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PubMed1986

Compensated 131I-therapy of solitary autonomous thyroid nodules: effect on thyroid size and early hypothyroidism.

Thyroid function and thyroid gland volume, ultrasonically determined, were investigated in 27 hyperthyroid patients with solitary autonomous thyroid nodules before and during one year after 131I-treatment. Total thyroid volume decreased gradually from 40.9 +/- 3.5 ml (mean +/- SEM) before treatment to 23.9 +/- 1.8 ml (P less than 0.001) at 3 months after 131I-treatment. No further change was observed. All but two patients received only one dose of 131I, and in spite of a significant decrease also of the non-adenoma side of the gland, none became hypothyroid. We conclude that 131I-therapy has an important place in the treatment of solitary autonomous thyroid nodules since all our patients became euthyroid within 3 months, only 2 of 27 patients needed more than one dose of 131I, no cases of hypothyroidism occurred, and thyroid volume was substantially decreased.

Adenoma↗
PubMed1988

Radioactive iodine thyroid uptake in patients with amiodarone-iodine-induced thyroid dysfunction.

Amiodarone, an iodine-rich drug, represents at the present, at least in Europe, one of the most common sources of iodine-induced thyroid dysfunction. The drug may induce both hypothyroidism and thyrotoxicosis. In spite of the large iodine intake occurring during amiodarone therapy, 131I thyroid uptake is detectable in patients with amiodarone-iodine-induced hypothyroidism, irrespective of the presence or absence of underlying thyroid disease. In contrast, in patients with amiodarone-iodine-induced thyrotoxicosis, 131I thyroid uptake is normal or even elevated in those with co-existent underlying thyroid disorders, whereas it is very low in those with an apparently normal thyroid gland. Perchlorate discharge test was performed in 8 patients with hypothyroidism and in 5 patients with hyperthyroidism induced by amiodarone: a positive test was found in all hypothyroid patients and a negative test in all hyperthyroid patients.

Adult↗
PubMed2004

Retarded bone growth in thyroid hormone resistance. A clinical study of a large family with a novel thyroid hormone receptor mutation.

OBJECTIVE: Thyroid hormone resistance (RTH) is characterised by variable tissue hyporesponsiveness to thyroid hormone. The disorder is usually caused by mutations in the thyroid hormone receptor beta (TR beta). We describe a large family with this disorder. SUBJECTS AND MEASUREMENT: We identified 36 family members with RTH in four generations by screening relatives of patients with the diagnosis. The diagnosis was verified by identification of a mutation in the thyroid hormone receptor beta (TR beta) gene. Symptoms, clinical findings and laboratory tests of 29 affected individuals were compared with those of 16 first-degree relatives. RESULTS: Bone maturation in children with RTH was delayed. The height was lower both in children and in adults with RTH than in the controls. Children with RTH had lower birth weight than the controls, particularly when the condition was inherited from the father. We did not observe increased prevalence of neuropsychological symptoms associated with RTH in this family. Palpitations and increased pulse rate indicated mild cardiac hyperthyroidism. Direct sequence analysis of the TR beta gene revealed a novel point mutation, a heterozygous transition c.1031G>C in exon 9 theoretically substituting Gly344Ala. CONCLUSIONS: We found evidence of skeletal tissue hypothyroidism that resulted in permanent growth retardation from prenatal to adult life. We found substantial variations in thyroid hormone levels and clinical presentation, but most individuals were without symptoms of thyroid disorder.

Adolescent↗
PubMed2000

Large amount of vitamin A has no major effects on thyroidal hormone synthesis in two-stage rat thyroid carcinogenesis model using N-bis(2-hydroxypropyl)nitrosamine and thiourea.

In our previous investigation, which focused on two-stage carcinogenicity in the thyroid, rats were administered N-bis(2-hydroxypropyl)nitrosamine (DHPN), followed by thiourea (TU) over an experimental period of 19 weeks. Simultaneous treatment with a high level of vitamin A (VA) enhanced the induction of proliferative lesions that originated from the thyroidal follicular epithelium. To examine whether hormone synthesis in the thyroid could be inhibited by simultaneous treatment with a large amount of VA and TU, all of the rats were initially given a single subcutaneous injection of 2,800 mg DHPN/kg followed by a supply of 0% TU + 0% VA (DHPN only, control group), 0.2% TU in their drinking water (DHPN/TU group), 0.1% VA in their diet (DHPN/VA group), or 0.2% TU + 0.1% VA (DHPN/TU + VA group) during an experimental period of 4 weeks. Results obtained indicate that the iodine uptake and organification, namely iodination of tyrosine residue in thyroglobulin, of the thyroid, were significantly decreased in the DHPN/TU group compared to the DHPN control group. The variation in these values was attributable to the inhibitory effect of TU upon thyroid hormone synthesis. Results obtained from the DHPN/TU + VA and DHPN/TU groups were comparable. Therefore, the possibility that modification of hormone synthesis contributes to the enhancing effect of simultaneous treatment with a large amount of VA on thyroidal tumor induction by TU is considered to be very minimal.

Adenoma↗
PubMed1995

Ten-year follow-up study of thyroid function in euthyroid patients with simple goiter or Hashimoto's thyroiditis.

In an attempt to study the natural course of Hashimoto's thyroiditis and simple goiter, 74 euthryroid patients with Hashimoto's thyroiditis and 212 patients with simple goiter were followed for 10 years. In 204 patients with simple goiter (96.2%) it remained as a simple goiter throughout the observation period, whereas 8 patients (3.8%) later had Hashimoto's thyroiditis as evidenced by the appearance of circulating thyroid autoantibodies. These 8 patients had HLA typing significantly different from that of control subjects. None of the patients with simple goiter had hyperthyroid Graves' disease despite the fact that 17.5% of those patients had mild to moderate exophthalmos with either Moebius' sign or von Graefe's sign. In contrast, 12 patients with Hashimoto's thyroiditis (16.2%) had exophthalmos with Moebius' sign and/or von Graefe's sign, and 4 of 12 such patients later had hyperthyroid Graves' disease. TSH binding inhibitory immunoglobulin was detected in 3 of 4 such patients with hyperthyroid Graves' disease. Forty-nine patients with Hashimoto's thyroiditis (66.2%) still remained euthyroid but 20 of those (27.0%) turned into hypothyroidism during the 10-year follow-up.

Adolescent↗
PubMed1986

Hashimoto's thyroiditis. An uncommon cause of painful thyroid unresponsive to corticosteroid therapy.

The records of eight patients with thyroid tenderness secondary to Hashimoto's thyroiditis were reviewed. The pathologic characteristics of thyroid tissue sections from these patients were compared with those from patients with nontender Hashimoto's thyroiditis, and no difference was identified. Laboratory features helpful in distinguishing tender Hashimoto's thyroiditis from subacute (de Quervain's) thyroiditis include normal erythrocyte sedimentation rate, significant 131I uptake, and significant antithyroid antibody titer. Diagnosis should be confirmed by fine-needle aspiration biopsy. Corticosteroid therapy was unsuccessful in treating these patients; L-thyroxine and aspirin were successful more often. Two patients required thyroidectomy to control pain.

Adrenal Cortex Hormones↗
PubMed2002

A study of thyroglobulin concentration in the thyroid and serum of patients with different thyroid disorders.

Knowledge concerning the structure and quality of thyroglobulin (Tg) has great significance for the better understanding of the pathogenesis of different thyroid diseases. The localization of the Tg gene and studies of its structure by molecular biological techniques make possible precise investigations of its expression. The aim of our study was to evaluate Tg content in the thyroids and Tg concentrations in the serum of 108 patients suffering from benign or malignant thyroid disorders. The method of investigation was isolating total protein from thyroid tissues obtained during surgery and determining Tg content in the thyroid extracts and Tg concentrations in serum. The Tg concentrations in serum and in thyroid protein extracts were evaluated by fluoroimmunometric assay. Statistical analysis was carried out with the help of the computing programmes.

Adolescent↗
PubMed2006

[Thyroid function and thyroid autoimmunity at the late pregnancy: data from 664 pregnant women].

OBJECTIVE: To study the prevalence of thyroid diseases, as well as characteristics of the disease spectrum and thyroid autoimmunity in women at the end of pregnancy. METHODS: Six hundred and sixty-four pregnant women (pregnancy group) and 276 non-pregnant women (control group) were enrolled in the study. Serum thyrotropin (TSH), thyroid peroxidase antibody (TPOAb), free T(3) (FT(3)) and free T(4) (FT(4)) were measured by high-sensitive immunochemiluminescent assay, and urinary iodine was also examined at the end of pregnancy. Overt hyperthyroidism was diagnosed when both TSH < 0.3 mU/L and FT(4) and/or FT(3) levels were elevated. Subclinical hyperthyroidism was diagnosed when TSH < 0.3 mU/L with normal FT(4) and FT(3) levels. The diagnostic criteria for overt hypothyroidism was TSH > 4.8 mU/L accompanied by decreased FT(4), and for subclinical hypothyroidism was TSH > 4.8 mU/L with normal FT(4) and FT(3) levels. RESULTS: (1) The median urinary iodine (MUI) of pregnancy group was 201.5 microg/L, and that of control group was 196.0 microg/L (P > 0.05). Women in the two groups were iodine-adequate. (2) The overall prevalence of thyroid diseases in pregnancy group and control group was 7.8% (52/664) and 6.9% (19/276), respectively (P > 0.05). (3) As for the diseases pattern, there were obvious differences between the two groups. In pregnancy group, the prevalence of hyperthyroidism was lower than that of hypothyroidism (1.1% vs 6.8%, P < 0.01). In control group, the prevalence of hyperthyroidism and hypothyroidism was 4.7% and 2.2%, respectively (P > 0.05). Compared with control group, the prevalence of hyperthyroidism in pregnancy group was much lower (1.1% vs 4.7%, P < 0.01), mainly due to the decrease of overt hyperthyroidism; whereas, the increment of subclinical hypothyroidism resulted in the higher prevalence of hypothyroidism in pregnancy group (6.8% vs 2.2%, P = 0.01). (4) The median TSH level of the healthy women in pregnancy group was significantly higher than that in control group (2.50 vs 1.54 mU/L, P < 0.01). The positive rate of TPOAb in pregnancy women was lower than that in non-pregnancy women (3.3% vs 9.4%, P < 0.01). CONCLUSION: At the end of pregnancy, hypothyroidism accounts for most thyroid diseases. Thyroid autoimmunity is suppressed.

Adult↗
PubMed1990

Immunopathological findings and thyroid autoantibodies in thyroid autonomy.

Different phenomena under consideration, lymphocytic and macrophagic infiltration and increased thyrocyte class I and class II antigen expression, normally ascribed to autoimmune thyroid disease (Graves' disease; Hashimoto's thyroiditis) were frequently found in thyroid glands with autonomous nodules, too. Contrary, nodular formations in the vast majority of nodular goiters were not associated with these immunopathological findings. Furthermore, thyroid microsomal, anti-peroxidase and TSH-receptor antibodies although at low frequency rates, were only detected in cases of autonomous nodules but not in cases of nodular goiters. From these findings we conclude that the immune phenomenon observed in thyroid autonomy could not be a consequence of nodular formations but that at least in some cases of thyroid autonomy immunopathogenic mechanisms may play an important role. Based on the fact that class I hyper-expression was more common and that a stronger correlation of cell infiltration with increased class I than with increased class II expression on thyrocytes existed we propose, that if the initial event of the autoimmune process is indeed increased class II expression, this stimulus may more likely originate from increased non-thyrocyte class II positivity (for example dendritic or endothelial cells) than from thyrocyte class II positivity. But, if aberrant class II expression is not the initial stimulus, another candidate could be the increased thyrocyte class I expression observed, probably due to the action of interferon alpha and/or beta induced by any unknown stimulus (viruses?).

Antibodies, Monoclonal↗
PubMed1989

[The effect of viral hepatitis A on thyroid function in adolescents with thyroid pathology].

In patients with virus hepatitis (VHA) without thyroid pathology, thyroid function decreases but during the recovery, it rapidly restores. In the presence of concomitant thyroid hyperplasia, its function in the acute period of VHA is inhibited to an ever greater degree and remains decreased during convalescence. This circumstance requires the use of replacement hormonal therapy. In cases of concomitant hypothyrosis, the initial level of thyroid hormones diminishes but it does not manifest itself by clinical disease exacerbation. In patients with concomitant toxic goiter, the hormonal status does not undergo any changes in mild forms of VHA, whereas in VHA of medium gravity and grave patterns of VHA, hyperthyroxinemia increases and the course of diffuse toxic goiter is exacerbated. Therefore, the treatment of patients with VHA associated with thyroid pathology should be conducted with regard to thyroid function.

Adolescent↗
PubMedDate not supplied

[Functional activity of human thyrocytes in diffuse toxic goiter, autoimmune thyroiditis and thyroid nodules using nucleolar silver staining].

A comparative study of the thyrocyte nucleolar organizer region (NOR) activity was performed on silver - stained thyroid gland aspiration biopsies from controls, 39 patients with Graves' disease (GD), 15 other patients with Hashimoto thyroiditis (HT), and 71 patients with nodules which underwent surgery. Thyrocyte nucleoli from unchanged thyroid gland were round and small-sized. Their number ranged from 1.34 up to 1.96 per nucleus (mean 1.61 +/- 0.07). The average number of silver (Ag) grains ranged from 3.0 to 6.9 per nucleus (mean - 5.36 +/- 0.36). Compared to the controls the patients with GD revealed thyrocyte nucleoli with increased mean number of AG - grains per nucleus (9.84 +/- 0.24). There was a close correlation between thyrocyte NOR activity, on the one hand, and the level of T3 or T4 hormones and thyroid gland size, on the other. In patients with AT the argentophilla of thyrocyte nucleoli was intermediate between that of controls and patients with GD. This group of patients revealed an increased NOR activity of thyroid gland lymphocytes. Nucleoli of malignant thyroid cells were larger and more irregular than those of benign cells. The mean number of malignant cell nucleoli (2.55 +/- 0.22) was greater than that of the control group (1.61 +/- 0.07; p < 0.05) being identical with those of follicular adenomas (2.47 +/- 0.11) and nodular goiter (2.46 +/- 0.11). The mean number of Ag-grains in the malignant cells (14.9 +/- 0.79) was higher than that in FA (7.95 +/- 0.2; p < 0.0001) and NG (8.0 +/- 0.12; p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Cardiac performance and thyroid function. The correlation between systolic time intervals, heart rate and thyroid hormone levels.

UNLABELLED: In the search for a clinical correlate to thyroid function, correlations were sought between the plasma level of thyroid hormones and the cardiac function, assessed by heart rate and the systolic time intervals. The present study is the first to 1) use a curvilinear correlation and 2) do so in the entire hormone range. A third degree Chebychew's regression equation was used to enable curvilinear correlation. In a population of 10 hypothyroid, 14 euthyroid, and 25 hyperthyroid patients a statistically significant curvilinear correlation was found between the thyroid hormone levels and the systolic time intervals. The correlation coefficients showed the heart rate equally correlated to the thyroid hormone levels as the best correlated of the systolic time intervals. The correlation between the heart rate and T3 was almost linear, with a heart rate increase of 4 beats/minute with each increase in plasma T3 of 1 nmol/l. CONCLUSION: The thyroid function reflects in the cardiac function in a curvilinear regression between T3 and systolic time intervals and in an almost linear regression between T3 and heart rate. The variation, however, is too great and the slope too low, to suggest the use of the heart rate as a clinical correlate to thyroid function.

Adult↗
PubMed1996

Recessive resistance to thyroid hormone in mice lacking thyroid hormone receptor beta: evidence for tissue-specific modulation of receptor function.

The diverse functions of thyroid hormone (T3) are presumed to be mediated by two genes encoding the related receptors, TRalpha and TRbeta. However, the in vivo functions of TRalpha and TRbeta are undefined. Here, we report that targeted inactivation of the mouse TRbeta gene results in goitre and elevated levels of thyroid hormone. Also, thyroid-stimulating hormone (TSH), which is released by pituitary thyrotropes and which is normally suppressed by increased levels of thyroid hormone, was present at elevated levels in homozygous mutant (Thrb-/-) mice. These findings suggest a unique role for TRbeta that cannot be substituted by TRalpha in the T3-dependent feedback regulation of TSH transcription. Thrb-/- mice provide a recessive model for the human syndrome of resistance to thyroid hormone (RTH) that exhibits a similar endocrine disorder but which is typically caused by dominant TRbeta mutants that are transcriptional inhibitors. It is unknown whether TRalpha, TRbeta or other receptors are targets for inhibition in dominant RTH; however, the analysis of Thrb-/- mice suggests that antagonism of TRbeta-mediated pathways underlies the disorder of the pituitary-thyroid axis. Interestingly, in the brain, the absence of TRbeta may not mimic the defects often associated with dominant RTH, since no overt behavioural or neuroanatomical abnormalities were detected in Thrb-/- mice. These data define in vivo functions for TRbeta and indicate that specificity in T3 signalling is conferred by distinct receptor genes.

Amino Acid Sequence↗
PubMed1997

The Relationship of Lymphocytic Thyroiditis to the Development of Thyroid Carcinoma.

There are many reported predisposing factors for thyroid papillary carcinoma, including genetic factors [1] previous irradiation [2,3], abnormal iodine intake [4-6], hyperthyroidism [7], pregnancy [8], and a dyshormonogenetic state [9]. However, whether there is a causative link between lymphocytic thyroiditis and thyroid papillary carcinoma remains controversial. Most reports indicating some association have suffered from methodologic problems. In particular, race, age, and sex differences in susceptibility to chronic lymphocytic thyroiditis and thyroid cancer have not been well-controlled in previous studies. We have therefore carefully evaluated previous studies and tried to determine if there is a definite relation between lymphocytic thyroiditis and thyroid papillary carcinoma histo-pathologically.

Journal Article↗
PubMed1994

Thyroid hormone autoantibodies and their implications for free thyroid hormone measurement.

Thyroid hormone autoantibodies (THAA) disrupt the equilibrium between thyroid hormones and their binding proteins. This may lead to spurious estimations of free thyroxine (FT4) and triiodothyronine (FT3) by radioimmunoassay (RIA). In the present study we highlight the importance of THAA by examining the frequency of THAA in consecutive sera sent to a routine district hospital laboratory. Over a period of six months, sera were collected from 200 consecutive hypothyroid, 200 hyperthyroid and seven patients whose clinical and biochemical thyroid status were contradictory. A further 200 patients with non-thyroid autoimmune conditions, 20 patients with insulin autoantibodies and 100 healthy blood transfusion donors were studied. In all sera, both effects of antigen removal on THAA detection and where THAA were found, the effect of their removal on FT4, were examined. The frequencies of THAA amongst hypothyroid, hyperthyroid and non-thyroid autoimmune conditions were 7%, 1.5% and 7.5% respectively, whilst no THAA were found in insulin autoantibody positive patients and 100 blood transfusion donors. However, THAA frequency was highest in those patients whose biochemical thyroid status was widely inappropriate to clinical state (5/7 = 64%). Sera stripped of thyroid hormones prior to THAA detection had significantly higher antibody activity than unstripped sera (p = 0.0027 and p = 0.0123 for T3 and T4 binding respectively). Free thyroxine levels measured by the Amerlex-M RIA kit after antibody removal fell in all 21 THAA positive sera tested. The correlation coefficient between antibody activity in serum with percentage fall in FT4 was 0.79 (Spearman's Rank Correlation Test).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Decline of T3 and elevation in reverse T3 induced by hyperglucagonemia: changes in thyroid hormone metabolism, not altered release of thyroid hormones.

Recently we reported that hyperglucagonemia induced by glucagon infusion causes a decline in serum Triiodothyronine (T3) and a rise in reverse T3 (rT3) in euthyroid healthy volunteers. These changes in T3 and rT3 levels were attributed to altered T4 metabolism in peripheral tissues. However, the contribution of altered release of thyroid hormones by the thyroid gland could not be excluded. Since the release of thyroid hormones is suppressed by exogenous administration of L-thyroxine (L-T4) in appropriate dosage, we studied thyroid hormone levels for up to 6 hours after intravenous administration of glucagon in euthyroid healthy subjects after administration of L-T4 for 12 weeks. A control study was conducted using normal saline infusion. Plasma glucose rose promptly following glucagon administration demonstrating its physiologic effect. Serum T4, Free T4 and T3 resin uptake were not altered during both studies. Glucagon infusion induced a significant decline in serum T3 (P less than 0.01) and a marked rise in rT3 (P less than 0.01) whereas saline administration caused no alterations in T3 or rT3 levels. Thus the changes in T3 and rT3 were significantly different during glucagon study when compared to saline infusion. (P less than 0.01 for both comparisons). Therefore, this study demonstrates that changes in serum T3 and rT3 caused by hyperglucagonemia may be secondary to altered thyroid hormone metabolism in peripheral tissues and not due to altered release by the thyroid gland, since the release of thyroid hormones is suppressed by exogenous L-T4 administration.

Adult↗
PubMed2005

High pre-therapy [99mTc]pertechnetate thyroid uptake, thyroid size and thyrostatic drugs: predictive factors of failure in [131I]iodide therapy in Graves' disease.

BACKGROUND AND OBJECTIVE: Several factors may interfere with the success rate of radioiodine therapy (RIT) in Graves' disease. Our aim was to evaluate, retrospectively, some of these factors in the outcome of RIT. METHODS: Patient gender, age at diagnosis, ophthalmopathy, disease duration, thyroid size, drug used as clinical treatment, thionamide withdrawal period during RIT preparation, FT4, TSH and [99mTc]pertechnetate thyroid uptake prior to RIT were studied as potential interference factors for RIT success. Eighty-two Graves' disease patients were submitted to RIT after thionamide treatment failure. Prior to RIT, 67 patients were receiving methimazole and 15 propylthiouracil. Thirty-three patients received thionamides during RIT; in 49 patients the medication was withdrawn for 2-30 days. [99mTc]pertechnetate thyroid uptake was determined before RIT. Fixed doses of 370 MBq of [131I]iodide were administered to all patients. RESULTS: Eleven patients became euthyroid; 40 became hypothyroid and 31 remained hyperthyroid. There was no association between outcome and age at diagnosis, gender, ophthalmopathy, pre-RIT FT4, TSH, antithyroid antibodies or thyrostatic drug. Multiple logistic regression showed higher probability of treatment success in patients with thyroid mass <53 g (odds ratio (OR)=8.9), with pre-RIT thyroid uptake <12.5% (OR=4.1) and in patients who withdrew thionamide before RIT (OR=4.9). CONCLUSIONS: Fixed doses of 370 MBq of radioiodine seem to be practical and effective for treating Graves' disease patients with [99mTc]pertechnetate uptake <12.5% and thyroid mass <53 g. This treatment is clearly not recommended for patients with large goitre. In contrast to what could be expected, patients with a high pre-RIT thyroid uptake presented a higher rate of RIT failure.

Adolescent↗
PubMed2006

Diffuse large B cell lymphoma of thyroid as a masquerader of anaplastic carcinoma of thyroid, diagnosed by FNA: a case report.

BACKGROUND: Both thyroid lymphoma and anaplastic carcinoma of thyroid present with rapidly growing mass in eldery patients. Anaplastic carcinoma has high mortality rate and combination of surgery, radiation therapy and multidrug chemotherapy are the best chance for cure. Prognosis of thyroid lymphoma is excellent and chemotherapy for widespred lymphoms and radiotherapy with or without adjuvant chemotherapy for tumors localized to the gland, are the treatment of choice. CASE REPORT: This article reports a 70 year old man presenting with diffuse neck swelling and hoarseness of few weeks duration. Fine needle aspiration was done and reported as anaplastic carcinoma of thyroid which thyroidectomy was planned. The slides were sent for second opinion. After review, with initial diagnosis of anaplastic carcinoma versus lymphoma, immunocytochemical study was performed. Smears were positive for B cell markers and negative for cytokeratin, so with the impression of diffuse large B cell lymphoma, the patient received two courses of chemotherapy by which the tumor disappeared during two weaks. CONCLUSION: Despite previous reports, stating easy diagnosis of high-grade thyroid lymphoma on the grounds of cytomorphological features we like to emphasize, overlapping cytologic features of the curable high grade thyroid lymphoma form noncurable anaplastic thyroid carcinoma and usefulness of immunocytochemistry to differentiate these two disease.

Journal Article↗