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PubMed1982

[Hepatitis and hyperthyroidism (author's transl)].

Two cases of hyperthyroidism with hepatic manifestations are reported. In both the clinical picture was misleading. In one case, hyperthyroidism was responsible for liver involvement. Hépatic manifestations of hyperthyroidism are both polymorphic and non-specific. Diagnosis should be considered only after outruling other possibilities. In the other case, cholestatic hepatitis developed independantly from hyperthyroidism. The resulting clinical picture was confusing. All patients should be checked for non-thyrotoxic liver disease which may be of prognostic and therapeutic significance.

Aged↗
PubMed1984

Study of insulin metabolism in hyperthyroid patients.

Hyperthyroidism is associated with degradation of carbohydrate metabolism. The insulin metabolism in 12 hyperthyroid patients is compared with 10 control subjects. The patients were connected to an artificial beta cell (Biostator GCIIS Miles) for two hours of insulin infusion (40 mU/m2/mn) while glycemia was maintained at its basal level by a modulated glucose infusion. Blood samples were taken, every 15 minutes for insulin and C peptide dosage. In control subjects the insulin steady state level was 93.3 +/- 5 microU/ml whereas this ranged from 42 +/- 3.4 microU/ml to 68 +/- 3.9 microU/ml in hyperthyroid patients. After treatment the insulin level was not quite normal, and ranged from 52 +/- 4.8 microU/ml to 82.2 +/- 9 microU/ml. A glucose intake not corresponding to the same insulin steady state is not therefore to be interpreted. Here there is no evidence of a correlation between the percentage decrease in the insulin test level and the thyroid hormone levels. An impairment of insulin metabolism is suggested in hyperthyroid patients, which might contribute to the decrease in carbohydrate tolerance.

Adult↗
PubMed1983

[Increase of circulating thyroid hormones following oral administration of TRH in preclinical hyperthyroidism. Biological efficacy of minimal TSH stimulation].

In patients with multinodular goiter and preclinical hyperthyroidism (euthyroid values of free T4-index, free T3-index, free T4, absent TSH response to oral TRH (40 mg), i.e. TSH after TRH less than 1.0 microU/ml) a statistical increase in the serum-T3 (free T3-index), serum-T4 (free T4-index) and free T4 was observed after oral TRH. No thyroid response to oral TRH occurred in multinodular goiter patients with hyperthyroidism or in preclinically hyperthyroid +athyrotic patients under T4. The thyroid response in patients with a preclinically hyperthyroid goiter was significantly lower than the response in goiter patients with a normal TSH reserve and in controls. The results demonstrate that (1) in euthyroid TRH-TSH unresponsiveness the pituitary TSH-reserve may not be completely suppressed; (2) very small variations in TSH not detectable by the available radioimmunologic assay may be of biological importance. In euthyroid TRH-TSH-unresponsive patients under T4 (simple goiter, differentiated thyroid carcinoma) thyrotropic function may not be completely suppressed. In euthyroid TRH-TSH-unresponsive patients with an autonomously functioning adenoma, additional exogenous suppression should be evaluated for protection of paranodular tissue before ablative radioiodine is given.

Administration, Oral↗
PubMed1983

[Retrospective study of 290 cases of hyperthyroidism after 55 years of age without previously documented thyroid disorders].

Previous studies having shown differences in the clinical presentation of hyperthyroidism in the young and in the over sixty-years old patients, we studied the presentation of hyperthyroidism of late onset without previous thyroid disorder to determine if it continued to change with age after 55 years. Two hundred and ninety cases of hyperthyroidism presenting after the age of 55 years without a previous history of goitre, collected in the Department of Nuclear Medicine of the Pitié Hospital between January 1976 and May 1980, were analysed retrospectively. There was no significant correlation between age and heart rate or total circulating thyroxine (T4) and triiodothyronine (T3) concentration. A positive correlation with weight loss and a negative correlation with I 131 fixation were observed. It was higher in cases of atrial fibrillation and hyperthyroidism with normal thyroid scintigraphy. Graves' disease with goitre was associated with the most overt signs of thyrotoxicosis and the highest hormonal concentrations, contrarily to toxic adenoma. The T3 but not T4 concentration correlated positively with heart rate. T3 and T4 were positively correlated with weight loss, and this correlation remained significant at constant T4 and T3 concentrations.

Age Factors↗
PubMed1980

Hyperthyroidism and diabetes mellitus. An analysis of 70 patients.

Hyperthyroidism developed in 70 patients with diabetes mellitus. Nine patients had masked hyperthyroidism with weight loss as the main sign. Diabetic control deteriorated in 28 of 48 insulin-dependent patients and in four of 22 taking hypoglycemic agents orally. Recurrent ketoacidosis occurred in two. Insulin requirements increased in 11 of 48 by 25% to 100% (mean, 50%). Following treatment of the hyperthyroidism, insulin requirements decreased in 13 of 48 by 20% to 100% (mean, 35%). Four of 22 patients were changed from orally ingested hypoglycemic drugs to insulin. Because of similar symptoms, underlying hyperthyroidism must be considered in any patient whose diabetes is poorly controlled.

Administration, Oral↗
PubMed1980

[Improved thyroid diagnosis in borderline hyperthyroidism by determination of free T3 index].

The measurements of circulating total thyroxine (T4) and total triiodothyronine (T3) depend on the concentrations of thyroid hormone binding proteins, especially TBG. A simple approach, the calculation of free T3 index (FT3I) and augmented FT3I (aFT3I) from total T3 and T3-resin uptake, corrects the total serum T3 for variation in thyroid hormone binding capacity. In a group of 95 patients with borderline elevated T3 levels (3.0-4.5 nmol/l) we have correlated the results of FT3I and aFT3I with clinical, biochemical and radioisotope findings: in a subgroup of 23 euthyroid females taking oestrogens (group A1) and in 22 other patients with TBG elevations (independent of oestrogens, group A2) the results for total T3 were within the slightly hyperthyroid range (3.32 +/- 0.3 and 3.26 +/- 0.24 nmol/l respectively), but FT3I was always within the normal range. In contrast, FT3I was clearly elevated in 50 hyperthyroid patients (group B) compared to the total T3 (4.6 +/- 0.6 and 3.9 +/- 0.4 nmol/l respectively). An even better discrimination was obtained by calculation of augmented FT3I. It is concluded that in patients with moderate elevations of T3 the FT3I and aFT3I are capable of distinguishing clearly between the euthyroid and hyperthyroid range. The estimation is thus indicated in all patients with changes in thyroid hormone binding protein concentration and is of great value in confirming or ruling out the diagnosis of T3-toxicosis, T4-toxicosis and in all cases of "preclinical" or borderline hyperthyroidism.

Diagnosis, Differential↗
PubMedDate not supplied

The thyroglobulin variations during the thyroid surgery for polynodular goiter, hyperthyroidism and cancer.

A radioimmunoassay (RIA) double antibody system for human thyroglobulin (Tgl) was developed with a sensitivity of 2.5 ng/ml T3 and T4 did not interfere in the antibody Tgl binding. The blood was collected pre-, intra- and 24 hrs post-thyroidectomy from 50 females and 4 males diagnosed as polynodular goiter, hyperthyroidism, chronic thyroiditis and thyroid cancer. The ratios of the intra- and post-operatory values versus pre-operatory values were calculated. The basal values in the patients having thyroid troubles varied within very large limits (two orders of magnitude) and these values could not be clearly correlated to the thyroid pathology, However, in untreated hyperthyroid patients the basal values exceeded 100 ng/ml, while in medullary carcinoma they were near the sensitivity limit of the technique. The intra-operatory values varied within the percentual area (thyroid carcinoma), multiplicative area (polynodular goiter and some cases of hyperthyroidism) and the order of magnitude area (hyperthyroid patients and some of the polynodular goiters). The value of the RIA measurement of the Tgl in the serum as an adjuvant in the post-treatment follow up of thyroid patients is discussed.

Female↗
PubMed1982

Electrocardiographic findings in 45 cats with hyperthyroidism.

Electrocardiographic (ECG) abnormalities were recorded in 36 (80%) of 45 cats with untreated hyperthyroidism caused by hyperfunctioning thyroid adenomas (adenomatous hyperplasia). Tachycardia (greater than or equal to 240/min) and increased R-wave amplitude in lead II (greater than or equal to 0.9 mV) were the most frequent abnormalities recorded (62% and 49%, respectively). Other abnormalities included atrial and ventricular arrhythmias (20%), prolonged QRS duration (16%), shortened Q-T interval (11%), intraventricular conduction disturbances (3%), and ventricular pre-excitation (1%). In 17 cats, repeat ECG were recorded 6 months after hemi- or total thyroidectomy; resolution of tachycardia, increased R-wave amplitudes, shortened Q-T intervals, and atrial and ventricular arrhythmias had occurred in all cats. It was concluded that many of the ECG changes associated with feline hyperthyroidism are similar to those associated with primary myocardial disease in cats; however, the ECG abnormalities and associated cardiovascular signs of hyperthyroidism generally resolve after successful treatment of the hyperthyroid state.

Adenoma↗
PubMed1982

[Prognosis and life expectancy in patients with hyperthyroidism].

The term "hyperthyroidism" comprises several different diseases of which two have to be distinguished particularly: 1. hyperthyroidism with Graves' disease: the immunopathogenesis of Graves' disease allows a symptomatic therapy only; therefore its prognosis is not as good as for the 2. autonomous hyperthyroidism ("toxic goiter"), which can be cured definitely by operation or radioiodine therapy. Both diseases may aggravate under iatrogenic iodine exposure (iodine-containing drugs or X-ray contrast media) to a thyroid storm; this most severe kind of hyperthyroidism still leads to death in almost 40% of the patients.

Adolescent↗
PubMed1981

Metabolism of plasma triglycerides in hypothyroidism and hyperthyroidism in man.

Studies on plasma triglycerides (TG) were performed in 10 nonobese and 16 obese patients with hypothyroidism and in 13 with hyperthyroidism. Nonobese, hypothyroid patients generally had normal levels of TG, but obese patients often had hypertriglyceridemia. In most hypothyroid patients 1-thyroxine treatment lowered plasma TG, and most hyperthyroid patients had low TG. One mechanism whereby thyroid hormones might decrease plasma TG could be to increase lipoprotein lipase (LPL). However, post-heparin LPL was not increased after therapy, nor was it increased in hyperthyroid patients. In contrast, hypothyroid patients had abnormally low levels of post-heparin hepatic triglyceride lipase. In hypothyroid patients without hypertriglyceridemia, clearance of chylomicrons was normal. A few obese, hypothyroid patients with fasting hypertriglyceridemia had low clearance of chylomicrons, which may have been due in part to competition for removal of excess endogenous TG. Thus, no evidence was obtained for a significant abnormality in chylomicron metabolism in hypothyroidism. Nonobese, hypothyroid patients had normal synthesis and clearance of very low density lipoprotein (VLDL)-TG. In contrast, VLDL-TG synthesis was increased in 8 obese, hypothyroid patients, and fractional clearance rates were relatively low compared to obese, euthyroid subjects. In striking contrast, hyperthyroid patients had remarkable facility in clearing VLDL-TG. Thus, TG metabolism is not grossly deranged in hypothyroidism, but thyroid hormones apparently can promote catabolism of VLDL.

Adult↗
PubMed1981

The importance of elevated TSH in serum after subtotal thyroidectomy for hyperthyroidism. A five-year follow-up study.

68 patients operated on for hyperthyroidism were observed regularly for 5 years after operation as regards the concentration of TSH in serum and the incidence of hypothyroidism and recurrent hyperthyroidism. 20 patients had elevated TSH 6 weeks after operation. 5 years later 9 of them had developed hypothyroidism, 6 had elevated TSH without clinical symptoms of hypothyroidism, while 5 were normal in all measured thyroid variables. 48 patients had normal TSH 6 weeks after operation. 5 years later 5 of them had developed a recurrence of hyperthyroidism, 4 had elevated TSH with no clinical symptoms of hypothyroidism, while the remaining 39 patients were euthyroid with normal thyroid variables. A scheme for follow-up of patients operated on for hyperthyroidism is proposed, with close follow-up of patients with elevated TSH soon after operation.

Adult↗
PubMed1980

No enhanced elimination of propranolol in patients with hyperthyroidism.

Propranolol, a widely used beta-adrenergic receptor blocking drug extracted mostly by the liver, plays an important role in the various aspects of managment of hyperthyroidism. If the elimination of this drug is enhanced in thyrotoxic patients, one may consider necessary a modification of the dosage regimien when treating patients with this dysfunction. We examined the disposition profiles of propranolol in four patients with hyperthyroidism before and after their thyroid states became euthyroid and compared them to those of the seven control subjects. The data indicated that the values (mean +/- SEM) of half-life (3.34 +/- 0.81 hr) and systemic availability estimated (28.2 +/- 3.5%) in the hyperthyroid state were comparable to those in the euthyroid state (2.98 +/- 0.32 hr and 29.2 +/- 5.1%) and these in the control subjects (3.20 +/- 0.32 hr and 29.0 +/- 4.0%). Although our observations were obtained from a small number of subjects, there appears to be no considerable difference in propranolol elimination from the plasma of hyperthyroid and euthyroid states or healthy subjects, and therefore adjustment of the dosage regimen seems unwarranted. Adjustment of propranolol therapy based on individual plasma levels might be useful in thyrotoxic patients who respond inadequately until additional data relating more precisely to propranolol disposition becomes available.

Adult↗
PubMed1995

Immunogenic and non-immunogenic hyperthyroidism. Recent trends in prealpine Switzerland and in coastal Poland.

Annual occurrences of immunogenic (IH) and non-immunogenic hyperthyroidism (NIH) between Berne (1976, 1982, 1991) and Szczecin (1973, 1980, 1991) were compared. Out of 21,025 patients referred for thyroid examinations, 10.1% (average) were hyperthyroid. In Berne (former endemic goiter region) and Szczecin (without goiter endemicity) IH occurred in 41% and 68%, NIH in 59% and 32% of hyperthyroid patients, respectively. Within a stable incidence of NIH in Berne, toxic adenomas (TA) decreased from 41% (1976) to 17% (1991) (p < 0.005). In Szczecin, where iodine deficiency is in an early stage, the TA frequency did not change significantly: from 24% (1973) to 28% (1991). Increases of TA or of multifocal functional autonomy apparently "mark" incipient or, respectively, decreasing deficiencies in nutritious iodine. Hyperthyroid patients in Berne compared to Szczecin were older, both with IH (54 versus 45 y) and NIH (65 versus 52 y). Age at diagnosis was stable in Berne but increasing (p < 0.05) in Szczecin (from 43 to 52 y).

Adenoma↗
PubMed1995

[Hyperthyroidism and osteoporosis].

Iodine-containing thyroid hormones lead to global stimulation of bone remodelling and increase the birth of multicellular units which harbour the osteoclast resorption-osteoblast formation sequence. Thus, hyperthyroidism accelerates trabecular, and especially cortical, bone loss. It is not rare to discover unrecognized hyperthyroidism in patients with wedge fractures of the vertebrae which were thought to be the result of common post-menopause osteoporosis. Measuring the level of biochemical markers of bone remodelling (serum osteocalcin, urinary pyridinoline and hydroxyproline) can also give evidence of stimulated bone remodelling in patients with hyperthyroidism. Densitometric studies show a significant though moderate reduction in lumbar and femoral bone density in hyperthyroidism. Bone loss is greater in the radius.

Adult↗
PubMed1994

Dorsolateral prostatic phosphomonoesterases and adenosine triphosphatases in hypo- and hyperthyroid rats.

Specific activities of phosphomonoesterases (acid and alkaline phosphatases) and adenosine triphosphatases (Mg2+, Ca2+ and Na+/K+ dependent ATPases) of dorsolateral prostate were studied in albino rats, under altered thyroid hormone status. Thyroidectomy induced hypothyroidism and thyroxine administered hyperthyroidism (25 micrograms/100 g body wt/day for 60 days, im) showed no impact on the activity of acid phosphatase. Three fold decrease in the activity of alkaline phosphatase was observed in hyperthyroid group. Ca2+ and Mg2+ dependent ATPases were significantly decreased in hypo- and hyperthyroid status whereas Na+/K+ ATPase was decreased in hyperthyroidism and showed an opposite trend in hypothyroid group.

Adenosine Triphosphatases↗
PubMed1995

Changes in serum lipoprotein(a) and lipids during treatment of hyperthyroidism.

Because of suggestions that thyroid hormones modulate serum lipoprotein(a) [Lp(a)] concentration, we evaluated prospectively the serial changes of serum Lp(a), measured as apolipoprotein(a) [apo(a)], and other lipoproteins in 40 subjects with hyperthyroidism treated with radioactive iodine (RAI) therapy. Hyperthyroid patients had lower (P < 0.001) concentrations of apo(a), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and apo B, but higher apo A-I concentrations compared with age-matched controls [geometric mean (range)]; apo(a) 81 (17-614) vs 187 (17-1808 IU/L): TC 4.07 +/- 0.8 vs 5.22 +/- 1.00 mmol/L (mean +/- SD); LDL-C 2.47 +/- 0.89 vs 3.40 +/- 0.88 mmol/L; HDL-C 1.05 +/- 0.33 vs 1.24 +/- 0.34 mmol/L; apo B 0.66 +/- 0.23 vs 1.13 +/- 0.34 g/L, and apo A-I 2.07 +/- 0.42 vs 1.46 +/- 0.28 g/L, respectively. Euthyroidism was associated with normalization of serum TC, LDL-C, and apo B within 1 month of treatment. However, apo(a) required 4 months to normalize, and HDL-C and apo A-I were still abnormal 6 months after RAI. Serum apo(a), TC, LDL-C, and apo B were negatively correlated with serum thyroxine (T4), free thyroxine index, and triiodothyronine (T3) and positively correlated with thyrotropin during the transitional period from hyperthyroidism to euthyroidism. Parallel changes of these lipoproteins and thyroid hormones were also observed after treatment of hyperthyroidism. In conclusion, thyroid hormones do modulate lipoproteins, particularly Lp(a). The delay in normalization of apo(a) but not LDL suggests an effect on apo(a) production rather than on LDL removal.

Adult↗
PubMed1995

Iodine-131 therapy of hyperthyroidism in pediatric patients.

UNLABELLED: The purpose of this retrospective study was to evaluate the utility of 131I as therapy for hyperthyroidism in children and to evaluate its short-term side effects. METHODS: The results of 131I therapy of hyperthyroidism were evaluated in a group of 35 pediatric patients. RESULTS: In 29 patients propylthiouracil or methimazole therapy was abandoned due to noncompliance (13), relapse or failure to control hyperthyroidism (13), vasculitis (1), neutropenia (1) or a lupus-like syndrome (1). Average treatment activity was 7.7 +/- 2.9 (s.d.) mCi, corresponding to 0.16 +/- 0.03 mCi/g. Thirty patients (86%) received a single radioiodine treatment and five (14%) were retreated. In patients who became hypothyroid after a single dose, hypothyroidism was noted within 100 days of treatment. Clinical management problems included vomiting in four patients and enuresis in four patients. Mild radiation thyroiditis occurred in one patient and nodularity was noted after therapy in two patients. CONCLUSION: Iodine-131 is effective for both initial treatment of hyperthyroidism and the treatment of medical treatment failures in pediatric patients. Awareness of vomiting and enuresis as potential management problems is crucial when using 131I in this age group. Therefore, special treatment precautions may be required.

Adolescent↗
PubMed1994

Changes in renal function associated with treatment of hyperthyroidism in cats.

We measured glomerular filtration rate (GFR) estimated by plasma disappearance of 99mTc-labeled diethylenetriaminepentaacetic acid, serum concentrations of thyroxine (T4), creatinine, and urea nitrogen, and urine specific gravity in 13 cats with naturally acquired hyperthyroidism before and 30 days after treatment by bilateral thyroidectomy, and in a group of 11 control cats. Mean (+/- SD) serum T4 concentration decreased from a pretreatment value of 120.46 (+/- 39.21) nmol/L to a posttreatment value of 12.15 (+/- 6.26) nmol/L (P < 0.0001; reference range, 10 to 48 nmol/L). Treatment of hyperthyroidism resulted in a decrease in mean (+/- SD) glomerular filtration rate, from 2.51 (+/- 0.69) ml/kg of body weight/min to a posttreatment value of 1.40 (+/- 0.41) ml/kg/min (P < 0.0001). Mean serum creatinine concentration increased from 1.26 (+/- 0.34) mg/dl to 2.05 (+/- 0.60) mg/dl (P < 0.01). Mean serum urea nitrogen concentration increased from 26.62 (+/- 6.83) mg/dl to a mean postthyroidectomy concentration of 34.92 (+/- 8.95) mg/dl (P < 0.01). All changes were significant. Two cats developed overt renal azotemia after treatment of hyperthyroidism. Our results provide further evidence that treatment of hyperthyroidism can result in impaired renal function. In addition, our results suggest that, in some instances, thyrotoxicosis might mask underlying chronic renal insufficiency.

Animals↗