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Familial dysalbuminemic hyperthyroxinemia associated with multinodular goiter and elevated radioiodine uptake. A case report.

Familial dysalbumenic hyperthyroxenemia characterized by elevations in serum total thyroxine (T4) and free-thyroxine index and normal free T4 and radioiodine uptake has been previously described. This syndrome is secondary to an autosomal dominant inheritance in which affected individuals are mistakenly diagnosed as thyrotoxic because of the elevation of serum levels of total T4 and free T4. The excess T4 level is caused by the presence of an abnormal serum protein that binds excess T4, thereby raising the level of total T4. The authors report the case of a patient with familial dysalbumenic hyperthyroxenemia who presented with superimposed multinodular goiter and an elevated 24-hour radioiodide uptake.

Aged↗

[The specific features of thyrotoxicosis and euthyroid hyperthyroxinemia developed due to the use of cordarone].

Thyrotoxicosis (TT) is one of the thyroid (T) dysfunctions occurring with the use of cordarone. The clinical features of TT were studied in cordarone-treated patients living in Moscow and its regions (mild and moderate iodine deficiency regions). The patients were examined by using currently available procedures for measuring thyroid-stimulating hormone, free thyroxine, free triiodothyronine, antibodies to TH, TPO, interleukin-6 (IL-6), and C-reactive protein (CRP), and by employing T ultrasound study, Holter ECG monitoring. TT was ascertained to develop in the presence of both the pathologically altered (16/23, 69%) and intact T (7/23, 31%). Examining the course of cardiac arrhythmias (CA) in developed TT has established that this condition gives rise to their recurrence. As compared with the control group, the patients with TT were not found to have higher levels of IL-6 and CRP (p > 0.05; Mann-Whitney test). Therapy with thyrostatic agents alone or in combination with glucocorticosteroids normalizes the levels of thyroid hormonesfollowing, on the average, 2-3 months. Euthyroid hyperthyxinemia (EHT) is frequently recorded with the use of cordarone. Examination of 20 patients with EHT has revealed organic pathology in 13 (65%) patients and its absence in 7 (35%). Recurrences of prior CA have not been found in EHT (p < 0.05; McNemar test). The confidence interval for the difference of relative frequencies of signs did not include 0). Thus, TT is a condition that leads to the fact that cordarone loses its antiarrhythmic effects and TT requires compulsory treatment. If required, therapy should be performed during the continued administration of the drug. EHT is not thyrotoxicosis, which is to be followed up.

Amiodarone↗

The diagnostic dilemmas of hyperthyroxinemia and hypothyroxinemia.

It should be apparent that the diagnosis of thyrotoxicosis and hypothyroidism can be correctly made in the majority of ambulatory patients. However, the clinician needs to be extremely careful in reaching such a definitive diagnosis on the hospitalized patient. Both the clinical features and the standard thyroid function tests need careful evaluation and reanalysis before the diagnosis of thyroid dysfunction can be made with confidence.

Humans↗