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PubMed1977

Painless thyroiditis and transient hyperthyroidism without goiter.

Eight women had painless thyroiditis, transient thyrotoxicosis, and low radioactive iodine uptakes but were without goiter; they constituted 15% of all thyrotoxicosis cases that we saw during the past year. Standard antithyroid antibody tests by tanned erythrocyte hemagglutination, complement fixation, and colloid and microsomal fluorescence, if present initally, were only weakly psotivie and became negative by 9 months. However, human antithyroglobulin antibody levels by a sensitive radioimmunoassay were elevated initially in all patients. In general, these radioimmunoassayable antibody levels fell, but they had not returned to normal by 9 months. Serial thyroid function tests and standard antithyroid antibody tests were most compatible with subactue thyroidtis. However, the persistence of radioimmunoassayable antithyroblobulin antibodies and recent reports of histologic evidence of lymphocyte thyroiditis in similar patients with goiter leaves open the possibility that this is a previously unrecognized presentation of chronic lymphocytic thyroiditis. Neither the cause nor the ultimate course of this syndrome is known.

Adult↗
PubMed2002

Transient hyperthyroidism of hyperemesis gravidarum.

OBJECTIVE: To characterise the clinical, biochemical and thyroid antibody profile in women with transient hyperthyroidism of hyperemesis gravidarum. DESIGN: Prospective observational study. SETTING: Hospital inpatient gynaecological ward. POPULATION: Women admitted with hyperemesis gravidarum and found to have hyperthyroidism. METHODS: Fifty-three women were admitted with hyperemesis gravidarum and were found to have hyperthyroidism. Each woman was examined for clinical signs of thyroid disease and underwent investigations including urea, creatinine, electrolytes, liver function test, thyroid antibody profile and serial thyroid function test until normalisation. MAIN OUTCOME MEASURES: Gestation at which thyroid function normalised, clinical and thyroid antibody profile and pregnancy outcome (birthweight, gestation at delivery and Apgar score at 5 minutes). RESULTS: Full data were available for 44 women. Free T4 levels normalised by 15 weeks of gestation in the 39 women with transient hyperthyroidism while TSH remained suppressed until 19 weeks of gestation. None of these women were clinically hyperthyroid. Thyroid antibodies were not found in most of them. Median birthweight in the infants of mothers who experienced weight loss of > 5% of their pre-pregnancy weight was lower compared with those of women who did not (P = 0.093). Five women were diagnosed with Graves' disease based on clinical features and thyroid antibody profile. CONCLUSIONS: In transient hyperthyroidism of hyperemesis gravidarum, thyroid function normalises by the middle of the second trimester without anti-thyroid treatment. Clinically overt hyperthyroidism and thyroid antibodies are usually absent. Apart from a non-significant trend towards lower birthweights in the infants of mothers who experienced significant weight loss, pregnancy outcome was generally good. Routine assessment of thyroid function is unnecessary for women with hyperemesis gravidarum in the absence of any clinical features of hyperthyroidism.

Adult↗
PubMedDate not supplied

[Comparative analysis in assessing the thyroliberin test in thyroid function disorders].

The thyroliberine test was performed in 128 subjects with euthyroidism, thyrotoxicosis and initial hypothyrosis, using a "Hoechst" (FRG) drug in a dose of 200 micrograms, injected intravenously before and 30 minutes after thyroliberine administration, followed by radioimmunoassay of thyreotropic hormone. The test results were evaluated according to the difference and ratio of stimulated basal thyrotropin levels. Distribution of random errors of these findings was studied. Examination of a statistical hypothesis on the normal law of propagation of errors was realized according to the X2 criterion. It was detected that the introduction of a new index for the test evaluation is of interest, i.e. logarithm of ratio between stimulated and basal thyrotropin levels, which was the best one in the thyroid function increase. In initial hypothyrosis the use of the difference between stimulated and basal thyrotropin levels is more informative.

Evaluation Studies as Topic↗
PubMed2003

Fate of human thyroid tissue autotransplants.

PURPOSE: We conducted this study to establish whether human thyroid tissue autografts can survive and function in the absence of their native blood supply in muscle. The benefits of this potential could be incorporated in routine surgery to reduce the incidence of post-operative hypothyroidism. METHODS: Fifteen patients with benign thyroid disorders, seven of whom had Graves' disease and eight, multinodular goiter (MNG), underwent modified subtotal thyroidectomy and the autotransplantation of thyroid tissue in the sternocleidomastoid muscle. About 3-5 g of thyroid tissue was cut and implanted into the sternocleidomastoid muscle. Postoperative clinical assessment, thyroid function tests, and technetium scans of the neck were done to assess the function of remnant and transplanted thyroid tissue. RESULTS: The transplanted tissue was functional in six of the eight patients with MNG and four of the seven with Graves' disease. All the patients with MNG and a functional transplant became euthyroid within 6 months postoperatively. Although the transplanted tissue was functional in four patients with Graves' disease, only one became euthyroid, while the other three required supplemental hormone therapy for postoperative hypothyroidism. CONCLUSIONS: These findings demonstrate the ability of autotransplanted thyroid tissue to survive, function, and grow in muscle.

Follow-Up Studies↗
PubMed2004

Definitive diagnosis in children with congenital hypothyroidism.

OBJECTIVES: To investigate the definitive diagnosis and underlying causes of congenital hypothyroidism (CH) in eligible children through the use of a standardized protocol. STUDY DESIGN: Children > or =3 years of age with CH without an identified permanent cause underwent a diagnostic algorithm. Eligible subjects had an anatomically normal thyroid or had not undergone imaging studies. After thyroxine was discontinued for 4 weeks, thyroid function tests and a thyroid ultrasound were obtained. An abnormal ultrasound was followed by a (99m)Tc thyroid scan. A perchlorate washout test was performed in subjects with a normal ultrasound but abnormal thyroid function tests. Children with normal results were followed for 1 year. RESULTS: Of 33 children, 17 were boys. Nine (27%) had an absent or ectopic thyroid, 12 (36%) had dyshormonogenesis, and 12 (36%) had transient CH. Average thyroxine dose before medication discontinuation was 2.9 +/- 0.83 microg/kg in permanent cases versus 2.0 +/- 0.53 microg/kg in transient (P <.002). No complications from discontinuation of thyroxine occurred. CONCLUSIONS: A significant percentage of children with CH have a transient requirement for thyroid hormone. A standardized protocol with thyroid ultrasonography is a safe and sensitive approach to a trial off of thyroxine in select patients.

Algorithms↗
PubMedDate not supplied

A case of Resistance to Thyroid Hormone without mutation in the thyroid hormone receptor beta.

BACKGROUND: Resistance to Thyroid Hormone (RTH) is a condition caused by tissue hyposensitivity to the effects of circulating thyroid hormone, and may be misdiagnosed as hyperthyroidism. AIMS: We report the first case of RTH in an Irish patient highlighting the clinical features and the pathophysiological mechanism underlying the characteristic laboratory abnormalities found in the condition. METHODS: We describe an isolated case of RTH initially misdiagnosed as hyperthyroidism, and detail the investigations which ultimately led to the correct diagnosis. Genetic screening of the thyroid hormone receptor beta gene was performed. RESULTS: Thyroid function tests including T3 suppression test and TRH-stimulation test suggested a diagnosis of RTH. Genetic testing failed to demonstrate a mutation in the thyroid hormone receptor. CONCLUSION: RTH is a rare inherited condition that may be misdiagnosed as hyperthyroidism. The case we describe most likely results from a de novo mutation in an as yet undiscovered gene. RTH should be considered in patients with elevated thyroid hormone levels and normal TSH so that unnecessary and potentially harmful treatment can be avoided.

Adult↗
PubMed1975

Ocular myasthenia gravis and Hashimoto's thyroiditis.

Two patients had ocular myasthenia gravis coexistent with Hashimoto's thyroiditis. A 37-year-old woman presented with diplopia and displayed a head tremor and thyroid enlargement. Thyroid function tests showed an elevated thyroid stimulating hormone (TSH). A quantitative Tensilon test yeilded a "perverse" response and a needle biopsy indicated Hashimoto's disease. A 26-year-old woman presented with diplopia and subsequently developed blepharoptosis and thyroid enlargement. Examination revealed Cogan's eyelid twitch sign, a paradoxical quantitative Tensilon test, and laboratory studies revealed normal thyroid function tests. Treatment was directed at each disease entity separately. Ocular myasthenia gravis was managed with an anticholinesterase agent in combination with oral corticosteroids that provided additional control. Suppressive therapy with desiccated thyroid hormone reduced the size of the thyroid gland, diminished the signs and symptoms of hypothyroidism, and lowered the levels of TSH, possibly decreasing the risk of thyroid carcinoma. Both patients showed gratifying responses to therapy.

Adult↗
PubMed1995

High incidence of occult thyroid disease among general medical ward patients.

The objective of this study was to prospectively determine the efficacy of the results of routine testing of thyroid functions in patients admitted to a general medical ward. Blood for thyroid function tests was drawn on admission as part of the laboratory screening panel from 270 consecutive patients. Fifty-one were excluded due to recognition of thyroid-related problems by the clinical staff. 138 patients (63%) had normal free thyroxin (FT4) levels, one patient had hyperthyroidism, 15 patients (6.8%) had laboratory primary hypothyroidism and 65 patients (29.6%) had equivocal results (FT4 < 0.9 ng/dL and TSH < 5.0 mmu/L). In eight out of 31 patients in the latter group, the thyroid releasing hormone (TRH) test revealed primary or secondary hypothyroidism. A total of 55 patients (25.1%) expired within one year. The mortality rate was significantly higher among the low FT4 patients (p < 0.01), and was independent of age and sex. We conclude that inclusion of FT4 in a laboratory screening panel will reveal a large patient population with abnormal results. However, establishing the diagnosis requires additional tests. Therefore, screening for occult hypothyroidism among a select population, not the acutely sick, populations may be more efficient.

Adult↗
PubMed2000

[Hypothyroidism after combined surgical and radiotherapy treatment of cancer of the ORL area].

INTRODUCTION: Hypothyroidism is a well described complication of head and neck cancer treatment, but routine testing of thyroid function is generally not done. The combination of surgery and radiotherapy seems to increase the risk of thyroid hypofunction. METHODS: Thyroid function was measured in 82 patients treated for head and neck cancer (different types of surgical resection combined with pre- or postoperative radiotherapy). The treatment was undertaken 1 to 220 months before measurement of THS and T4. RESULTS: 43 out of the 82 patients (52%) had abnormal thyroid tests. Hormonal replacement was necessary in 20/43 cases (24%). More than 85% of patients treated by total laryngectomy or pharyngo-laryngectomy, associated with hemithyroidectomy or not, had hypothyroidism and replacement therapy was necessary in more than half of these patients. For the other types of surgery the incidence of hypothyroidism was 32% with 10% of patients needing substitution. DISCUSSION: A high percentage of patients treated by surgery and radiotherapy develop hypothyroidism. In our experience, routine thyroid function testing is necessary in this group.

Adult↗
PubMed1985

Diagnosis of hyperthyroidism: the newer biochemical tests.

Investigation of suspected hyperthyroidism is conventionally based on measurement of total or free T4 as the initial test, followed in equivocal cases by total or free T3, and the TRH test. Recent developments in techniques for measuring free hormones and TSH promise to change this approach. Free T4 and free T3 can now be rapidly and simply quantitated in whole serum using labelled analogue radioimmunoassays. Specific and highly sensitive assays using labelled monoclonal antibodies are now available for serum TSH that permit the suppressed levels found in most cases of hyperthyroidism to be distinguished from euthyroid levels. These newer assays are available at a cost per test that is often similar to that of the more established tests. Available evidence indicates that measurement of basal serum TSH by a sensitive labelled antibody method can serve as a first line test, at least in uncomplicated cases of suspected hyperthyroidism. In patients with a suppressed TSH, a serum free T4, and in equivocal cases free T3, will distinguish the clinical and subclinical forms of hyperthyroidism. Such an approach would obviate the need for the TRH test. It must be emphasized, however, that experience with this new approach is limited. Caution is advised in the interpretation of low TSH and free hormone levels when there are associated complicating features, such as severe non-thyroidal illness, or pregnancy. These developments mark a trend in thyroid function testing away from measurement of circulating total hormone levels. The newer tests provide an assessment of end organ (thyrotroph) response, and an assessment of biologically active (free) hormone to which the tissues are exposed. These complementary approaches have the potential to identify relatively minor degrees of thyroid dysfunction.

Diagnosis, Differential↗
PubMed1998

Thyroid function in premature infants. The hypothyroxinemia of prematurity.

Advances of perinatal and neonatal medicine have been associated with a progressive reduction in mortality of premature infants and a progressive increase in number of the surviving very low birth weight (VLBW) cohort less than 28 to 32 weeks gestation age. Hypothalamic-pituitary-thyroid (HPT) function is immature in most premature infants, and this is particularly true of the VLBW group. Accumulated information has allowed development of a unique nosology of HPT system disorders in these infants to facilitate thyroid function testing, test interpretation, and patient management.

Congenital Hypothyroidism↗
PubMed1979

A visual index of thyroid function.

A visual index of thyroid uptake (VITU) is introduced as a qualitative measure of thyroid trapping. This index is determined from the 20-minute 99mTc-pertechnetate scan by visually comparing the relative tracer uptake between the thyroid and salivary glands. Three categories are defined: low, normal and elevated. The VITU correctly identified the functional status of the thyroid in 94% of 123 patients studied and agreed with the 24-hour radioiodine uptake (RAIU) in 89%. The VITU is a very simple but highly accurate, reliable and reproducible test. It was primarily designed to complement other tests of thyroid function by contributing qualitative information about the thyroidal trapping mechanism, but it can also be useful in confirming blood tests of thyroid function in cases in which one would prefer to avoid 131I administration for RAIU studies.

Diagnostic Errors↗
PubMedDate not supplied

Assessing thyroid function in the elderly.

Problems in thyroid function are commonly encountered in caring for the elderly patient. Due to difficulties in clinically assessing thyroid status, thyroid function tests become increasingly important. Many problems exist in terms of interpretation of these tests due to physiological alterations accompanying aging and interactions with medications often taken by the elderly. This article discusses aspects of thyroid hormone economy, clinical presentation of disorders of the thyroid gland and offers advice to avoid pitfalls in diagnosing thyroid problems in the elderly.

Aged↗
PubMed1989

Oculopharyngeal muscular dystrophy in an Irish family.

Victor and his associates coined the term oculopharyngeal muscular dystrophy to describe a clinical syndrome characterised by dysphagia and ptosis. Subsequent authors have traced a large series in French Canadians to a single Quebec isolate and have emphasized that the condition is usually inherited as a dominant trait. In 1974 Fried reported two isolated cases in an Ashkenazi Jewish family of Hungarian extract in whom the condition was recessively inherited. In this paper we report an Irish family from North Cork with typical features of oculopharyngeal muscular dystrophy in whom the inheritance pattern is dominant with incomplete expression. In reporting such cases the ethnic and genetic heterogeneity of oculopharyngeal muscular dystrophy is highlighted. Case Report 1. A 68 year old farmer was admitted for investigation of recurrent chest infections. He complained of a 20 year history of progressive difficulty swallowing, productive cough and impaired vision. On examination he had a gaunt expressionless appearance with bilateral ptosis to mid pupillary level. Both right and left gag reflexes were noted to be reduced and sluggish, and on swallowing fluids were noted to regurgitate through his nostrils. Chest examination revealed the presence of bibasal coarse crepitations suggestive of aspiration. No further physical abnormalities were noted. On investigation, full blood count, urea, and electrolytes, liver function tests, sedimentation rate, thyroid function tests, muscle enzymes (PK, LDH) and electrocardiogram were normal. Chest radiograph confirmed aspiration. Tensilon test was negative. Oesophagoscopy outruled organic obstruction, and confirmed sluggish pharyngeal muscular activity. A clinical diagnosis of oculopharyngeal dystrophy was made on the basis of associated ptosis and dysphagia occurring in the presence of a supportive family history.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗