A detailed comparison was made over 18 months of the serial mean 20 min 132I uptake behavior between 15 Graves' disease patients whose hyperthyroidism ultimately remitted (Group E) and 20 in whom it persisted (Group R). All were treated with carbimazole and T3. There were not qualitative differences in uptake between the 2 groups. In both, the uptake fell with time, and the slopes were parallel. The fact that the mean uptake started lower in Group E patients was sufficient to explain why it became normal much earlier than that of Group R, which had not normalized by 18 months. In both groups, over half the overall fall in uptake occurred during the first month of treatment with carbimazole. We conclude that, while time remains the most important determinant of outcome in Graves' disease, some possible immunosuppressive action of carbimazole can shorten the cycle length to a major degree.

Adult↗

PubMedDate not supplied

Altered plasma protein binding of drugs in thyroid disease.

The plasma protein binding of propranolol and warfarin was studied in vitro by ultrafiltration in hyper- and hypothyroid patients both before and after treatment. The degree of binding of propranolol was significantly decreased in hyperthyroid patients and increased in hypothyroid patients, and was negatively correlated with serum thyroxine and the free thyroxine index. The plasma protein binding of warfarin was also decreased in hyperthyroid patients, but was unchanged in hypothyroid patients. These results suggest that the binding of both acidic and basic drugs may be altered by thyroid disease.

Adolescent↗

PubMedDate not supplied

The variations in thyroid function tests compatible with clinical euthyroidism after medical and surgical treatment for Graves' disease.

Eight widely used tests of thyroid function (clinical and biochemical) were performed simultaneously on 46 thyrotoxicosis patients who were clinically well at a standardised interval after medical or surgical treatment. The aim was to establish the range of thyroid function compatible with clinical normality. While clinical scoring systems gave broadly similar results between surgically and medically-treated patients, thyroid biochemistry showed major differences. Thus while 87% of medically-treated and 74% of surgically-treated patients were classified clinically euthyroid by the clinical indices devised by Crooks and Billewicz, the TRH test was exaggerated in 77% of the latter group but in only 13% of the former. On the other hand, half of the 26% of surgical patients with a clinical index suggesting hyperthyroidism had normal thyroid hormone levels and exaggerated TRH tests. No patient was categorised as clinically hypothyroid despite basal TSH levels as high as 21 mU/L (N : less than 5 mU/L) and T4 levels as low as 42 nmol/L (N: 70.150 nmol/L). Substitution of FT4 index for total T4 did not significantly alter the classification or ranking of patients in either treatment group. The early (20-minute) 132I uptake was normal in all but one case. We conclude that abnormal laboratory tests of thyroid function are found frequently after treatment in thyrotoxicosis patients with few or no clinical features of thyroid disturbance.

Graves Disease↗

PubMedDate not supplied

[The 20 min. iodine uptake in Graves' disease. 1. Technique and reliability (author's transl)].

The 20 minute intravenous radioiodine uptake technique is described in detail and results compared with those from the classical 2 1/2 hour oral uptake in 93 Graves' disease patients. Two methods used in correcting for extrathyroidal radioactivity in the early uptake are similarly compared. The 20 minute uptake was normal (locally less than 8% dose) in only 6,5% of the patients while the 2 1/2 hour uptake was normal (locally less than 35% dose) in 18,5%; in six patients the uptake at 20 min. was higher than at 2 1/2 h, observations indicating the superior sensitivity and diagnostic value of the early uptake. The suppression test performed at 20 minutes was, furthermore, pathological in 97,8% of patients. The comparison of methods to correct for extrathyroidal radioactivity in the 20-minute test showed excellent agreement between thigh count subtraction and application of a formula based on the thyroid uptake at 2 minutes. The former technique, however, was considered to be simpler. We conclude that the 20 minute intravenous iodine uptake technique is not only simpler to perform than the classical oral method, but is also diagnostically more accurate. A high quality scan was obtained 30-60 minutes after the injection of radioiodine in most of these patients.

Administration, Oral↗

PubMedDate not supplied

[The 20-minute iodine uptake in Graves' disease. 2. Natural course during medical treatment (author's transl)].

The early (20 min) radioiodine uptake has been used to monitor the fluctuations in disease activity among 35 Graves' disease patients treated for 18 months with carbimazole and T3. A wide variety of behaviour was observed. Although as a group the uptake tended to fall progressively with time, in some it fell only to rise again and in others it fluctuated erratically. The initial fall in uptake in a substantial minority of patients was sufficient to suggest that carbimazole may exert a fundamental and beneficial influence of the immunological disturbance in Graves' disease.

Carbimazole↗

PubMedDate not supplied

[The 20-minute iodine uptake in Graves' disease. 3. Prognostic value (author's transl)].

The early (20-min.) radioiodine uptake was used to monitor disease activity in 35 Graves' patients undergoing an 18-month course of treatment with carbimazole and T3. T3 alone produced no change in uptake, but four weeks after the introduction of carbimazole, the mean uptake had fallen by more than 50%. Six months after completion of treatment, 20 patients (group R) had relapsed, and 15 (group E) were in remission. The only quantitative difference in mean uptake behaviour between R and E patients was one of degree, their slopes being parallel. Thus, while the mean uptake of both groups fell progressively towards normal, that of group E patients arrived much the earlier, and carbimazole seemed to hasten both. Major fluctuations in thyroid uptake were observed in most individuals, but certain defined patterns emerged. While the uptake suppressed at some time during treatment in 32 (91,4%) patients, remission was associated only with early (ie before month 5) and stable suppression. The predictive value of the uptake test early during treatment was limited to identifying a group certain to relapse, but these non-suppressors accounted for only 40% of all patients, and it was not possible to identify with any certainty those who would ultimately remit.

Female↗