6 +/- 1.6 microU/mL; (ii) Hypothyroidism Stage II (group II) (n = 10, mean age: 43 +/- 6 years), T4 = 7.7 +/- 0.8 microgram/dL, TSH = 20 +/- 5 microU/mL, TSH post-TRH > 50 microU/mL; (iii) Control Group (n = 20, mean age 41 +/- 5 years), healthy subjects. All patients and controls were women. TRH test consisted in the i.v. injection of 200 micrograms TRH (normal peak value up to 25 microU/mL, normal basal TSH < 5.5 microU/mL. None of the patients had carpal tunnel syndrome or any other neurological or metabolic disturbances. We studied the distal motor latencies, motor and sensory amplitudes, and nerve conduction velocities. The motor parameters were measured in the median and external sciatic popliteal (ESP) nerves, and the sensory parameters in the median and sural nerves. In most cases values were obtained from both right and left nerves. Motor parameters: no differences were found between all groups for conduction velocities (CV).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Psychological changes during thyrotoxicosis.

Psychological changes during hyperthyroidism are well known. However, no studies were performed in order to quantify or evaluate them in numerical details. We have studied the personality of 15 women with Graves' disease by means of the 16PF Cattell Test, before and after treatment of hyperthyroidism with surgery or radioactive iodine. The first test was performed when patients relapsed the thyrotoxicosis after a period of euthyroidism, achieved through the treatment with antithyroid drugs during one year. At the time of the second test all patients had 6-12 months of euthyroidism. Hormonal circulating levels were as follow (mean +/- SEM): a) at the first test, T3 = 320 +/- 27 ng/dl, T4 = 19.7 +/- 1.2 micrograms/dl, TSH < 0.2 microU/ml; b) at the second test, T3 = 128 +/- 9 ng/dl, T4 = 8.8 +/- 0.8 micrograms/dl, TSH = 1.9 +/- 0.4 microU/ml. Differences between both tests were expressed for each factor as the mean difference +/- SEM (paired "t" test). After treatment patients were: 1) more relaxed and emotionally trustful and cooperative (factor A + 1.06 +/- 0.39, p < 0.02); 2) better and faster intellectual comprehension (factor B + 0.80 +/- 0.31, p < 0.05); 3) more capable of analysis (factor Q1 + 0.93 +/- 0.41, p < 0.05); 4) lower in lingering anxiety and tension (factor Q4-0.87 +/- 0.36, p < 0.05); 5) more independent, less submissive (factor QIV + 0.88 +/- 0.41, p < 0.05); 6) more relaxed (factor QI-0.69 +/- 0.20, p < 0.01). The other factors remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Abnormal H2O2 supply in the thyroid of a patient with goiter and iodine organification defect.

A 71-yr-old man, clinically euthyroid, with a 570-g goiter causing severe mechanical neck compression underwent thyroidectomy. His total serum T4 level was 1.8 micrograms/dL, T3 was 200 ng/dL, and TSH was 35 microU/mL, and a perchlorate test was markedly abnormal. The excised thyroid tissue had normal peroxidase activity in the tyrosine iodinase and guaiacol assays. [131I]Iodide, given 24 h before surgery, was distributed in thyroglobulin isolated in vitro as follows: monoiodotyrosine, 71.6%; diiodotyrosine, 26.7%; T3, 1.05%; and T4, 0.65%. The [131I]iodide content of the whole thyroid homogenate was 59%. The goiter content of thyroglobulin was 94.7 mg/g tissue. The thyroglobulin reacted normally with antihuman thyroglobulin antiserum. Fresh goiter slices and slices from five normal human thyroid specimens were incubated with 10(-6) M KI and [131I]iodide (tracer) containing medium alone (basal), medium plus 1 mg/mL glucose oxidase (GO), and medium plus 10(-4) M NADPH and 10(-5) M vitamin K3 (NA-K3). The percentages of organic iodine in the slices, measured as protein-bound 131I, were: basal: goiter, 0.8%; normal, 6.9 +/- 1.8% (+/- SE); GO: goiter, 15.1%; normal, 17.4 +/- 3.1%; and NA-K3: goiter, 16.7%; normal, 4.6 +/- 1.14%. We conclude that an abnormal H2O2 supply may be the cause of the iodine organification defect in this goiter.

Aged↗
PubMed1986

Thyroid glands in patients with Graves' disease are sources of thyrotropin-binding inhibitory (TBI) activity.

In order to investigate the main sources of production of Graves' immunoglobulins, 4 women with Graves' hyperthyroidism, which relapsed after withdrawal of methimazole (MMI) therapy, were selected for this study. The patients underwent subtotal thyroidectomy after pre-operative treatment with MMI and Lugol's solution. Seven blood samples were obtained in each patient during surgery from: a peripheral vein, immediately before neck incision; the carotid artery; and the left and right inferior thyroid veins, respectively, before manipulation of the thyroid; and the left and right inferior thyroid veins, respectively, after surgical handling of the gland; a peripheral vein at the end of operation. Thyrotropin-binding inhibitory (TBI) activity was measured in all samples by a radioligand method. Serum TSH was also measured in those samples. There was a substantial increment of TBI in the thyroid veins compared with the activity in the carotid artery. The mean TBI was significantly higher after surgical handling of the thyroid lobes. The two lobes from each gland secreted differing levels of TBI, whereas the TSH concentrations were similar in all samples from each individual patients. We conclude that at least part of the TBI activity in patients with Graves' disease comes from the lymphocytic infiltration of the glands, and that differences in antibody production between the thyroid lobes may explain the difference in TBI activity in their respective thyroid veins.

Adult↗
PubMed1985

Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of the melasma.

Melasma is localized hyperpigmentation over the forehead, upper lips, cheeks, and chin. In this study, evidence suggesting an association between autoimmune thyroid disorders and melasma and the relationship of thyroid disorders to the origin of melasma is presented. A total of 108 nonpregnant women, aged 20-56 yr, were divided into 2 groups for the purpose of this study: 1) melasma, 84 patients; 2) control group, 24 patients from the Dermatology Clinic matched for age and sex. Microsomal thyroid autoantibodies (MCHA) were sought in all subjects. TRH-TSH tests were performed in patients with melasma and in those women with goiter and/or positive MCHA tests from the control group. Studies were completed with serum T4, T3, and antithyroglobulin antibody (TGHA) measurements in all patients with thyroid abnormalities. In patients with melasma, the frequency of thyroid disorders (58.3%) was 4 times greater than in the control group. The MCHA-negative patients had 1) simple goiter (13.1%), 2) Plummer's disease (2.4%), and 3) TSH hyperresponse to TRH in nongoitrous patients (10.7%). Patients with positive MCHA tests (32.1%) were divided into 2 subgroups. One comprised those women with an apparently normal thyroid gland and thyroid function (n = 7), while the other included all patients with goiter and/or subclinical hypothyroidism (n = 20). Regarding the origin of the melasma, it was found that 70% of women who developed melasma during pregnancy or while using oral contraceptives had thyroid abnormalities compared to 39.4% of patients with idiopathic melasma. Subjects from the control group had a 12.5% incidence of thyroid abnormalities, and only 8.3% had positive MCHA. Estrogen, progesterone, or both could be the triggering factor in the development of melasma in women who have a particular predisposition toward both melasma and thyroid autoimmunity. Patients with idiopathic melasma had a lower frequency of thyroid abnormalities, suggesting that there may be different genetic patterns linked to autoimmune thyroid disease. We conclude that there is a true association between thyroid autoimmunity and melasma, mostly in women whose melasma develops during pregnancy or after ingestion of oral contraceptive drugs.

Adult↗
PubMed1983

Kinetics of the iodide trapping mechanism in normal and pathological human thyroid slices.

Kinetics of the iodide trapping mechanism in thyroid slices was studied in human and animal tissues. Slices were incubated with several medium iodide concentrations, ranging from 5 x 10(-6)M to 2 x 10(-4)M, in order to calculate in the steady state the following kinetic parameters of the iodide transport: Km, maximal capacity (C) and diffusion factor (D). Results indicated that the Km was similar in magnitude (10(-5)M) in all cases where trapping activity was present, while maximal capacity (C) values showed significant differences between those pathologies in which trapping activity was hyperstimulated (dishormonogenetic goitre, Graves' disease, toxic adenoma) and those where thyroid tissues presented focal or total alterations on its structure (non-toxic nodular goitre, Hashimoto's thyroiditis, thyroid cancer) or where thyroid tissues were not sufficiently stimulated by TSH (extranodular tissue of toxic adenoma). 'Warm' nodules were not significantly different from normal human thyroid. These results suggest that the scattered trapping values observed in the different thyroid pathologies correspond to quantitative differences between them rather than to qualitative alterations in the thyroid iodide pump.

Adenoma↗
PubMed1980

Congenital goitre due to "thyroid peroxidase-iodinase defect".

A 16-year-old male cretin with congenital goitrous hypothyroidism and 95% discharge in the perchlorate test underwent thyroidectomy. Thyroid studies disclosed negligible peroxidase (TPO) activity in the tyrosine iodinase assay, 6 nmoles I- inc./g (normals: 220-410). Using the same particulate preparations, a high activity was obtained in the guaiacol assay, 485 U/mg vs. 176 U/mg of a control gland. Goitre TPO was solubilized by treating the thyroid pellets with deoxycholate, trypsin and acetone. Soluble goitre TPO was further purified on Sephadex G-200. By this procedure we obtained a single peak of enzyme activity for oxidizing guaiacol, although no activity was found for iodinating tyrosine. I2 formation, as measured by the triiodide assay, was only 28% of that expected for normal TPO when compared for guaiacol oxidation. It is concluded that this abnormal TPO was the cause of the congenital hypothyroidism of the patient. We suggest the term "thyroid peroxidase-iodinase defect" for defining this newly found inborn error.

Adolescent↗