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PubMed2004

['Hungry bone' syndrome, characterized by prolonged symptomatic hypocalcemia, as a complication of the treatment for hyperthyroidism].

A 22-year-old woman presented with palpitations, agitation, heat intolerance and unintentional weight loss that had started several months before. Pharmacotherapy for hyperthyroidism was prescribed, but a year later thyroidectomy was performed in connection with a lack of treatment compliance. A few hours after the operation the patient developed a tingling sensation and muscle cramp, which were found to be due to severe hypocalcaemia. Although surgery was complicated by hypoparathyroidism, there was an unusually high need for calcium combined with a low calcium excretion in the urine. Such a high need for calcium due to the increased bone reconstruction induced by the hyperthyroidism is referred to as the hungry bone syndrome. One should be particularly alert to this complication in cases of severe, prolonged hyperthyroidism, certainly in the presence of existing or peroperatively induced damage to the parathyroids. In this patient, calcium suppletion led to normalisation of the serum calcium level two weeks postoperatively; she was discharged from the hospital in good condition after 3 weeks.

Adult↗
PubMed2003

Positive inotropic effect of the inhibition of cyclic GMP-stimulated 3',5'-cyclic nucleotide phosphodiesterase (PDE2) on guinea pig left atria in eu- and hyperthyroidism.

The significance of PDE2 on the atrial inotropy was studied in eu- and hyperthyroidism. The contractile force was measured and negative inotropic capacity of N6-cyclopentyladenosine (CPA) was determined on left atria isolated from 8-day thyroxine- or solvent-treated guinea pigs, in the presence or absence of EHNA (adenosine deaminase and PDE2 inhibitor) or NBTI (nucleoside transporter inhibitor). EHNA was administered to inhibit PDE2, while NBTI was used to model the accumulation of endogenous adenosine. The reduction of the contractile force caused by EHNA was smaller in the thyroxine-treated atria than in the solvent-treated samples. Contrary, NBTI induced a decrease in the contractile force without significant difference between the two groups. In addition, EHNA enhanced the efficiency of CPA in thyroxine-treated atria and did not affect it in solvent-treated samples, while the response to CPA was decreased by NBTI in all atria, especially in hyperthyroidism. On the basis of greater retention of the contractile force and sustained/enhanced responsiveness to CPA in the presence of EHNA we conclude that PDE2's inhibition has a significant positive inotropic effect in guinea pig atria and this effect is proven to be augmented in hyperthyroidism.

Adenine↗
PubMed2004

[Anterior mediastinal mass with hyperthyroidism; report of a case].

The patient was a 27-year-old man who had been diagnosed as having hyperthyroidism and with an anterior mediastinal mass which was reduced in size after anti-thyroid therapy. This mass was thought to be thymic hyperplasia associated with hyperthyroidism. An anterior mediastinal mass accompanying hyperthyroidism should be surgically treated when it dose not regress after an appropriate antithyroid therapy or there is a clinical suspicion of malignancy.

Adult↗
PubMed2003

Liver function tests during antithyroid therapy in hyperthyroidism.

AIMS: To investigate the liver function tests during antithyroid treatment in the patients with hyperthyroidism. METHODOLOGY: Four hundred sixty five patients with hyperthyroidism (285 Graves' disease and 180 toxic nodular/multinodular goiter) and fifty healthy subjects were included in the study. The patients who had abnormal liver function tests were excluded from the study. Blood levels of thyrotropin (TSH), free thyroxine (FT4), alanine transaminase (ALT) and aspartate transaminase (AST) were detected at the beginning of the treatment (basal levels), and at the third and sixth months of the treatment. The patients were treated with propylthiouracil (PTU). RESULTS: Average of age was 40.1 +/- 5.8 years in the patient group and was 37.3 +/- 4.5 years in the control group. TSH, FT4, ALT and AST levels measured in the patient and control group are shown in Table 1. Basal levels of TSH were lower in the study group than in the control group (p<0.001), and basal levels of FT4 were higher in the study group than in the control group (p<0.001). Basal levels of ALT and AST, and the levels of TSH, FT4, ALT and AST measured at the third and sixth months were similar in both groups. CONCLUSIONS: We did not find abnormal liver function tests during the antithyroid treatment in the patients with hyperthyroidism.

Adult↗
PubMed2004

Effects of antithyroid medication on the flow-volume loop in patients with hyperthyroidism.

This prospective study was designed to evaluate the effects of hyperthyroidism on flow-volume loops in nonasthmatic 20 patients with hyperthyroidism. Thyroid related hormones (Total T3, Total T4 and TSH), thyroid gland volumes with ultrasonography, circumference of neck values and flow-volume loops were obtained at the beginning and after three months of antithyroid treatment. Propylthiouracil treatment was followed by a statistically significant decrease in thyroid gland volume and circumference of neck (p< 0.001 and p< 0.001, respectively). The most significant result was improvement of maximum midexpiratory flow rate (MMEFR) after propylthiouracil therapy for three months (p= 0.003). Increases in mean forced expiratory flow after 25% of FVC has been exhaled (FEF25), mean forced expiratory flow after 75% of FVC has been exhaled (FEF75) values were found consistent with the overall improvement in expiratory flow parameters (p= 0.044, p= 0.012 respectively). In conclusion, we speculated that improvement of expiratory flow parameters might be the earlier changes in flow volume loops of patients who were treated with propylthiouracil for hyperthyroidism.

Administration, Oral↗
PubMed2004

Potentiation of haloperidol neurotoxicity in acute hyperthyroidism: report of a case.

Haloperidol has been used extensively for the treatment of many psychiatric illnesses as well as for control of agitated patients. Side effects including anticholinergic, extrapyramidal, sedative side effects as well as neuroleptic malignant syndrome are not unusual. Many factors may contribute to these complications including withdrawal or toxicity, concomitant use of other medications or the underlying illness itself. We report a case without previous history of thyroid disorder sufferring acute manic episode. Haloperidol was prescribed to control psychotic symptoms. Symptoms and signs of extrapyramidal syndrome, catatonia and hyperthyroidism ensued. Prescription of anti-thyroid agents and discontinuation of haloperidol were essential in the successful treatment of this patient. It is hypothesized that underlying hyperthyroidism might have precipitated haloperidol neurotoxicity. Haloperidol might play a role in the exacerbation of hyperthyroidism.

Adult↗
PubMed2004

[Parameters of lipid peroxidation and low density lipoprotein (LDL) oxidation in the course of hyperthyroidism].

The aim of this study was to evaluate the influence of hyperthyroidism on lipid peroxidation and oxidative modification of low density lipoprotein (LDL). Twenty patients with hyperthyroidism due to Graves' disease or toxic multinodular goitre and 17 healthy subjects as the control group were investigated. Lipid peroxidation was measured by the serum level of malondialdehyde and 4-hydroxynonenal (MDA+4-HNE) whereas the oxidative modification of LDL was determined by measuring the serum levels of antibodies against oxidized LDL (anti-oxLDL). Ratios, which were evaluated as proportions of lipid peroxidation products level or anti-oxLDL level to the LDL-cholesterol level (LDL-C) were also determined: MDA+4-HNE/LDL-C and anti-oxLDL/LDL-C. The patients with hyperthyroidism displayed a significant elevation of the MDA+4-HNE/LDL-C ratio. The level of anti-oxLDL and anti-oxLD/LDL-C ratio were positively correlated with FT4 level and inversely correlated with HDL-cholesterol. These data suggest that the intensification of lipid peroxidation and oxidative modification of plasma lipoprotein is affected by changes in the level of thyroid hormones.

Adult↗
PubMed1992

Hypothyroidism and hyperthyroidism in the elderly.

Thyroid disease in the elderly can be easily overlooked. Symptoms too often are explained away as normal processes of aging. Development of unstable illness, especially cardiac disease, is a frequent mode of presentation. One symptom or one clinical feature of thyroid disease in the elderly may be overwhelming in its presentation, as in apathetic hyperthyroidism, thyroid myopathy, depression and dementia. Physical examination of the thyroid gland can be helpful but in a high percentage of older patients the gland is normal to palpation. The treatment of hypothyroidism is straightforward. Only myxedema coma requires large doses of levothyroxine parenterally; all other forms of hypothyroidism are treated with oral levothyroxine. The dose is started very low and increased gradually over months. The euthyroid state is achieved gradually and safely. Hyperthyroidism can be treated by several modalities. In the unstable elderly patient, antithyroid medication can quickly produce a euthyroid state. When the patient is stable, further decisions can be made regarding definitive therapy. Radioactive iodine therapy is well-tolerated and effective. On occasion, a second course of therapy is needed to suppress hyperthyroidism. Close follow-up of all patients ever having received this therapy is needed to identify the development of hypothyroidism. Surgical thyroid ablation may be necessary in patients who fail to respond to radioactive iodine therapy. Abnormalities associated with unresolved thyromegaly, dysphagia, or tracheal compression may require surgical intervention. If suspicion exists that the gland is cancerous, surgical intervention is warranted.

Aged↗
PubMed2005

[Hyperthyroidism in the elderly: aspecific signs may cause a delay in diagnosis].

The clinical manifestations of thyroid diseases in the elderly are often atypical and can easily be attributed to other medical conditions or 'normal aging'. Two nursing home patients with hyperthyroidism are described. Due to the atypical presentation of the thyroid disease their complaints were attributed to other conditions. In both patients there was a significant delay in diagnosis and treatment of hyperthyroidism. In elder patients signs and symptoms of thyreotoxicosis are frequently related to cardiovascular, gastrointestinal and neuropsychiatric disorders. Most often occur atrial fibrillation, worsening of cardiac failure and angina pectoris, weight loss, anorexia, constipation, cognitive impairment and delirium. Delay of diagnosis and treatment of hyperthyroidism may be potentially harmful to the patient. Untreated thyreotoxicosis may lead to serious cardiovasculair complications (particularly cardiac failure and cerebrovascular accidents), mental deterioration and osteoporosis. In elder people with unexplained and vague signs and symptoms thyroid function should always be checked. The TSH assay is a very accurate diagnostic test for screening thyroid function. A normal TSH indicates euthyroidism with an accuracy of almost 100%. The medical treatment for hyperthyreoidism in the elderly are antithyroid drugs. When an euthyroid state is rendered, suppletion with L-thyroxine may be nessecary. Radioactive iodine treatment is preferred in some cases though there may be practical difficulties with the application of this treatment in nursing home patients because temporary isolation is necessary.

Aged↗
PubMedDate not supplied

Testicular function in hyperthyroidism.

Testicular function was assessed in nine men aged 17 to 35 years and seven men aged 36 to 46 years with Graves' disease. Levels of total testosterone, estradiol, sex hormone binding globulin, luteinizing hormone, and follicle stimulating hormone, and gonadotropin responses to gonadotropin releasing hormone were significantly greater than these levels and responses in age-matched controls. Although the percentage of free testosterone was lower than control values in the hyperthyroid men, calculated levels of free testosterone were not different from normal. Lower than normal percentages of free estradiol values resulted in higher than normal calculated free estradiol levels. As a result, the free testosterone/free estradiol ratio in the men with Graves' disease was lower than normal. Although mean sperm densities in the hyperthyroid men were not different from control values, the percent forward progressive motility of sperm from these men was significantly lower than control values. The hormonal and seminal abnormalities corrected when the patients became euthyroid after radioiodine therapy. The results of this study indicate that hyperthyroid men may have abnormalities in their hypothalamic-pituitary-testicular axes.

Adolescent↗
PubMed2005

Radioiodine treatment of hyperthyroidism in patients with low thyroid uptake.

BACKGROUND: The aim of the study was to analyze the effectiveness of radioactive 131I in hyperthyroid patients with confirmed lowered iodine uptake as compared to patients with an uptake of over 30%. MATERIAL AND METHODS: We retrospectively analyzed 53 consecutive patients aged from 29 to 84 (mean age 60 years) suffering from hyperthyroidism caused by Graves' disease or toxic nodular goitre. The patients were divided into 2 sub-groups: the 1st with a maximum iodine uptake of 18.7 +/- 3.2% (range, 11-23%) - 24 patients; the 2nd with a maximum iodine uptake of 27.1 +/- 2.1% (range, 24-30%) - 29 patients. The control group consisted of 50 patients treated with 131I with an iodine uptake of over 30%. Each patient was evaluated before, and 6 months after, treatment for fT3, fT4 and TSH with ECLIA; TRAb with RIA; ultrasound with a 7.5 MHz linear probe. The volume of the thyroid gland was determined using the Gutekunst method. All these factors underwent statistical analysis and were considered along with the results of clinical examinations. RESULTS: Clinical remission of hyperthyroidism was evident in 79.3% of both sub-groups, in total (83.3% and 75.3%, respectively). TSH was normalized in 62.3% of these patients (54.2% and 69.0%, respectively). The mean range of TSH levels increased from 0.081 microU/ml to 4.0 microU/ml after therapy; that is, from 0.087 microU/ml to 4.97 microU/ml in the 1st sub-group and from 0.076 microU/ml to 3.3 microU/ml in the 2nd sub-group. The volume of the thyroid gland was uniformly significantly lower, with a mean range of 40.5 ml before treatment and 21.7 ml afterwards. The results seen in both sub-groups were similar; only age and dose of radioiodine were slightly higher in the 1st, while mean uptake was higher in the 2nd. By comparison of these results to those of the control patients, we observed that the values of TSH, as well as thyroid volume and evidence of clinical remission, reflected those found in the control group. The mean dose of 131I was lower in the control group, that is 11.3 m Ci, as compared to the sub-groups as a whole, specifically, 15.7 mCi. The mean age of patients in the control group was slightly less than that of the study group (50.8 and 60, respectively). CONCLUSIONS: 1. The results of the treatment of patients with a low iodine uptake are similar to the results obtained in the group of patients with iodine uptake above 30% and therefore low iodine uptake should not be a contraindication for isotope I-131 therapy. 2. Additionally, we have demonstrated that a statistically significant decrease in thyroid volume is observed in all patients after the iodine isotope treatment which indirectly proves the effectiveness of the prescribed treatment, and that low thyroid iodine uptake is more frequently observed in elderly patients and in patients treated with iodine or anti-thyroid drugs.

Adult↗
PubMed2005

[Methimazole versus methimazole and diphosphonates in hyperthyroid and osteoporotic patients].

AIM: It is well-know that hyperthyroidism is one of the key causes of secondary osteoporosis. High values of thyroid hormones increase the bone mineral turnover speed by promoting osteoclastic and osteoblastic activities. The aim of our study is to evaluate the increase of bone mineral density (BMD) in osteoporotic and hyperthyroid patients treated with only antithyroid drugs versus patients treated with antithyroid drugs and diphosphonates. METHODS: Twenty-six elderly male patients, 65-75 years, were selected. In all these patients, thyroid function (FT3, FT4, TSH, Tg, AbTg, AbTPO) was evaluated at baseline and after 6 and 12 months from the start of medical treatment; the following were evaluated: BMD, calcium serum, phosphorus serum, alkaline phosphatase, PTH and 24 hours urinary calcium, phosphorus and hydroxyprolin. Thirteen patients (group 1) were treated with antithyroid drugs (methimazole 5-20 mg/die/os) and diphosphonates (alendronate 10 mg/die/os). The control group of 13 patients (group 2) was treated with antithyroid drugs only. RESULTS: After 6 months of treatment, the patients of group 1 showed a mean increase of 2.5% in lumbar spine BMD compared with a mean increase of 0.3% in group 2 (p<0.01). After 12 months, group 1 showed a mean increase of 6.2% in lumbar spine BMD, compared with a mean increase of 2% in group (p<0.001). CONCLUSIONS: The combination of antithyroid and diphosphonates drugs appears to be more efficacious than antithyroid therapy alone for the treatment of osteoporosis in male hyperthyroid patients.

Aged↗
PubMed2005

[Effect of long-term treatment with octreotide-lar in a TSH-secreting pituitary macroadenoma and secondary hyperthyroidism].

A 74 year-old man was admitted to the hospital for heart failure and atrial fibrillation episodes. He had been irregularly treated for hyperthyroidism during the previous 3 years, with poor control. Thyroid function evaluation showed secondary hyperthyroidism, with high free thyroid hormone levels and TSH inappropriately in the high-normal range (4.2 mU/ml), only slightly responsive to TRH-stimulation (6 microU/ml). Alpha-subunits were hyper-responsive to TRH stimulation (+123%). Thyroid autoimmunity tests were negative and ultrasonography evidenced a diffusely enlarged gland. Magnetic resonance (MR) imaging of the pituitary showed a macroadenoma. The patient underwent transphenoidal adenomectomy, and immunohistochemistry confirmed the diagnosis of a TSH-secreting pituitary macroadenoma. A moderate secondary hyperthyroidism was still present and a new MR evidenced residual disease, involving the right cavernous sinus. A (111)In-octreoscan revealed an increased captation in this area. The patient was treated with octreotide-Lar (20 mg/monthly), which normalized FT3, FT4 and TSH levels already after 3 months of therapy. This effect is still maintained at 42 months of treatment. MR imaging showed a reduction in the residual lesion after 18 months (>50% in comparison with postsurgical MR) and a further decrease after 36 months of treatment). This suggests that the antiproliferative effect on the adenomatous cells is progressive and continues over time. This patients did not receive radiotherapy, so this action is entirely due to the medical treatment. No significant side effects developed and the patient's compliance was good. He has not had further arrhythmic episodes.

Adenoma↗
PubMed1992

Holter ECG recordings before and after surgical treatment of hyperthyroidism: circadian pattern of heart rate and arrhythmias.

Holter ECG recordings obtained form 11 hyperthyroid patients (mean age 29.2 +/- 11.4 years) before and after surgical treatment were analyzed regarding heart rate (HR) and arrhythmias. The mean 24-hour HR significantly decreased form 104 +/- 8.8 bpm before to 76.8 +/- 8.9 bpm after the treatment (p less than 0.001), with the most pronounced reduction while asleep form 0:00 AM to 6:00 AM. HR variability also significantly decreased (p less than 0.02), but the circadian rhythm of HR did not change before and after the treatment. Serum T3 level correlated with the mean HR (r = 0.63, p less than 0.05) in hyperthyroid state. The percent changes in T3 (% delta T3) best correlated with the percent changes in the mean HR (% delta mean HR) (r = 0.84, p less than 0.01). The frequencies of supraventricular and ventricular premature contractions significantly decreased after the surgical treatment (p less than 0.01). Normal circadian pattern of hourly HR before the treatment highly suggests that normal adrenergic responsiveness is maintained in hyperthyroidism.

Adult↗
PubMed2005

Hyperthyroidism presenting as isolated tricuspid regurgitation and right heart failure.

Although hyperthyroidism has many signs and symptoms, right heart failure can occasionally be the main presenting symptom. We describe the case of a previously healthy 42-year-old woman whose chief complaint was progressive bilateral lower extremity edema. The echocardiogram revealed right atrial dilatation and moderate-to-severe tricuspid regurgitation. Results of laboratory studies were consistent with hyperthyroidism. Thyroid ablation resulted in permanent resolution of symptoms and resolution of tricuspid incompetence on echocardiography. In a case of isolated, unexplained tricuspid regurgitation, it is important to consider indolent hyperthyroidism in the differential diagnosis.

Adult↗
PubMed2005

[Prolonged ventricular repolarization measured by QTc interval in hyperthyroidism].

UNLABELLED: Thyroid dysfunction exerts an effect on cardiac function and on an electrocardiographic curve. Few studies analyzed the influence of thyroid hormones on heart repolarization. Heart repolarization is assessed in every-day-practice with corrected QT interval in ECG. Prolonged QTc is associated with increased risk for heart rythm disturbances and mortality. The aim of this study was to assess the effect of hyperthyroidism on heart repolarization, measured with QT corrected by Bazett's formula. MATERIAL AND METHODS: The study group included 68 hyperthyroid patients (30 males, 38 females, mean age 39+/-10 yrs) and the controls were 39 in age and sex matched healthy subjects. TSH and free thyroxine were assessed. The QTc was measured in a standard 12 lead ECG. RESULTS: In the study group the heart rhythm was faster when compared to controls (91.8 vs.73.7, SD+/-16.11, p<0.0001). The mean corrected QT (QTc) was 0.430, SD+/-0.0273 sec., in controls respectively: 0.414, SD+/-0.0208 sec., p<0.01. QTc did not correlate with free thyroxine concentrations (p=0.2785). CONCLUSIONS: Corrected QT intervals were significantly prolonged in hyperthyroid patients, although they did not reach high values.

Action Potentials↗
PubMed2006

Clinical manifestations of primary hyperthyroidism in the elderly patients at the out-patient clinic of Srinagarind Hospital.

The authors reviewed the outpatient charts diagnosed as hyperthyroidism at Srinagarind Hospital from June 1998-June 2004. The objective was to compare the clinical features of hyperthyroidism in patients older and younger than 60 years old. There were 922 cases enrolled, 84 cases (9.11%) were 60 years old and above. The female: male ratio was 3.4:1 and 4:1 and the mean ages were 64.2 +/- 3.7 and 37.4 +/- 11.2 years old in the elder and younger group, respectively. The common presentations were dyspnea (94.1, 96.5%), weight loss (93.8, 87.9%) and palpitation (83.3, 93.1%) in the elder and younger, respectively. The more significant clinical presentations in the elder group were atrial fibrillation, weakness and anorexia whereas exophthalmos, goiter, heat intolerance and hyperhidrosis were not as frequent. Thus, the classic presentations often lacked in the elder group. Therefore, unexplained AF, weakness and anorexia should not exclude hyperthyroidism even with paucity of typical clinical features.

Age Factors↗
PubMed2006

Juvenile hyperthyroidism: an experience.

OBJECTIVE: To analyze the clinical profile of juvenile hyperthyroidism at presentation, their treatment outcome; predictors of remission and relapse. METHODS: Retrospective analysis of medical records of 56 patients with juvenile hyperthyroidism seen over a period of 16 years. A cohort of 38 females and 18 males with mean (+/-SD) age of 14.9 +/- 3.4 years (range 3 to 18 years) was analyzed. RESULTS: Majority of patients was in the age group of 12-16 years. Common symptoms observed at presentation were weight loss (82.1%), excessive sweating (78.6%), heat intolerance (76.8%), increased appetite (73.2%) and diarrhea in 48.2%. In addition, accelerated linear growth was observed in 7.1% of patients. Goiter was present in 98.2% of children; 94.5% of which was diffuse and 4.8% was multinodular. The mean ((+/-SD) T3 was 4.8 +/- 3.4 ng/mL (N, 0.6-1.6), T4 was 218 +/- 98 ng/mL (N, 60-155) and TSH was 0.44 +/- 0.36 (N, 0.5-5.5 microIU/mL). TMA positivity seen in 36.9% of patients. All patients were treated with carbimazole; subsequently 4 patients required thyroidectomy and one required radioactive iodine ablation. Mean (+/-SD) duration of follow-up in our patients was 4.9 +/- 3 years, ranging between 1.6 to 16 years and mean (+/-SD) duration of treatment was 34.4 +/- 22.6 months (range 12 to 120 months). Mean (+/-SD) duration to achieve euthyroidism was 5.2 +/- 4.7 months, ranging between 1-33 months. On intention to treat analysis, remission with carbimazole was achieved in 47.6%, remaining patients failed to achieve remission with drug treatment. CONCLUSION: Graves disease is the commonest cause of juvenile hyperthyroidism. Carbimazole is safe, effective, cheap, and easily available form of therapy. It is occasionally associated with serious side effects but requires prolonged follow up.

Adolescent↗