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PubMedDate not supplied

Coexistence of hyperthyroidism and ulcerative colitis: report of 4 cases and a review of the literature.

Four cases of coexisting hyperthyroidism and ulcerative colitis are presented. In two patients the diseases appeared simultaneously, in one the diagnosis of ulcerative colitis preceded the diagnosis of hyperthyroidism, while in the fourth the diagnosis of hyperthyroidism preceded the diagnosis of ulcerative colitis. Hyperthyroidism intensifies the symptoms of ulcerative colitis and impairs response to therapy. Treatment of both diseases should be conservative. There is no clear explanation for the concurrent existence of the two diseases, although immunological mechanisms seem to play the most significant role. The clinician must bear in mind that coexistence of hyperthyroidism and ulcerative colitis in some patients, although infrequent, nevertheless is a reality, which obviously is very important for the patient's outcome.

Adult↗
PubMed2003

[Hyperthyroid rheumatism. Review of the literature and a case report].

INTRODUCTION: It is extremely rare that an inflammatory rheumatism reveals a hyperthyroidism. Only six observations have been described. We report a case of rheumatismal hyperthyroidism successfully treated with carbimazole and propranolol. OBSERVATION: A 52 year-old woman presented with inflammatory rheumatismal pain predominating at the waist for the past six months and resistant to synthetic anti-inflammatories. Thyroid hormone analysis permitted diagnosis of hyperthyroidism. Initiation of treatment with carbimazole led to the rapid regression of the rheumatismal manifestations. COMMENTS: Hyperthyroidism is classically manifested by signs of hypercatabolism. Osteoarticular manifestations are dominated by humeroscapular periarthrosis. Rheumatismal hyperthyroidism is characterised by inflammatory rheumatismal pain evoking, as in our patient, a rhizomelic pseudo-polyarthritis. The outcome, whatever the anti-thyroid treatment, is always good. The physiopathological mechanisms are unknown. They may be due to an attack of the antibodies against the synovial and/or cartilage structures, or to the effect of propranolol. CONCLUSION: It is important to underline the interest of thyroid hormone assay in cases of dubious etiological inflammatory rheumatism and/or resistant to classical treatments.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Iopanoic acid as an adjunct to carbimazole in the management of hyperthyroidism.

BACKGROUND: The thiourea drugs take a few weeks to control the symptoms of hyperthyroidism whilst iodine containing radiographic contrast agents (iopanoic acid and sodium ipodate) have a more rapid effect. There is no report on the use of iopanoic acid administered in conjunction with carbimazole, so we evaluated the efficacy of this combination in the early medical management of patients with hyperthyroidism. METHODS: Thirty hyperthyroid patients diagnosed by clinical and biochemical criteria were randomized into two treatment groups. Group A (n = 16) received iopanoic acid (500 mg orally twice a day for the first 3 weeks) and carbimazole (30 mg orally in three divided doses) while group B (n = 14) received carbimazole alone. Clinical examination and estimation of serum total T3, total T4 and TSH were done by radioimmunoassay at the start of therapy, weekly for 4 weeks and then at 6, 8 and 12 weeks. RESULTS: In the initial 3 weeks, iopanoic acid induced a significantly greater fall in mean serum total T3 levels (Z = 2.298, p < 0.02) and a slower fall in mean serum total T4 (Z = 2.396, p < 0.05) in group A patients compared to those in group B. This was accompanied by earlier clinical improvement in group A patients. The mean serum total T3 and T4 values rose to higher levels in group A at 4 weeks, one week after discontinuation of iopanoic acid. At the end of 12 weeks, however, there was no significant difference in the mean serum total T3 and T4 levels between the two groups (p > 0.05). Biochemical euthyroidism (i.e. total T3 < 3 nmol/L and total T4 < 170 nmol/L) was achieved later in group A patients than in group B (10.4 +/- 5.0 weeks v. 3.6 +/- 1.2 weeks, p < 0.0001). CONCLUSIONS: Iopanoic acid given together with carbimazole induces rapid clinical improvement in hyperthyroid patients than carbimazole alone. However, the delayed achievement of euthyroidism may preclude its routine use in the management of patients with hyperthyroidism except in those with thyrotoxic emergencies.

Adult↗
PubMed1976

Effect of autonomic blockers on the heart rate of intact rats and animals with artificial hyperthyroidism.

The effect of various autonomic blockers on the heart rate (from the ECG recording) of intact rats and of animals with experimental hyperthyroidism induced by the administration of dried thyroid was studied. In intact rats, the heart rate fell significantly (by 22%) during the first week after the peroral administration of propranolol (0.05% in food), but trimepranol (0.02%), reserpine (0.001%) and guanethidine (0.1%) had no effect (in a suplementary experment, a small, but statistically significant decrease was also found after trimepranol). In experimental hyperthyroidism, using the same blocker doses, the heart rate fell significantly after propranolol (by 23%), trimepranol (22%), reserpine (16%) and, in a preliminary experiment, guanethidine (19%). On injecting 0.05 mg propranolol intravenously, the maximum drop in the heart rate in intact rats was 22%, while in hyperthyroidism it was hardly more than half this value (at all the intervals from 2 to 30 minutes the decrease was statistically significant). Practolol, in a dose of 0.3 mg i.v., was less effective -- in intact rats the heart rate fell by not more than 12% (at all the intervals from 2 to 30 minutes the decrease was significant), but in hyperthyroidism the drop was slower and statistically non-significant. The results do not furnish an unequivocal answer to the question of the role of adrenergic regulation of the heart rate under physiological conditions and in experimental hyperthyroidism in rats.

Animals↗
PubMed2003

Fruit extract of Emblica officinalis ameliorates hyperthyroidism and hepatic lipid peroxidation in mice.

The ethanolic extract from the fruits of Emblica officinalis Gaertn (Euphorbiaceae) was investigated to evaluate its possible ameliorating effects, on the L-thyroxine (L-T4) induced hyperthyroidism and on hepatic lipid peroxidation in mice. While an increase in serum T3 (triiodothyronine) and T4 (thyroxine) concentrations, and in a thyroid dependent parameter, hepatic glucose 6-phospatase (glu-6-pase) activity was observed in L-T4 (0.5 mg/kg/d) treated animals, simultaneous oral administration of the plant extract at a dose of 250 mg/kg/d (p.o.) for 30 days in hyperthyroid mice reduced T3 and T4 concentrations by 64 and 70% respectively as compared to a standard antithyroid drug, propyl thiouracil (PTU) that decreased the levels of the thyroid hormones by 59 and 40% respectively. The plant extract also maintained nearly normal value of glu-6-pase activity in hyperthyroid mice. The plant extract also decreased hepatic lipid peroxidation (LPO) and increased the superoxide dismutase (SOD) and catalase (CAT) activities in hyperthyroid mice, exhibiting its hepatoprotective nature. Our findings suggest that the test material may potentially ameliorate the hyperthyroidism with an additional hepatoprotective benefit.

Animals↗
PubMed2003

[Therapeutic specifics in atrial fibrillation in hyperthyroidism. Study of 14 cases].

The aim of this study is to clarify the specificities of atrial fibrillation in hyperthyroidism. It's a retrospective study of 6 years, about 14 patients hospitalized for hyperthyroidism with atrial fibrillation. There were 9 Women and 5 men, 55.7 +/- 11.5 years old. Arryhthmia was discovered especially with palpitation and dyspnea. Cardiac echography diagnosed valvular disease in 83.3% of cases. Cardiovascular complications concerned 5 patients and consisted in cardiac insufficiency and cardiomyopathy in one case. Treatment of hyperthyroid consisted in radio-iodine administered to 7 patients at the dose of 9.8 +/- 3.9 mCi. Two patients had total thyroidectomy. Arryhthmia was treated with propranolol, 98.3 +/- 70 mg daily and anticoagulant treatment was given. From the group of nine hyperthyroid recovered patients, arryhthmia was reduced in 3 cases. In this group, age was higher and arryhthmia history was longer. We conclude that chances to treat arryhthmia associated to hyperthyroid are higher when euthyroidism or even hypothyroidism is rapidly obtained, during of atrial evolution is short and some factors aren't present, like aging, existence of valvular disease or left auricular dilatation.

Aged↗
PubMed1992

[Results of radioiodine therapy in different forms of hyperthyroidism in relation to the planned dosage].

The aim of this study was to assess the efficacy of radioiodine therapy (131J) in a large group (n = 925) of hyperthyroid patients treated at two major departments of nuclear medicine (Freiburg, abbr. FR, and Munich, abbr. M). 761 patients suffered from non-immunogenic hyperthyroidism (Plummer's disease) and the remaining 164 patients from immunogenic hyperthyroidism (Graves' disease). In these cases, radioiodine therapy using doses between 60 and 80 Gy proved ineffective, FR (80 Gy) recording 28% success and M (60 Gy) 54%. A dose of 150 Gy, however, is successful in more than 80% of the cases: FR 81%, M86%. However, the incidence rate of hypothyroidism increases consecutively with 150 Gy: FR 49%, M 62%. In patients suffering from Plummer's disease, the solitary autonomous nodule can be eliminated by radioiodine therapy (400 Gy) with a high rate of success (95%); the same applies to multinodular autonomous adenomas. The therapeutic concept applying a dose of 400 Gy to the total functional autonomous tissue (delineated by ultrasound) yields slightly better results (95%) than 150 Gy applied to thyroid gland (M88%, FR82%). This dosimetric compromise is a practicable alternative which is tolerably successful. In patients suffering from disseminated non-immunogenic hyperthyroidism, a dose of 150 Gy applied to the entire organ succeeds in 85% of the cases. The rate of hypothyroidism resulting from these dose recommendations is the lesser evil compared to residual or recurrent hyperthyroidism, since hypothyroid patients can be treated without any problem with thyroid hormones.

Adenoma↗
PubMed1992

[Circadian blood pressure rhythm in hyperthyroidism and primary hyperparathyroidism].

Some secondary forms of hypertension are characterized by an abnormal circadian blood-pressure rhythm. Therefore, the circadian blood-pressure variability was investigated in a prospective study using ambulatory blood-pressure monitoring in patients with hyperthyroidism and in patients with primary hyperparathyroidism. Both endocrine disorders are often associated with hypertension. Out of 17 patients with hyperthyroidism 73% were hypertensive, and out of 15 patients with hyperparathyroidism 80% were hypertensive. The blood-pressure profiles were compared to profiles from controls comprising normotensive subjects and patients with essential hypertension. The patients with hyperthyroidism and hypertension had a blunted circadian blood-pressure curve with only a small nocturnal reduction of systolic and diastolic blood pressure as compared to control patients. In patients with hyperthyroidism and normal blood pressure, the circadian blood-pressure rhythm was normal; however, in these patients the circadian heart-rate curve was blunted. All patients with hyperparathyroidism (with and without hypertension) had a normal circadian blood pressure and heart-rate rhythm. From these observations we conclude that in hyperthyroidism the circadian regulation of blood pressure or heart rate is significantly blunted. The circadian blood pressure and heart-rate curve is normal in primary hyperparathyroidism.

Adult↗
PubMed2005

[Hyperthyroidism: current concepts and management].

Hyperthyroidism leads to an overproduction of thyroid hormones, which determine diverse expressions of thyrotoxicosis. However a high prevalence of mild and subclinical forms of hyperthyroidism are now recognised, since the biological measurement of thyroid hormones and TSH modified the diagnostic criteria. Clinical, biological, ultrasonographic and scintigraphic data allow the identification of the different causes of hyperthyroidism. This point is very important to assess the prognosis and to choose the right therapy. Graves' disease, solitary and multinodular toxic goiters constitute the main causes of hyperthyroidism, with iatrogenic thyrotoxicosis. Antithyroid drugs, surgery and radioactive iodine, are useful for the traditional forms of hyperthyroidism. But the choice of the therapy and the procedures for the follow-up has now a more rational background.

Antithyroid Agents↗
PubMed2005

[Significance of ultrasound bone measurement in diagnosis of hyperthyroidism].

OBJECTIVE: To evaluate the role of ultrasound in bone density measurement in patients with hyperthyroidism. METHODS: The speed of sound (SOS) through distal radius and midshaft tibia of 118 patients with hyperthyroidism 138 males and 80 females, aged 20 approximately 73, were measured with ultrasonic apparatus, the bone mass density (BMD) was measured at the lumbar spine and proximal femur with dual energy X-ray absorptiometry, the serum levels of total thyroxine (TT(4)), total triiodothyronine (TT(3)), free thyroxine (FT(4)), free triiodothyronine (FT(3)), and thyroid stimulating hormone (TSH) were measured by radioimmunoassay, and alkaline phosphatase (ALP) was measured by routine method. RESULTS: The SOS of the patients with hyperthyroidism was significantly lower than that of the healthy subjects (P < 0.05). A strong positive correlation was found between SOS and BMD. The prevalence of SOS (Z < -1, Z < -2.5) through distal radius and midshaft tibia was significantly higher than that of BMD (Z < -1, Z < -2.5) at lumbar spine and proximal femur in the patients with hyperthyroidism. A negative linear correlation was found between SOS and ALP. CONCLUSION: SOS may be one of the significant markers for abnormal bone metabolism for hyperthyroidism.

Adolescent↗
PubMed2005

Quality of life, depressive symptoms and anxiety in hyperthyroid patients.

PURPOSE: The aim of the study was to evaluate quality of life and to assess frequency and severity of depressive and anxiety symptoms in hyperthyroid patients. MATERIAL AND METHODS: Forty-seven hyperthyroid patients (38 female, 9 male, mean age 51.4 +/- 13.0; 25-Graves disease, 22 - nodular goitre) and fifty-eight sex- and age-matched controls (40 female, 18 male, mean age 49.6 +/- 16.0) were studied. Quality of life was assessed by means of WHO QuoL Questionnaire. Psychometric evaluation included assessment of depressive symptoms (Hamilton Depression Rating Scale and Beck Depression Inventory) and anxiety level (State and Trait Anxiety Inventory--STAI). RESULTS: Patients presented significantly decreased perception of quality of life and health state, and scored worse in physical domain and global score of WHO QuoL. Nineteen patients showed depressive symptoms, remaining 28 were euthymic. Level of anxiety did not differ significantly between the patients group and controls. Free thyroxine plasma level correlated with psychological domain of QuoL. Depression severity correlated with anxiety (STAI 2). Anxiety as a state marker influenced psychological and environmental domains and global score of quality of life questionnaire. CONCLUSIONS: The influence of hyperthyroidism on the quality of life was observed. Depressive symptoms are frequent in hyperthyroidism, occurring in 40% hyperthyroid patients. We found also the association between the anxiety level and the quality of life.

Adult↗
PubMed2005

[The observation of serum sexual hormone levels before and after treatment in male hyperthyroidisms].

OBJECTIVE: To explore the changes of serum sexual hormone levels in male hyperthyroidisms before and after treatment. METHODS: Compared with the control group, the serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and estradiol (E2) of 68 cases of male hyperthyroidisms before and after treatment were detected by chemiluminescence immunoassay technique, and then statistical analysis was performed. RESULTS: The serum T and E2 levels of male hyperthyroidisms were significantly higher than those of the control group before treatment (P < 0.005); while no significant difference in FSH and LH levels existed between the patients and the control group (P > 0.05). There was no difference in FSH, LH, T and E2 levels between patients and the control group after treatment (P > 0.05). CONCLUSION: There are sexual hormone metabolism disorder in hyperthyroidism men, and the increasing serum T and E2 levels are only to adapt the high metabolism environment, and the changes of hypothalamus-pituitary-gonadal axes. Along with the control of hyperthyroidism, the sexual hormone levels return to normal.

Adult↗
PubMedDate not supplied

Neuropsychological findings in hyperthyroid patients.

AIM: to evaluate attention, concentration, memory changes and executive function inpatients with hyperthyroidism compared with normal thyroid function patients. METHODS: a cross sectional study was conducted in 21 patients (14F, 7M) with symptoms of sweating, sleep disturbance, fine tremor, headache, palpitation, nervousness, forgetfulness and diarrhea. Neurological examination found that 2 patients had proximal paresis and periodic paralysis. Their thyroid functions (FT4 and TSHS) were done, 13 patients were hyperthyroid, 2 patients were subclinical hyperthyroid and 6 patients were euthyroid. Neuropsychological tests such as: Mini Mental State Examination (MMSE), Trail Making Test (TMT) A and B, Continuous Performance Test (CPT), Vigilance Complex Task (VCT), Digit Forward and Backward Repetition (DFR, DBR) were performed in all of those patients. The mean age of sample was 47,3 +/- 8,45 years old and all of them had minimal 6 years education background, no history of cerebro vascular disease, brain injury or tumour or infection, epilepsy, cerebral degeneration, and taking neuroleptics or antidepressants. RESULTS: using the Kendall correlation coefficients showed that FT4 had negative correlation with VCT, CPT, DFR, DBR and positive correlation with TMT A (time) and TMT B (time and error). Study T-test showed that high level of thyroid function had significant difference in TMT A (time), TMT B (time), DBR, DFR, VCT, CPT. Fischer exact gave statistically significant in VCT and fine tremor in hyperthyroid patients (RR VCT 5.60, 95% CI 0.93-33.68, RR fine tremor 0.50, 95% CI 0.28-0.88). CONCLUSION: hyperthyroid patients had significant decrease on attention, concentration, verbal memory and executive function (working memory) compared with euthyroid patients.

Adult↗
PubMed2006

[Transdermal carbimazole for the treatment of feline hyperthyroidism].

Orally administered antithyroid drugs are frequently used to treat hyperthyroidism in cats; however, the non-cooperative behaviour of some cats may make it difficult to administer tablets. The aim of this study was to develop a carbimazole ointment for application to the inner pinna of the ear and to test its effectiveness in 13 cats with hyperthyroidism. Laboratory investigations were performed before, and 4, 8, and 12 weeks after start of the treatment. Laboratory data for 9 cats were available at the end of the observation period. The starting dose of carbimazole ointment was 5 mg once daily. If no complications occurred, the dose was increased to 5 mg twice daily from the 6th day onwards. Further dose adjustments were mainly based on the plasma thyroxine (T4) concentration. The median plasma T4 concentration at the end of the observation period (24 nmol/l) was significantly lower than that before treatment (152 nmol/l). The dosage of carbimazole needed to achieve euthyroidism ranged from 4 to 17 mg twice daily. Treatment with carbimazole ointment resulted in disappearance of signs of hyperthyroidism; plasma concentrations of urea and creatinine increased significantly. The results of this study indicate that twice daily administration of carbimazole ointment to the inner pinna of the ear is an effective treatment for hyperthyroidism in cats. This provides the veterinarian with a new and promising treatment option. Because carbimazole ointment has not been registered, according to European law it can only be used for the treatment of hyperthyroidism in cats if other licensed medications have been tried and if there is a therapeutic need.

Administration, Cutaneous↗
PubMed2006

Surgery for hyperthyroidism in Down syndrome: case report.

Thyroid disorders are common in patients with Down syndrome (DS). In these patients, hyperthyroidism occurs much less frequently than hypothyroidism, but it is likely to be underestimated. We report a case of an adult man with DS and hyperthyroidism. After 2 years of antithyroid therapy in a special facility, he was referred to our center with recurrence of hyperthyroidism with leukopenia and elevations of liver enzymes 14 months after remission. The patient underwent subtotal thyroidectomy, with rapid preparation with inorganic iodine and prednisone. After thyroidectomy the patient was found to have hypothyroidism and was given thyroid replacement therapy. We also review the literature on the treatment options for hyperthyroidism with DS. We conclude that the role of surgery in the treatment of hyperthyroid patients with DS has yet to be defined.

Adult↗
PubMed1990

Clinical outcome and costs of care in radioiodine treatment of hyperthyroidism.

The long-term clinical outcome and costs of treatment of hyperthyroidism with radioiodine have been examined in two cohorts of patients from Sheffield and Scotland. The majority of patients in both series were considered to have Graves' disease. The Sheffield patients (660) were included in a trial of three radioiodine dose regimens of 3,500 (312), 7,000 (323) and 14,000 (25) rad determined using a formula for accurate dosimetry. The Scottish patients (3,920) drawn from five centres in Aberdeen, Dundee, Edinburgh, Glasgow and Inverness were treated using an arbitrary scale, for the activity of radioiodine administered, related to goitre size. Their results are grouped into five MBq 'dose' bands: 37-185, 186-370, 371-555, 556-740 and 741+. The proportion of patients with persistent hyperthyroidism was higher in both cohorts for low-dose radioiodine regimens, but 15-25% of patients who received high doses showed persistent hyperthyroidism. Early and late onset hypothyroidism was lower after low doses but differences between the treatment groups were small in terms of clinical benefit. Total morbidity at 10 years follow-up, in terms of hyperthyroidism, and hypothyroidism, was highest after low-dose therapy. There was little variation in total costs, but patient costs were lowest for the Scottish regimen and highest for low-dose therapy. A dose of at least 370-555 MBq which will ensure early elimination of hyperthyroidism will also limit the medical workload and total costs.

Adult↗
PubMed1990

Effect of experimental hyperthyroidism on atropine pharmacokinetics in sheep.

Atropine sulfate (0.02 mg/kg, i.m.) was administered to normal sheep and to sheep with experimentally induced hyperthyroidism. Serum and urine concentrations of atropine measured by radioimmunoassay were monitored over an 8-h period. The time to reach maximum serum concentration was similar in both hyperthyroid and normal sheep. A comparison between normal and hyperthyroid sheep indicated that the atropine absorption rate was not changed, but its rate of elimination was significantly greater in hyperthyroid sheep (p less than 0.01). Hyperthyroidism resulted in significant decreases in atropine (p less than 0.05), MRT (p less than 0.01), AUC (p less than 0.01) and an increase in C1/F (p less than 0.01) when compared to atropine kinetics of normal sheep.

Animals↗
PubMedDate not supplied

[Electrophoretic and enzymatic analysis of glycosaminoglycans in the blood serum of patients with hyperthyroidism].

An effect of hyperthyroidism on the composition and levels of glycosaminoglycans in the blood serum was studied. Glycosaminoglycans isolated from 1-ml blood samples were assayed with the following techniques: carbazole, electrophoretic and enzymatic. Separation and assay of particular GAG were made with bidirectional electrophoresis. Isomers of the remaining chondroitin sulphates were assayed enzymatically. Electrophoretograms of GAG in blood serum of healthy women have shown two fractions: low sulphate chondroitin sulphate and chondroitin-4-sulphate. The same fractions of GAG were found in blood serum of the female patients with hyperthyroidism. Mean concentration of GAG in the blood serum of hyperthyroid patients increased by 51%: low sulphate chondroitin sulphate and chondroitin-4-sulphate concentrations increased by 22% and 190% respectively. Chondroitin sulphates in the blood serum of both groups were degraded to unsaturated disaccharides not containing sulphur and unsaturated 4-sulphate disaccharides. Concentrations of unsaturated 4-sulphate and unsaturated sulphur-free disaccharides increased by 71% and 17% in hyperthyroidism. Observed changes in the blood serum GAG concentrations reflect changes in the connective tissue metabolism in hyperthyroidism.

Adult↗