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PubMed2002

Clinical analysis of hyperthyroid heart disease in 31 elderly patients.

A clinical analysis of hyperthyroidism heart diseases was conducted in 31 elderly patients, of whom 15 (48.4%) had been misdiagnosed before accurate diagnoses were reached 4 months to 3 years later. Among the 15 misdiagnosed cases, 9 were misdiagnosed as coronary heart disease, 3 as pulmonary heart disease, 2 as hypertension heart disease and 1 as dilated cardiomyopathy. This result suggests that physicians need to be more aware of elderly hyperthyroidism, and thorough history inquiry, systemic examination and timely thyroid function test can reduce the misdiagnosis of hyperthyroid heart disease in elderly patients.

Aged↗
PubMed2002

Experimental hyperthyroidism increases the effectiveness of predegenerated peripheral nerve graft implantation into hippocampus of adult rats.

PURPOSE: The aim of the study was to ascertain whether experimental hyperthyroidism changes the neurotrophic activity of 14- and 21-day-predegenerated peripheral nerve grafts towards CNS neurites. METHODS: Hyperthyroidism was induced by subcutaneous injections of T_4. Autologous peripheral nerve grafts were implanted into the hippocampus of both euthyrotic and hyperthyrotic animals 14 or 21 days after sciatic nerve transection (groups ET14, Et21, Ht14 and Ht21, respectively). Non-predegenerated grafts were used as a control group (groups EtN adn HtN). Cells extending their neurites into the grafts were traced with FITC-HRP. RESULTS: The number of traced cells in individual groups was as follows: EtN - 39.4 +/- 9.46, Et14 - 1 +/- 0.94, Et21 - 0.6 +/- 0.69; HtN - 95 +/- 19.46; Ht14 - 95.94 +/- 16.3, Ht21 - 99.94 +/- 7.26. CONCLUSIONS: We found that experimentally induced hyperthyroidism strongly enhanced the regeneration of injured hippocampal neurites after implantation of peripheral nerve grafts that were practically inactive in euthyrotic animals.

Animals↗
PubMed2002

Radioiodine treatment of feline hyperthyroidism in Germany.

AIM: Establishment of radioiodine treatment of feline hyperthyroidism in veterinary routine in accordance with German radiation protection regulations. PATIENTS AND METHODS: 35 cats with proven hyperthyroidism were treated with 131I in a special ward. Thyroid uptake and effective halflife were determined using gammacamera dosimetry. Patients were released when measured whole body activity was below the limit defined in the German "Strahlenschutzverordnung". RESULTS: 17/20 cats treated with 150 MBq radioiodine and 15/15 cats treated with 250 MBq had normal thyroid function after therapy, normal values for FT3 and FT4 were reached after two and normal TSH levels after three weeks. In 14 cats normal thyroid function was confirmed by controls 3-6 months later. Thyroidal iodine uptake was 24 +/- 10%, effective halflife 2.5 +/- 0.7 days. Whole body activity < 1 MBq was reached 13 +/- 4 days after application of 131I. Radiation exposure of cat owners was estimated as 1.97 microSv/MBq for adults. CONCLUSION: Radioiodine therapy of feline hyperthyroidism is highly effective and safe. It can easily be performed in accordance with German radiation protection regulations, although this requires hospitalisation for approximately two weeks. Practical considerations on radiation exposure of cat owners do not justify this long interval. Regulations for the veterinary use of radioactive substances similar to existing regulations for medical use in humans are highly desirable.

Adult↗
PubMedDate not supplied

[Atrial fibrillation and hyperthyroidism: results after thyroidectomy].

Hyperthyroidism patients can develop atrial fibrillation (AF) with a frequency range between 10 and 25%. The Authors consider 256 hyperthyroid patients operated in their Department, from 1985 to 2001. Before and after surgery, thyroid examination, routine blood tests and common diagnostic evaluations were performed. The follow-up has been 12 months and during this period a L-Thyroxine (50-200 mg/die) therapy has been arranged. Before surgery 59 patients (23%) showed an AF associated with palpitations (76%), asthenia (66%), tremors (54%) and dyspnea (43%). The onset of AF was less than 1 months in 18% of cases, less than 3 months in 30% and chronic in remaining 52%. The 87% of patients was already pharmacologically treated. All the patients were treated with anticoagulants, with a INR value between 2 and 3. After the surgery, 47% of patients presented a restoration of the sinusal rhythm, while the 53% showed a stronger therapeutic responsiveness to specific antiarrhythmic therapy. Treatment of FA hyperthyroid patients with FA tends to normalize the function of the thyroid gland (euthyroidism). In our experience the restoring of sinusal rhythm usually develops in patients with 50 years of age (45 +/- 5 years), while in older patients AF tends to be resistant to treatment.

Atrial Fibrillation↗
PubMed1976

Effect of hyperthyroidism on hypoprothrombinemic response to warfarin.

Clinical observations and studies regarding hyperthyroidism and enhanced response to warfarin are reviewed. The reported cases of increased sensitivity to warfarin in hyperthyroidism are summarized, and possible mechanisms for this disease-drug interaction are discussed. Most recent studies indicate that the activity of warfarin is enhanced in hyperthyroidism because of increased catabolism of vitamin-K-dependent clotting factors.

Blood Coagulation↗
PubMed2003

Use of oral cholecystography agents in the treatment of hyperthyroidism of subacute thyroiditis.

AIM: In this study, we describe our experience in treating subacute thyroiditis patients with 2 OCAs (sodium ipodate and sodium iopanoate). METHODS: We studied 10 consecutive patients with subacute thyroiditis treated with 1 of the 2 oral cholecystography agents (OCAs). RESULTS: Hyperthyroidism was controlled and symptoms improved markedly in each case without any evidence of subsequent relapse of thyroiditis after withdrawal of OCAs. Three of the 10 patients had been treated previously with corticosteroids and had demonstrated relapse of thyroiditis and hyperthyroidism after tapering or withdrawal of steroids. We observed no side effects of treatment with OCAs. CONCLUSION: Our data suggest that OCAs are effective and safe agents for management of hyperthyroidism in patients with subacute thyroiditis, even when they have relapsed after treatment with corticosteroids.

Acute Disease↗
PubMed2003

Radioiodine treatment of hyperthyroidism. Success rate and influence of thyrostatic medication.

OBJECTIVE: The aim of this study is to evaluate the response rate of hyperthyroidism to radioactive iodine (RAI) treatment, optimum effective dose, effect of pretreatment with thyrostatic medications, etiology, ophthalmopathy, mortality and cancer incidence post RAI treatment. METHODS: Retrospective study analysis of 360 patients records who received RAI treatment (dose 5-15 mCi) for hyperthyroidism in Hamad Medical Corporation, Qatar between 1984-1999, treated and analyzed. Follow-up data was available in 215 patients, with a follow-up range of 2-10 years, of these 84 were males and 131 were females, with an age range of 12-74 years. Eighty percent were toxic diffuse goiter, 13.5% were toxic multinodular goiter and 6.5% were toxic single nodule. Eighty-seven percent had been pre-treated with anti-thyroid medications. Free thyroxine4, and thyroid stimulating hormone were recorded at diagnosis; 6 months, one year and yearly post RAI treatment. RESULTS: The incidence of hypothyroidism was 55.8% at 6 months and 67.9% at one year. There was no significant difference in the response rate to different doses of RAI treatment groups (50-59%, p=0.46). The response rate was significantly higher in the group without pre-treatment with anti-thyroid medications (95% versus 80.9%, p<0.0001) and 27.4% of our patients had ophthalmopathy. There was no significant worsening or new development of ophthalmopathy post RAI treatment. Three of our patients developed cancer: one with colonic, one with breast and one with acute leukemia. The mortality rate according to the age group was linear in the positive direction of age and the highest was 74-year-old (10.5 per 10,0000 population). CONCLUSION: Radioactive iodine treatment is an effective modality for definitive treatment of hyperthyroidism with long-term cure approaching 80%. Response rate was not related to gender, etiology or RAI dosage. Pre-treatment with anti-thyroid medication reduces the response rate. Radioactive iodine treatment has no significant influence on ophthalmopathy, mortality or thyroid cancer.

Adolescent↗
PubMed2003

[Subclinical hyperthyroidism: not necessarily a thyroid disorder].

Three women, aged 16, 70 and 72 years, were seen in our outpatients' clinics with a decreased TSH value. In two of them, thyroid dysfunction was not the cause of the low TSH activity. In patient A, the cause was diminished food intake and in patient B, who was also known with nodular thyroid disease, the cause was the use of glucocorticoids. Only patient C had subclinical hyperthyroidism due to goitre with concomitant atrial fibrillation. She was recommended for treatment with 131I. Patients A and B recovered spontaneously. Subclinical hyperthyroidism is being increasingly encountered due to the availability of sensitive assays for measuring TSH activity and the increased frequency with which general practitioners test thyroid function. However, in about 55% of cases suppressed TSH values normalise spontaneously. This means that it is important to establish if thyroid disease is truly present. The treatment of subclinical hyperthyroidism should be initiated on the basis of individual data.

Adolescent↗
PubMed2003

Weight gain in patients after therapy for hyperthyroidism.

OBJECTIVE: To determine the prevalence of obesity following therapy for hyperthyroidism and to assess the contributing factors associated with an undesirable weight gain. DESIGN: A retrospective analysis was undertaken of clinical records for 160 hyperthyroid patients attending an endocrine clinic in Bloemfontein (1994-2001). RESULTS: Of the 160 patients, 143 had Graves' disease and 17 patients had multinodular goitre. Most of our patients (N = 147) were treated with radioiodine, 10 patients with carbimazole and 3 patients had thyroidectomy. The median weight gain 6 months after therapy was 5.0 kg, after 12 months 9.0 kg, and after 24 months 12 kg, whereafter body mass stabilised. Before therapy 27.5% of patients had a body mass index (BMI) of < 22 kg/m2, 29.4% were overweight (BMI > 25 kg/m2) and 19.3% were obese (BMI > 30 kg/m2). Two years after treatment only 8.7% of patients had a BMI of < 22 kg/m2, 27.5% had a BMI > 25 kg/m2, and 51.3% had become obese. The main factors associated with weight gain 24 months after therapy were poor control of thyroid function on replacement therapy, diagnosis of Graves' disease and need for thyroxine replacement. CONCLUSION: This study has shown a large increase (32%) in the prevalence of obesity following treatment for hyperthyroidism. The main weight gain was during the first 2 years after therapy. The main factors contributing to excessive weight gain were need for replacement therapy and poor control of thyroid function.

Antithyroid Agents↗
PubMedDate not supplied

[Osteocalcin and hyperthyroidism].

Osteoporosis may be induced by hyperthyroidism through an increase of bone turnover, because bone resorption exceeds formation in this condition. Also therapy with 1-thyroxine, especially by TSH-suppressive doses, may induce a reduction in bone mineral content. Circulating osteocalcin (sBGP) significantly increases both in endogenous and exogenous hyperthyroxinemia and is considered a reliable non invasive marker of bone turnover. In this study an extra-increase of sBGP in hyperthyroid post-menopausal women towards pre-menopausal is reported, the persistence of high sBGP levels in patients affected by any type of hyperthyroidism after four months of therapy and a positive relationship with thyroid hormones (fT4). Therefore monitoring of this serum marker may be suggested also in patient chronically treated with 1-thyroxine to avoid, if possible, overzealous therapy.

Adult↗
PubMed1992

[Influence of treating hypothyroidism and hyperthyroidism upon psychical reaction time].

The aim of the study was answering the question whether determination of psychical reaction time may be useful for the monitoring of treatment of hypothyreosis and hyperthyreosis. The correlation of disease symptoms (diagnostic index for hypothyroidism after Murray and for hypothyroidism according to Crooks), concentration of triiodothyronine, thyroxine, index of free thyroxine in blood serum and Achilles tendon reflex--with the simple reaction time (srt) as well as with the choice reaction time (chrt) before and during treatment was investigated in 18 patients with primary hypothyroidism and in 24 with hyperthyroidism caused by Graves-Basedow's disease. Two control groups comprised 84 healthy persons. Either in hypothyroidism or in hyperthyroidism the srt and chrt was significantly prolonged. The substitution therapy in hypothyroidism resulted in a normalization of both parameters. On the other hand, administration of thiamazole, especially in the early period of treatment of hyperthyroidism, further prolonged the srt and chrt. A shortening of the time of each of the two reactions occurred, however, when the restoration of euthyroidism was achieved, which was accompanied by reduction of thiamazole dosage. The obtained data point to the usefulness of srt and chrt determination for the diagnosis and therapy monitoring of functional disturbances of the thyroid gland.

Adult↗
PubMedDate not supplied

Single daily dose of carbimazole in the treatment of hyperthyroidism.

BACKGROUND: The antithyroid drugs, methimazole and carbimazole, are conventionally used in divided daily doses. However, these drugs have a longer intrathyroidal than a plasma half-life. We undertook this prospective, controlled study, in an area of mild iodine deficiency, to compare the efficacy of a single daily dose of carbimazole with divided doses in the treatment of hyperthyroidism. METHODS: Nineteen patients with hyperthyroidism received 30 mg of carbimazole daily at bed time (group A) while 14 received 10 mg of carbimazole every 8 hours (group B). These patients were assessed clinically and biochemically by estimation of serum total thyroxine, total triiodothyronine and thyrotropin before and 1, 2, 3, 4 and 6 weeks after treatment. RESULTS: There was no significant difference between mean baseline concentrations of thyroxine and triiodothyronine. After 1, 2, 3, 4 and 6 weeks there was a decline in their concentrations which was similar in both groups (p > 0.05). Euthyroidism was achieved in 4.6 +/- 1.4 weeks (range 2-6 weeks) in group A and in 3.8 +/- 1.2 weeks (range 3-6 weeks) in group B (p > 0.05). CONCLUSIONS: We conclude that carbimazole in a single daily dose is an effective method for treating hyperthyroidism in an area of mild iodine deficiency and its efficacy is comparable to divided dose therapy. This practical and acceptable method of treatment can be specially useful in patients who find it difficult to remember to take divided doses.

Adolescent↗
PubMed1992

Hyperemesis, hyperthyroidism, or both?

Nausea and vomiting are common during pregnancy and, when severe enough to require intervention, may develop into the syndrome known as hyperemesis gravidarum. When the diagnosis of hyperemesis is considered, a careful search for secondary causes is necessary. The list of secondary causes includes hyperthyroidism, a relatively uncommon condition during pregnancy. Because many of the signs and symptoms of hyperthyroidism are common, and thyroid function tests are more difficult to interpret during normal pregnancy, making the diagnosis of hyperemesis gravidarum is a challenge. The decision to treat or to await spontaneous resolution depends on the severity of the illness and the likelihood of the presence of true Graves' disease. The case summarized here demonstrates these issues, and includes treatment options for hyperemesis-associated hyperthyroidism.

Adult↗
PubMed2003

[Disorders of the thyroid gland in neonates and youth: latent hypothyroidism and hyperthyroidism].

Etiology and clinical manifestation of subclinical hypothyroidism is different in neonates and in young. In the neonatal period babies present with jaundice and/or constipation due to thyroid hypoplasia, thyroid ectopia or transient hypothyroidism. The main reason for subclinical hypothyroidism in the youth is Hashimoto thyroiditis. Indication for thyroxin therapy in subclinical hypothyroidism is discussed controversial in the literature. For best growing and maturation in childhood thyroxin therapy should be given. Subclinical hyperthyroidism is rare in childhood. The main reasons are Graves' disease or Hashimoto thyroiditis (initial period). The therapy of subclinical hyperthyroidism is the same as in overt hyperthyroidism.

Adolescent↗
PubMed2003

Trophoblastic hyperthyroidism.

Hyperthyroidism can occur secondary to gestational trophoblastic disease. The clinical and biochemical data of four women who had hyperthyroidism secondary to gestational trophoblastic disease was analyzed. The parity ranged from primi to gravida four and the period of amenorrhoea from six weeks to sixteen weeks. Three women had vomiting, two had bleeding per vaginum and two had tachycardia and minimal thyromegaly. The betahCG was more than 5,00,000 mlu/ml in all the cases. Three women required treatment for the hypermetabolic status and one woman had biochemical hyperthyroidism. Two of them had molar pregnancy, one had partial mole and one had persistent trophoblastic disease.

Adult↗
PubMed2003

[Subacute motor neuropathy induced by T3 hyperthyroidism].

Subacute motor neuropathy involving bulbar nerves is an unusual complication of hyperthyroidism. Clinical and neurophysiologic follow-up of such patients has been rarely reported. We describe a 41-year-old Colombian patient who developed respiratory failure associated with motor neuropathy and severe weight loss. The major clinical features included diffuse amyotrophy, bilateral facial paresis, and fasciculations, suggesting motor neuropathy. Electromyography confirmed the presence of axonal neuropathy, with predominant motor involvement. Goiter with hypervascularization was noticed, associated with pure T3 hyperthyroidism (T3l=26 pg/ml; N<3.8). The patient was given carbimazole which induced a severe skin vasculitis 10 days later. Carbimazole was stopped and replaced by propylthiouracile, which also induced vasculitis with secondary cardiac failure. Total thyroidectomy was then performed. General status improved rapidly as well as motor deficit, amyotrophy and pyramidal syndrome. Electromyographic abnormalities improved significantly within 3 months. This observation demonstrates that hyperthyroidism can produce motor axonal neuropathy, curable with radical surgery.

Acute Disease↗
PubMedDate not supplied

[QT/QS2 index in patients with arterial hypertension, mitral valve prolapse and hyperthyroidism].

QT/QS2 ratio has been assessed in 26 patients with both borderline and mild hypertension and mitral valve prolapse syndrome (19 patients), and hyperthyroidism (16 patients) in comparison with method control groups. The following polycardiographic parameters have been analyzed: QT, QTp, QS2, QT/QS2, and QTp/QS2. Higher values of QT/QS2 ratio have been noted in patients with mitral valve prolapse syndrome and hyperthyroidism than that in the control group. There has been no difference in patients with mild hypertension while the values of the analyzed parameter have been significantly lower in patients with borderline hypertension. QT has been longer than QS2 (QT)QS2 1/in 9 (56%) patients with hyperthyroidism. A positive correlation between QT/QS2 ratio and ++thyroxine levels have been noted in these patients. QT values have been higher than QS2 values only in 1 patient with mild hypertension. It seems that QT/QS2 value has limited value as an indirect index of the adrenergic activity in the dysfunction of the autonomic nervous system.

Adrenergic Fibers↗
PubMedDate not supplied

[Beta-2-microglobulin in hyperthyroidism].

The aims of the study were to clarify the cause of increased serum beta 2-microglobulin as a marker of thyroid hyperfunction. Serum beta 2-microglobulin was measured in 31 untreated hyperthyroid patients, all of them with normal renal function. Twenty-one subjects were affected by diffuse toxic goiter and 10 by toxic adenoma. Serum free thyroid hormones, TSH, anti-thyroglobulin and anti-microsomal antigen autoantibodies were determined, too. Thyroid hormone and creatinine levels did not differed between both sets of patients. beta 2-microglobulin was higher than normal in 90% of cases with diffuse toxic goiter and in 70% of those with toxic adenoma (p less than 0.05), but mean beta 2-microglobulin concentrations didn't differ between the two groups. No difference was found in beta 2-microglobulin levels in diffuse toxic goiter group according to the presence or absence of autoantibodies. beta 2-Microglobulin and thyroid hormones were not correlated in either diffuse toxic goiter and toxic adenoma groups. These data confirm the high prevalence of elevated beta 2-microglobulin concentrations in hyperthyroidism. As renal function was normal, this rise is due to beta 2-microglobulin overproduction. This increased production is a hormone mediated effect, even if lymphocyte activation may contribute in diffuse toxic goiter. beta 2-microglobulin is not correlated with thyroid hormone concentrations so that at present it isn't a useful marker of hyperthyroidism severity for practical purposes.

Adenoma↗