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PubMed1988

[Therapy resistance of amiodarone-induced hyperthyroidism].

The case of a 77-year-old patient who suffered from clinically severe and persistent hyperthyroidism induced by amiodarone is described. Amiodarone-associated hyperthyroidism is a rare (1-5%) but potentially severe complication. Its treatment presents a serious problem. The newer forms of treatment of this specific type of hyperthyroidism with prednisone and perchlorate are described. Under a combined therapy with thionamide drugs, prednisone and perchlorate euthyroidism could be achieved only after months. We propose a simple diagnostic procedure during amiodarone therapy based on the determination of basal ultrasensitive TSH enabling early recognition of amiodarone-associated hyperthyroidism. Thus, with well defined cardiac criteria for therapy with amiodarone as well as early assessment of thyroid dysfunction the incidence of this potentially severe complication can be reduced.

Aged↗

PubMedDate not supplied

The binding of 3H-(3-MeHis2) thyrotropin releasing hormone to brain and pituitary membranes of hyperthyroid rats.

The effect of chronic treatment of male Sprague-Dawley rats with thyroxine (1 mg/kg, s.c., every other day) for 18 days on the brain and pituitary receptors for thyrotropin releasing hormone (TRH) labeled with 3H-(3-MeHis2)TRH (3H-MeTRH) was determined. Rats serving as controls received the injection of the vehicle for thyroxine. Chronic administration of thyroxine resulted in the development of hyperthyroidism as evidenced by slower rate of gain of body weight, increased colonic temperature, increased systolic blood pressure and heart rate in comparison to vehicle-injected rats. The development of hyperthyroidism by thyroxine treatment was also evidenced by increases in the serum concentration of triiodothyronine (total T3) and thyroxine (T4) in comparison to vehicle-injected rats. The binding of 3H-MeTRH to membranes prepared from different brain regions (striatum, hypothalamus, pons + medulla, cortex and midbrain) and pituitary membranes of thyroxine-treated and untreated rats was determined at 2 nM concentration. The binding of 3H-MeTRH to membranes prepared from any brain region of thyroxine-treated and untreated rats did not differ. The binding of 3H-MeTRH to pituitary membranes of thyroxine-treated rats was much greater than that of untreated rats. It is concluded that chronic administration of thyroxine to rats leads to the development of hyperthyroid state as evidenced by both physiological and biochemical indices, and that hyperthyroid state does not alter the TRH receptors in the hypothalamus or any other brain region but the pituitary TRH receptors are up-regulated.

Animals↗

PubMed1989

[Changes in the blood picture in hyperthyroidism].

On the basis of a retrospective study about 276 clinically and paraclinically ascertained cases of hyperthyroidism in 34% of the patients above all mild anaemias could be proved which under thyreostatic therapy with thiamazol which after repeated incidence of an euthyroid metabolic situation vastly normalized themselves also without an anaemia-specific additional medication. Leukocytopenias (5.8%) and thrombocytopenias (3.3%) had only a low frequency in untreated hyperthyroidism. Nevertheless an unequivocal parallelity of the haematologic changes was to be observed in erythro-, granulo- and thrombopoiesis. There was a clear correlation between the activity of hyperthyroidism, measured at the T3- or T4 level, and anaemia and haemocytopenia, respectively. Lacking substance deficiency conditions and signs of haemolysis let us first of all think of a causal thyrotoxic bone-marrow damage on account of the dependence of the haematologic changes on the activity of hyperthyroidism and their immediate influencibility by aimed thyrostatic therapy. A relatively low dosed thiamazol therapy has influence on haematopoiesis and peripheral blood picture only at a very small percentage, in which cases the changes mostly are fully reversible. Thereby the initial haematologic situation before the therapy does not provide any predictability for perhaps appearing haematotoxic or allergic side-effects under thyreostatic treatment. The thiamazol therapy does not show any recognizable side-effects in the dosage administered on the investigated leukocytic functions agglomeration, adhesion and phyagocytosis. Only for the adhesion of leukocytes was proved a significant functional disturbance of leukocytes, which was, however, reversible with normalization of metabolism and with high probability was also directly thyreotoxically induced.

Adolescent↗

PubMed1989

[Neonatal hyperthyroidism with early onset and protracted course].

Neonatal hyperthyroidism has often been described as a rare, transient disorder in which the mother has hyperthyroidism during her pregnancy. We have found 99 cases mentioned in recent literature, but not in all reports the clinical characteristics were described. This survey has shown that the prolonged clinical course, though less common than the transient one, is to be taken into account. A case of a female child who had signs of hyperthyroidism soon after the birth is presented. Now, at the age of 7.8 years, she continues to have hyperthyroidism with several problems in treatment.

Child↗

PubMed1989

[Isolated thyroid gland sarcoidosis and hyperthyroidism].

A case of isolated sarcoidosis of the thyroid gland, associated with hyperthyroidism, is reported in a 28-year-old male patient whose thyroid was removed for hyperthyroid multinodular goitre. Histology revealed a regressive adenoma and sarcoidosis in non-adenomatous thyroid residue. Further diagnosis, therapeutic management and a 3-year follow-up did not disclose any specific changes or involvement of other tissues. Isolated thyroidal sarcoidosis with hyperthyroid alterations are extremely rare and mostly chance findings; simultaneous occurrence of thyroid sarcoidosis and hyperthyroidism may be a symptom of gland infiltration for which an adequate explanation is still lacking.

Adult↗

PubMed1988

Echocardiographic findings in 103 cats with hyperthyroidism.

Using M-mode echocardiography, cardiac abnormalities were studied in 103 cats with untreated hyperthyroidism. In addition, follow-up echocardiography was performed on 24 of these cats to assess the long-term (4 to 21 months) effect of treatment (thyroidectomy or radioiodine) on thyrotoxic cardiac disease. The most common echocardiographic abnormality in the 103 untreated hyperthyroid cats was hypertrophy of the left ventricular caudal wall (71.9%). Hypertrophy of the interventricular septum also was documented in 39.8% of the 103 cats. Other abnormalities included high values for left atrial diameter (70.0%), aortic root diameter (18.5%), and left ventricular diameter at end diastole (45.6%). In some of these cats, indices of contractility were enhanced; in 21.4% and 14.6% of the cats, values for shortening fraction and velocity of circumferential fiber shortening, respectively, were greater than those values measured in clinically normal cats. After treatment of the hyperthyroidism, left ventricular hypertrophy resolved or improved in many of the cats, as indicated by decreases in left ventricular caudal wall and interventricular septum thicknesses. Hyperdynamic wall motion resolved in all cats after treatment, as evidenced by consistent decreases in shortening fraction and velocity of circumferential fiber shortening. Despite these improvements, some cats had one or more persistently abnormal echocardiographic values after treatment. These results suggested that in cats, hyperthyroidism commonly is associated with largely reversible cardiomyopathy. In those cats in which cardiomyopathy persists or worsens after treatment, underlying primary cardiomyopathy or thyroid hormone-induced cardiac structural damage may exist.

Animals↗

PubMed1986

Intracellular sodium concentration and transport in red cells in essential hypertension, hyperthyroidism, pregnancy and hypokalemia.

UNLABELLED: Intracellular sodium content ([Nai]), ouabain-sensitive ('Na-K ATPase') and ouabain-insensitive ('passive permeability') sodium efflux, Na-K cotransport and Na-Li ('Na-Na') countertransport were estimated in erythrocytes in 39 control subjects, 20 patients with essential hypertension, 14 patients with hypokalemia of renal or unknown etiology, 13 hyperthyroid patients and 19 pregnant women. In normokalemic essential hypertension there was only a moderate, but significant elevation of the activity of the Na-Li countertransport system. In the group of patients with hypokalemia, there was a significant increase of [Nai], ouabain-insensitive sodium efflux and Na-Li countertransport. In hyperthyroidism, a marked decrease of Na-Li countertransport was associated with a marked elevation of [Nai], in pregnancy an elevation of the Na-Li countertransport with a [Nai] 43% lower than the control values. The ouabain-sensitive sodium efflux was elevated in hyperthyroidism and hypokalemia, in which [Nai] was increased. In the control subjects there was a positive linear correlation between ouabain-sensitive sodium efflux and [Nai]. The sodium component of the Na-K cotransport was decreased to about one third of the unchanged furosemide-sensitive potassium component during pregnancy. CONCLUSIONS: The changes of cellular sodium metabolism in essential hypertension are of minor degree as compared to those in the other conditions studied. Cellular sodium metabolism in blood cells is influenced by thyroid hormones and metabolic disorders. Na-Li countertransport, i.e. Na-Na countertransport, seems to be involved in the regulation of [Nai]: an increase of its activity diminishes [Nai] (pregnancy); a decrease elevates [Nai] (hyperthyroidism). Ouabain-sensitive sodium efflux, i.e. 'Na-K ATPase', is mainly regulated by its substrate, [Nai].

Adult↗

PubMed1985

[Pathogenesis of tachycardia in hyperthyroidism. Value of Holter monitoring and the use of a beta-blocker].

The mechanisms of tachycardia in hyperthyroidism were investigated by means of Holter recordings of heart rate in 45 patients, 33 of whom had sinus rhythm and were left untreated. In the remaining 12 patients, recordings were taken after 3 days of treatment with either propranolol (120 mg/day; 6 patients) or pindolol (15 mg/day; 6 patients). Propranolol is a beta-blocker devoid of intrinsic sympathetic activity whereas pindolol possesses such activity. Changes in heart rate under the influence of each of these drugs were compared with those observed in 96 controls similarly treated. The difference in baseline heart rare between day and night was significantly higher (p less than 0.01) in patients with hyperthyroidism (17 +/- 1 QRS/min) than in controls (13 +/- 1 QRS/min). Day and night heart rates were increased by pindolol, the increase in night heart rate being significantly greater (p less than 0.05) in patients with hyperthyroidism (23.4 +/- 4.9%) than in controls (11.6 +/- 2.6%). These results suggest that sinus tachycardia in hyperthyroidism is related to an increase in the number of myocardial beta-adrenoceptors. They also indicate that thyrotoxicosis should not be treated with beta-blockers possessing intrinsic sympathetic activity.

Adolescent↗

PubMed1987

Various manifestations of hyperthyroidism in an ambulatory clinic: case studies.

This study reviews five cases of women with hyperthyroidism, three black women and two Hispanic women. Initially, two patients presented with voice changes, weight loss, and increased appetite. Only two patients presented with classical symptoms of hyperthyroidism. Examination showed all patients had diffusely enlarged thyroids and exaggerated reflexes. Two patients showed Graves' opthalmopathy.These cases document the variety of presentations of hyperthyroidism. Hence, a high index of suspicion must exist for this disease, even in the absence of a number of the classical manifestations of hyperthyroidism. When patients present to primary care centers with a constellation of symptoms, an examination of the thyroid gland is essential.

Adult↗

PubMed1986

[Regeneration of the parathyroid glands in experimental hyperthyroidism].

By means of morphological, morphometric and radioautographic methods, regeneration of mechanically traumatized parathyroid glands has been studied in 22 euthyroid and 22 hyperthyroid rats on the 1st-20th days after the operation. The thyroid gland is stimulated by daily injection of thyrotropin (1 ME/100 g of body mass). Twelve non-operated animals (6 hyperthyroid and 6 euthyroid rats) serve as control. In the regenerating parathyroid glands of the hyperthyroid animals in comparison with the euthyroid ones, certain increase of proliferative activity is noted in parathyrocytes and in cells of the granular tissue on the 2d-6th days, a more pronounced hypertrophy of epitheliocytes on the 2d-20th days, hyperplasia of their nucleolar apparatus on the 2d-5th days. The experimental hyperthyroidism stimulates manifestation of restorative processes in the regenerating parathyroid glands during development of active inflammatory reaction in them; however, it does not influence the parameters of the organ's structure studied in the nonoperated animals.

Animals↗

PubMed1985

[Hyperthyroidism caused by metastatic choriocarcinoma. A new male case].

The authors report a case of hyperthyroidism induced by a metastatic choriocarcinoma (retroperitoneal, lungs, vertebral and epidural localisations) in a 49 year old man. Tachycardia and possibly weight loss were the only clinical signs of thyrotoxicosis. Chemotherapy led to a remission of hyperthyroidism and tumoral syndrome for 4 months. Neoplasia relapsed and circulating levels of thyroid hormones were increased during the final stages. This is the fifth male reported case of choriocarcinoma associated with hyperthyroidism. Many previous studies suggest that hyperthyroidism is induced by HCG thyroid stimulating activity.

Choriocarcinoma↗

PubMed1977

[Reduced radiation sensitivity of hyperthyroid goiter with endocrine ophthalmopathy (author's transl)].

The therapeutic success of fractionated radioiodine treatment of hyperthyroid patients with and without endocrine ophthalmopathy is examined. To achieve a stable euthyroid metabolism, patients with endocrine ophthalmopathy generally need a greater number of treatments with a necessarily higher total dose of radioiodine and longer duration of treatment than hyperthyroid patients without endocrine ophthalmopathy. The average age, the average uptake of 131l and the serum concentration of free T4 were comparable in both groups of patients. A struma nodosa was more frequently found in the group of hyperthyroid patients with endocrine ophthalmopathy than in hyperthyroid patients without exophthalmus.

Dose-Response Relationship, Radiation↗

PubMed1979

Serum vitamin B12 and folic acid levels in hyperthyroidism.

Serum vitamin B12 and folic acid levels were measured in 48 hyperthyroid patients and in a group of euthyroid controls. The levels of vitamin B12 ranged from 120-900 pg/ml with a mean of 429.3 +/- 30.9 pg/ml (SE). The mean serum vitamin B12 level was lower in hyperthyroid patients than in normal controls, the difference being statistically significant (t = 2.584, p less than 0.025). Serum vitamin B12 levels showed a statistically significant negative correlation with the clinical index of Grooks et al. (r = 0.344, p less than 0.05). The findings, although not excluding the involvement of auto-immune gastritis in patients with low serum vitamin B12 levels, suggest a direct action of increased thyroid hormone concentrations. Serum folic acid levels ranged from 0.5-13.8 ng/ml with a mean of 6.8 +/- 0.46 ng/ml (SE). The mean serum folic acid levels were higher in the hyperthyroid patients than in normal controls but the difference was not statistically significant (t = 1.2, p greater than 0.2). The serum folic acid levels did not show any statistically significant correlation with the clinical index of Grooks et al. The fact that no statistically significant difference was found between the mean value in hyperthyroid patients and the mean value in normal controls is probably due to the high folic acid intake in Greece.

Adult↗

PubMed1978

[Unrecognized hyperthyroidism in hospital patients. Analysis of clinical symptoms compared to aged euthyroid goiter patients].

During a 14-month period hyperthyroidism has been diagnosed in 39 of 2916 inpatients of a general medical service. Graves' disease was present in only 8 cases. 21 patients had solitary autonomous nodules or multiple autonomous nodules (toxic multinodular goiter). In 10 patients the type of hyperthyroidism could not be established. The referring practitioner suspected hyperthyroidism in all 8 patients with Graves' disease, but in only 5 of the 31 remaining cases. The relative rarity of Graves' disease in inpatients reflects the fact that this form of hyperthyroidism is easily recognized by the practitioner and treated on an out-patient basis. Graves' disease patients and those with autonomous solitary or multiple nodules were of comparable age and had an identical serum free-thyroxin. Thus, neither higher age nor lower thyroxin is responsible for the atypical clinical presentation of autonomous nodules. A comparison with age- and sex-matched carriers of euthyroid goiters identified weight loss, resting pulse rate over 90 and auricular fibrillation as reliable clinical features. A thyroid function test is therefore indicated in every patient with a goiter and one of the three above clinical findings.

Adenoma↗

PubMed1983

[Hyperthyroidism in the aged].

Clinical symptoms in elderly patients with hyperthyroidism are atypical and uncharacteristic. In 13 patients with overt hyperthyroidism a goiter was found in only half the patients, eye signs in just three of them. Tachycardias, sometimes even paroxysmal tachycardias, predominate. In old people the diagnosis of hyperthyroidism is frequently missed, in 11 of 13 patients the disease was diagnosed following transfer to the rehabilitation center. About 50% of patients were iodine contaminated and this may have contributed to the disease. Data are presented to demonstrate that hyperthyroidism in old age may be a life threatening disease.

Age Factors↗

PubMed1984

[Evolution of serum gammaglutamyl transpeptidase activity in treated hyperthyroid and hypothyroid patients].

The pattern of gammaglutamyl transpeptidase levels was studied in the sera of 25 subjects with hyperthyroidism and 11 subjects with hypothyroidism, before and after treatment, and in 14 age- and sex-matched control subjects. Gammaglutamyl transpeptidase levels were significantly increased in hyperthyroidism (65 +/- 59 U/l) (p less than 0.01) and significantly decreased under treatment (40 +/- 27 U/l) (p less than 0.001). Before treatment, gammaglutamyl transpeptidase levels correlated with alkaline phosphatase levels and 5'-nucleotidase levels, the correlation persisting after treatment with 5'-nucleotidase. Alkaline phosphatase levels significantly increased under treatment (p less than 0.01). The percentages of gammaglutamyl transpeptidase variation correlated with thyroxine (r = 0.44, p less than 0.03), triiodothyronine (r = 0.47, p less than 0.02) and latent fixation capacity (r = 0.44, p less than 0.03) variations. Subjects with hypothyroidism had significantly decreased gammaglutamyl transpeptidase levels before treatment (18 +/- 9 U/l, p less than 0.01). Alkaline phosphatase levels were significantly decreased before treatment, and significantly increased after treatment. For all subjects with hyperthyroidism of hypothyroidism, the percentages of gammaglutamyl transpeptidase variations correlated with thyroxine (r = 0.48, p less than 0.003) and triiodothyronine (r = 0.39, p less than 0.016) variations. These results suggest that variations in gammaglutamyl transpeptidase levels in hyperthyroidism and hypothyroidism are, at least in part, in relation with variations in thyroid hormone levels.

Adult↗

PubMed1984

[Fruste form of hyperthyroidism manifested by auricular arrhythmia. Importance of the assay of the free fraction of thyroxine (FT4) and the role of the TRH test].

The TRH test was used to detect hyperthyroidism in 87 patients aged from 38 to 85 years who presented with atrial arrhythmia with or without heart disease. The patients had no clinical evidence of thyrotoxicosis, and total thyroxine (T4), free thyroxine index (FTI) and triiodothyronine (T3) values were normal. Hyperthyroidism was diagnosed in the 18 patients (21%) with negative TRH test; 15 of them had high free thyroxine (FT4) levels. The most common causes of hyperthyroidism were "warm" nodules in 7 and iodine overload in 10. Adding an anti-thyroid treatment to the hitherto unsuccessful anti-arrhythmic treatment resulted in a return to sustained sinus rhythm in 50% of cases. FT4 levels became normal in all. This study indicates that all patients with atrial arrhythmia, with or without heart disease, should be investigated for occult hyperthyroidism. It also demonstrates the value of FT4 assays to detect the disease. The TRH test is only required as a second-line exploratory method in some patients, notably those with iodine overload.

Adult↗

PubMedDate not supplied

[Disorders of neuromuscular transmission in hyperthyroidism].

Using the method of supramaximal electrostimulation 35 hyperthyroid patients with signs of muscle weakness or muscular fatigability were investigated and in over half the cases (53.5%) disturbances of neuromuscular transmission were found using sufficiently sensitive methods of activation. In nearly 70% of the tested muscles stimulated at 10 Hz a fall of the amplitude of successive potentials was observed. The analysis of these results suggested the following conclusions: 1. Muscular fatigability in hyperthyroidism is reflected in electrophysiological findings. 2. A comparison of hyperthyroidism with myasthenia showed that similarities and differences exist in the electrophysiological findings between both groups. 3. An additional, besides disturbances of neuromuscular transmission, factor determining muscular fatigibility in hyperthyroidism is probably damage to the muscle fibre.

Action Potentials↗