[Physiopathology and therapy of transient thyroid dysfunction syndrome].
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Hypothyroidism or hyperthyroidism may develop during iodine excess. Hypothyroidism occurs mostly in newborns or in elderly patients with underlying autoimmune thyroiditis and is treated by substitutive doses of thyroxine. Hyperthyroidism is of two types. Type I develops in patients with pretoxic thyroid glands, the radioactive tracer uptake remains high. This type is treated with thionamides and potassium perchlorate, as well as, in some cases, by thyroidectomy or iodine 131. Type II develops in non pretoxic thyroid gland, and it evoluates spontaneously towards euthyroidism, in several months, despite continuation of iodine excess. It responds to glucocorticoid therapy.
Thirty patients with subclinical thyrotoxicosis and 32 with subclinical hypothyroidism with attacks of atrial fibrillation were investigated. At levels of thyroid-stimulating hormone below 0.1 or above 10.0 mIU/l average triiodothyronine and thyroxine levels in patients with subclinical thyrotoxicosis were 89.6 and 73.2%, respectively, higher than in patients with subclinical hypothyroidism. Some relationships were found between levels of thyroid hormones and hemodynamic and electrophysiological parameters of the heart. Differential therapy of attacks of atrial fibrillation was effective in 80 and 62.5% of patients with subclinical thyrotoxicosis or hypothyroidism, respectively.
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