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PubMed1989

Frequency of thyroiditis and postpartum thyroiditis in a 10-year consecutive hyperthyroid Danish population.

In a retrospective study 716 consecutive newly diagnosed and untreated hyperthyroid patients were examined in regard to the frequency of silent thyroiditis and postpartum thyroiditis. Six patients (0.8%) had possible silent thyroiditis (24-hour radioiodine uptake less than or equal to 5% and hyperthyroidism without anterior neck pain). None occurred within one year postpartum. We conclude that silent thyroiditis is a rare cause of hyperthyroidism in our thyroid clinic. The fact that none occurred postpartum suggests that postpartum thyroiditis is oligosymptomatic and that screening programmes are needed if one wants to diagnose the earliest phases of this condition.

Adolescent↗
PubMed1989

[Acetylation phenotype and the changes in selected indicators of calcium-phosphate metabolism in patients with hyperthyroidism treated with propranolol].

The occurrence of acetylation phenotype has been studied in 76 patients with untreated hyperthyroidism. In 23 of these patients having the "fast" and in 42 having the "slow" acetylation phenotype the selected parameters of calcium-phosphate metabolism have been determined before, during and after propranolol therapy lasting six days. Propranolol was administered at a dose of 160 milligrams daily. A significant decrease in the blood serum level of calcium and urinary calcium excretion following propranolol administration was found only in patients with hypercalcemia and hypercalciuria. On the other hand, a significant decrease in the urinary excretion of hydroxyproline was observed in all the patients with hyperthyroidism treated with propranolol. The effect of propranolol on the measured parameters of calcium-phosphorus metabolism was similar in hyperthyroid patients with both "fast" and "slow" acetylation phenotypes, what suggests that it does not depend on the N-acetyltransferase activity.

Acetylation↗
PubMed1989

Diagnostic algorithm for atrial fibrillation caused by occult hyperthyroidism.

Occult hyperthyroidism, a subclinical thyrotoxic state, is not readily identifiable clinically or through routine thyroid function tests. "Idiopathic" atrial fibrillation may be a manifestation of occult hyperthyroidism in the elderly. A normal response on a TRH stimulation test excludes this diagnosis. A blunted TSH response, coupled with elevation of free thyroid hormones and a high radioactive iodine uptake, will settle the diagnosis. Patients with occult hyperthyroidism frequently have toxic adenomas or nonpalpable nodular goiters, and treatment is best achieved with radioactive iodine ablation.

Aged↗
PubMed1989

Iodine-induced hyperthyroidism after contrast media: animal experimental and clinical studies.

The healthy thyroid can adapt to an iodine excess in many different ways. The autoregulation mechanisms may, however, fail in a diseased thyroid and severe hyperthyroidism may result. There must be autonomous portions of the thyroid functionally present to cause an iodine-induced hyperthyroidism. Retrospective and prospective studies, as well as animal experiments, were performed to establish further these pathophysiologic mechanisms. It was demonstrated that 15% of all cases of hyperthyroidism can be attributed to the use of iodine-containing contrast media. Furthermore, all contrast media exhibit a deiodinization during their intracorporeal retention time. The most frequent thyroid disorders, usually of a temporary nature, occur after choledochal contrast media. To some extent, these pathophysiologic processes can be reproduced in the animal model. Beyond this, the animal experimental studies show that it is possible to determine functionally autonomous portions of the thyroid by means of a dynamic thyroid scintigraph.

Adult↗
PubMed1989

[Effect of various beta-adrenolytic drugs on heart rate and changes in left-ventricular systolic time intervals in patients with hyperthyroidism and simple goiter].

The effects of a short-term application of various beta-adrenolytic drugs on heart rate and on the changes in subperiods of left ventricle contraction have been studied in 71 patients with untreated hyperthyroidism and in 72 patients with simple goiter. The following drugs were used: propranolol, metoprolol, atenolol, pindolol, nadolol and acebutolol. It was found that those betaadrenolytic drugs which have no sympathomimetic action cause a significant decrease in heart rate both in patients with hyperthyroidism and in those with simple goiter. The effect of these drugs on heart rate was not related to the changes in blood serum concentrations of thyroxine and triiodothyronine. None of the drugs tested influenced appreciably the contraction subperiods of left heart ventricle, both in the patients with hyperthyroidism and in those with simple goiter.

Adrenergic beta-Antagonists↗
PubMed1989

Nonimmunogenic hyperthyroidism: cumulative hypothyroidism incidence after radioiodine and surgical treatment.

During 1977, 246 hyperthyroid patients were seen in our departments, 140 (57%) with nonimmunogenic hyperthyroidism (NIH)--101 with a toxic adenoma (TA) and 39 with multifocal functional autonomy (MFA). All patients but one could be followed over 9 yr, 101 after 131I treatment (RIT), another 29 after surgery (S). Ten patients were left untreated. Thirty-four treated (24%) patients died, none as a result of thyroid or post-treatment complications. There was no hyperthyroidism later than 9 mo after therapy. Only 1% (RIT) and 24% (S) were hypothyroid 1 yr after treatment. But 19% of all treated NIH patients were hypothyroid after 9 yr or at the time of their death, 12% after RIT and 41% after S. The cumulative hypothyroidism incidences 1.4%/yr for RIT and 2.2%/yr for S, were not significantly different. Out of the five survivers without RIT or S, two TA patients were hypothyroid. The effect of RIT on goiter related loco-regional complications was not worse than after S. We conclude that RIT is the treatment for NIH, leaving surgery for exceptional cases.

Adenoma↗
PubMed1989

Relevance of cause of hyperthyroidism in determining its management.

We analyzed the relapse rates of hyperthyroidism and prevalence rates of hypothyroidism after partial thyroidectomy and radio-iodine therapy in patients with Graves' disease and toxic multinodular goitre. In achieving euthyroidism, partial thyroidectomy was more effective in patients with Graves' disease (P less than 0.02). In patients with toxic multinodular goitre, radio-iodine therapy was more successful (P less than 0.05). Relapse of hyperthyroidism occurred more often in the radio-iodine group (P less than 0.02), mainly in patients with Graves' disease, and was seen sooner after radio-iodine therapy than after surgery (P less than 0.0001). Patients with toxic multinodular goitre, developed hypothyroidism more often after partial thyroidectomy than after 131I (P less than 0.01). In contrast, in patients with Graves' disease, hypothyroidism occurred more often after radio-iodine therapy than in the toxic multinodular goitre group (P less than 0.02). We conclude that the cause of hyperthyroidism strongly influences the efficacy of the therapeutic regimen.

Adult↗
PubMed1989

[Psychological and possible psychiatric aspects of hyperthyroidism].

Hyperthyroidism has always been the challenge for psychosomatic investigations. In traditional scientific literature the specific structure of hyperthyroid personality was pointed out. Severe and important emotional influences can induce disease in such, prone personalities. This investigation fails in featuring the specific and unique psychosomatic patterns in hyperthyroid patients.

Adult↗
PubMed1989

Incidence and causes of hyperthyroidism in blacks.

Between 1974 and 1984 688 black patients with hyperthyroidism were seen at one clinic. Graves' disease made up 88% of cases, with a female: male ratio of 7,9:1. The average annual incidence for females was 8,75/100,000 and for males 0,70/100,000. There appeared to be a progressive increase in incidence (60%) over the period. A bimodal age distribution was observed with peaks at 35-54 years (almost exclusively Graves' disease) and in those older than 64 years (Graves' disease 66%, nodular goitres 34%). Although hyperthyroidism seems rare in rural Africa, 59% of the patients surveyed (N = 88) had been born in such an area and were urban migrants. Moreover, some ethnic groups were disproportionately represented. In one of these (Tswana-speaking), 81% had migrated from rural areas of endemic goitre, usually as adults. It is concluded that hyperthyroidism remains relatively uncommon in the black population in this region. The incidence of Graves' disease, but not of toxic nodular goitre, appears to be increasing rapidly. The process of urbanisation, including possible increases in dietary iodide, may contribute to this apparent increase in Graves' disease in urban areas.

Adolescent↗
PubMed1989

Hyperthyroidism and thyroid storm.

Thyrotoxicosis and thyroid storm are disease states that result from thyroid hormone-induced hypermetabolism. The excess thyroid hormone is released from the thyroid gland as a result of excess thyroid hormone production, or by processes that disrupt the follicular structure of the gland with subsequent release of stored hormone. True hyperthyroidism results from increased synthesis and release of thyroid hormone and can be distinguished from other causes of thyrotoxicosis by the thyroid 131I uptake. Graves' disease is the most common cause of hyperthyroidism and occurs most often in women aged 30 to 50 years. The classic features of a patient with fully developed Graves' disease are difficult to overlook, but the clinical features of thyrotoxicosis vary with the etiology of the disease and the sensitivity of the patient's peripheral tissues. Thyroid storm presents with an exaggeration of the features of uncomplicated thyrotoxicosis and, in addition, an alteration in mental status. Thyroid storm may lead to irreversible cardiovascular collapse and death if proper treatment is not initiated in the Emergency Department. Specific therapy of hyperthyroidism follows several strategies, including inhibition of hormone synthesis and release, inhibition of peripheral conversion of T4 to T3, and blocking of the systemic effects of excess thyroid hormone. Treatments directed at these ends may be initiated rapidly in the emergency setting.

Humans↗
PubMed1989

[Hyperthyroidism and pregnancy. A retrospective multicenter study Nord-Picardie-Champagne. Report of 48 cases].

In 92,130 pregnancies followed between 1980 and 1987, 48 cases of hyperthyroidism were reported including 38 Grave's diseases, 5 toxic adenomas, 4 multinodules goiters. In comparing the results with those mentioned in the literature, a number of conclusions may be reached. In case of hyperthyroidism treated before the pregnancy or discovered at the beginning, there is, in every other case, an aggravation at the end of the first trimester, then a stabilization in the 2nd or 3rd trimester and finally an aggravation in the post-partum period. There is a high rate of abortions (35 p. cent), a delayed intra-uterine growth in half of the cases. The problem of the treatment is of paramount importance; there is no problem with Beta-blockers but the SAT are not without danger: risk of hypothyroidism and fetal goiter, but also risk of maternal hypothyroidism. From the 15th week, the doses should therefore be decreased, and sometimes the treatment discontinued and replaced with Beta-blockers. The best SAT drug during pregnancy is the propylthioracile which is the least likely to cross the fetal barrier. Surgery is only exceptionally indicated. In a woman who is cured from her Grave's disease, recurrences are always possible, and also fetal hyperthyroidism caused by crossing of thyreostimulins immunoglobins, even in case of maternal euthyroidism.

Adult↗
PubMed1989

[Perioperative management of cesarean section in a patient pregnant with twins complicated by hyperthyroidism].

A 30-year-old twin pregnant woman complicated with hyperthyroidism was scheduled to receive anesthesia for cesarean section. During the early months of pregnancy, her thyroid status was stimulated, being positive for TSH-binding inhibitor immunoglobulins (TBII). Because maternal positiveness of TBII correlates with neonatal hyperthyroidism, she was treated with antithyroid drugs (methimazole). Her thyroid status was suppressed gradually and her TBII level became negative. On the 38th week of pregnancy, she underwent cesarean section by lumbar spinal anesthesia and twin girls were delivered with Apgar scores of 9. The thyroid statuses of the twins were measured, showing that their thyroid functions to be almost equal, although they were dizygotic twins. T3 and free-T3 were below the normal limits for adults, but they did not require any therapy. Maternal level of TBII is considered to be a useful index for management of patients with hyperthyroidism during the perianesthetic period for cesarean section. In this type of patients the thyroid status of both the mother and fetus should be carefully followed.

Adult↗
PubMed1989

Evidence of a new antigen-antibody system (anti-Mic-1) in patients with systemic lupus erythematosus and hyperthyroidism.

Autoimmune thyroid diseases may occur in association with systemic rheumatic disorders, and usually they show a high prevalence of antithyroglobulin and antimicrosomal antibodies. We report 6 patients with the clinical association of systemic lupus erythematosus (SLE) and hyperthyroidism. Of interest, in 5 of the 6 patients (83%), we found an antibody directed against a microsomal extract of human thyroid gland which was different than previous microsomal antibodies in that it was a precipitating antibody; we have called it anti-Mic-1 antibody. We investigated the prevalence of this specific autoimmune reaction in 58 patients with idiopathic SLE, 30 with hyperthyroidism, 15 with Hashimoto's thyroiditis, 25 with insulin dependent diabetes mellitus, 45 with rheumatoid arthritis, and 25 healthy controls. No control had anti-Mic-1 antibody. In addition, this antibody was shown to be organ specific. We suggest that patients with the combined association of SLE and hyperthyroidism may represent a different subset in the spectrum of SLE. The high prevalence of this antigen-antibody reaction in these cases may serve as a serological marker of this association.

Adolescent↗
PubMedDate not supplied

[Insulin resistance in experimental hypo- and hyperthyroidism].

The effect of thyroid hormones on the realization of body insulin function was investigated on the models of hypo- and hyperthyroidism. Hyperthyroidism resulting from thyroidectomy, caused the development of insulin resistance, expressed in a lowered body reaction to i. v. insulin infusion, a decrease in tissue sensitivity and reactivity to insulin. Insulin resistance in hypothyroidism was accountable for by a decrease in the serum total activity of insulin-like growth factors. Insulin resistance in hyperthyroidism was less notable and observed only in 10-day administration of thyroiodine; more prolonged administration of the drug (up to 30 days) restored insulin sensitivity. This effect can be accounted for by enhanced insulin independent glucose consumption caused by thyroid hormones.

Adipose Tissue↗
PubMed1989

[Evaluation of the phagocytic activity of peripheral blood neutrophils in patients with hyperthyroidism].

In 80 women with hyperthyroidism (40 with diagnosed Graves disease and 40 with hyperactive nodular goiter) the following tests related to the function of peripheral blood neutrophils have been carried out: 1. nitrotetrazolium blue (NRT) reduction test. 2. evaluation of phagocyting activity by using latex particles and living bacteria cells, and 3. determination of immunoglobulin concentration and the C3 component of the complement in blood serum. The following features were found in the patients with hyperthyroidism: 1. the elevated values of the index of spontaneous NBT reduction which return to normal following the treatment with propranolol or metizol lasting 14 days, 2. a decrease in the phagocyting activity of neutrophils occurring with stimulation of phagocytosis by both the latex particles and bacteria cells. 3. the return to normal values of the index of neutrophils phagocyting the latex particles following two-week treatment with propranolol or metizol. It was concluded that in patients with hyperthyroidism the changes in NRT reduction and phagocyting activity of peripheral blood neutrophils return to normal following the two-week treatment of these patients with both propranolol and metizol.

Adult↗
PubMed1989

[Synchronous occurrence of neoplasias of the thyroid gland and hyperthyroid nodular struma in an endemic area].

The simultaneous occurrence of hyperthyroidism and differentiated carcinoma of the thyroid gland is more frequent than previously assumed. In our endemic goiter region 16.5% of patients with thyroid carcinoma have hyperthyroidism and 1.8% of patients with hyperthyroidism have a thyroid carcinoma. The tumors are predominantly located in autonomous adenomas but are also found in cold nodules. Not only scintigraphically cold nodules but also warm and hot nodules must be suspected of malignancy. Consistent preoperative cytodiagnosis of all goiter nodules, including hot nodules, is therefore recommended. Surgical treatment of toxic multi-nodular goiters should be considered more often.

Adenoma↗
PubMed1986

Echocardiographic, electrocardiographic, and radiographic detection of cardiomegaly in hyperthyroid cats.

Hyperthyroid cats were examined by electrocardiography, radiography, and echocardiography for the presence of cardiomegaly. These examinations were performed at the time of the initial diagnosis of hyperthyroidism and repeated during the course of antithyroid medication and after thyroidectomy was done. If the hyperthyroid cats had cardiomegaly, reduction in cardiac size was detected once the euthyroid state was reestablished. This decrease in size was appreciated electrocardiographically and radiographically. The echocardiogram demonstrated a decrease in left atrial size. A consistent decrease in left ventricular wall thickness was not observed by the echocardiogram, although 2 cats did have resolution of free wall hypertrophy.

Animals↗
PubMedDate not supplied

Failure of propranolol to prevent chronic hyperthyroid induced cardiac hypertrophy and multifocal cellular necrosis in the rat.

The effect of excess thyroid and thyroid plus propranolol on right and left ventricular structure was examined. Perfusion fixed hearts from untreated adults and those treated for 10 weeks with thyroid, propranolol, and thyroid plus propranolol were embedded in plastic and sectioned for light and electron microscopy. Hyperthyroidism stimulated a significant increase in heart rate, oxygen consumption, and systolic blood pressure. Propranolol was effective in normalizing the heart rate of hyperthyroid rats, but did not affect oxygen consumption or blood pressure. Both left and right ventricular weight increased similarly in thyroid and thyroid-propranolol treated animals, but right ventricular mass increased more than left ventricular mass in both groups. The majority (21 of 24) of right ventricles from thyroid and thyroid-propranolol treated animals had multifocal areas of histologically detected fibrosis. Left ventricular fibrosis was absent or minimal in both hyperthyroid groups. Neither left nor right ventricular fibrosis was observed in control or propranolol only treated animals. We conclude that beta adrenergic stimulation is unnecessary for thyroid induced cardiomegaly, and excess thyroid hormones induce right ventricular fibrosis which is not prevented by propranolol.

Animals↗