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PubMed1977

Thyroid uptake of radioactive iodine in hyperthyroidism.

We compared the 24-hour uptake of radioactive iodine (RAIU) in hyperthyroid patients diagnosed from 1970 to 1972 (Group A) and from 1975 to 1976 (Group B). Mean RAIU values in Group B decreased from those in Group A. In 1969 we lowered the normal range for the RAIU test to 0% to 24%, and used the new range for the diagnosis of hyperthyroidism in both groups of patients. The RAIU in Group B is within normal limits in 14% of the patients with Graves' disease and 80% of the patients with toxic nodular goiter (TNG). This study demonstrates that in our geographic area, the 24-hour RAIU has become a poor test for the diagnosis of hyperthyroidism, particularly TNG. However, the test should be performed before radioactive iodine therapy because it is necessary in calculating the therapeutic dose.

Adult↗
PubMed1978

Transient hyperthyroidism in patients with lymphocytic thyroiditis.

We have studied seven episodes of transient hyperthyroidism in three men and one woman, aged 19 to 38 years. No patient had fever or neck tenderness. All had palpable thyroid glands. Elevated serum thyroxine values persisted for 1 to 3 months. Thyroid131I uptake at 6 and 24 hours was low (1 to 3%). Erythrocyte sedimentation rates were normal or only slightly increased. Needle biopsy in four patients and a thyroidectomy specimen in one patient, all taken during the hyperthyroid phase, showed lymphocyte infiltration and extensive follicular disruption without oxyphilia. There was no evidence of granulomatous thyroiditis. Thyroglobulin antibodies were normal in all. In three patients, transient hypothyroidism followed the hyperthyroid episode. In two patients, the condition was recurrent. The findings are compatible with transient unregulated discharge of thyroid follicle content in some patients with lymphocytic thyroiditis. Recognition permits avoidance of unnecessary treatment with surgery, radioiodine, or antithyroid drugs.

Adult↗
PubMed1978

[Hyperthyroidism in older patients].

This study comprises 81 thyrotoxic patients with onset after the age of 60. In elderly persons, toxic multinodular goiter is the most common cause (68%) of hyperthyroidism, followed by solitary thyroid nodules (16%) and Graves' disease (16%). Cardiovascular disorders (cardiac failure, arrythmias etc.) constitute the first and often the only symptom in 62% of the cases. The other forms of appearance are both various and deceptive: depression, slight fever, asthenia or nausea. Separate analysis of the three forms of hyperthyroidism did not reveal clinical, biological or therapeutic differences between them, except an inferior rate of captation for the toxic nodules. Isolated measurement of T3 or T4 is often insufficient to confirm the diagnosis because either of these hormones may appear at a normal rate. In three cases only the free thyroxin index was pathological on first determination. The authors have established that the autonomous nodules are larger and more active after, rather than before, 60 years of age, and have attempted to define their morphological identity. The results of the treatment are analyzed and preference is expressed for radioactive iodine in every form of hyperthyroidism.

Aged↗
PubMed1976

Hemodynamics of hyperthyroidism. The effects of autonomic nervous blocking and anti-thyroid drug treatment.

This work was intended to analyze the sympathetic and parasympathetic factors affecting the hemodynamics of hyperthyroidism. Seven patients with hyperthyroidism, diagnosed based on the determinations of BMR, 131I-uptake, T3-resin sponge uptake (T3-RSU), and serum level of thyroxine (T4) were subjected to the study. The hemo-dynamic estimation was done (1) at rest, (2) after vagus blocking by the injection of 0.04 mg/Kg b.wt. atropine and 0.2 mg/Kg b.wt. propranolol before (hyperthyroid state=H) and after (euthyroid state=E) anti-thyroid drug therapy. Cardiac output was measured by the dye-dilution method, and the valve was calculated according to the standard Hamilton formula. The following results were obtained. (1) The vagal tone is lower in H than in E, on the other hand, sympathetic beta-receptor tone is higher in H than in E. (2) The sympathetic alpha-receptor tone in H may be equivalent to that in E. (3) There might exist inotropic factors which affect the hemo-dynamics, other than autonomic nervous system in H.

Adult↗
PubMed1977

[Do lithium salts have a place in the treatment of severe hyperthyroidism? (author's transl)].

In a patient with hyperthyroidism resulting in cachexia, severe cardiac complications and functional renal failure, and a second case of hyperthyroidism refractory to carbimazole as a result of iodine overload, the administration of 1 to 3 g of lithium gluconate every 1 to 3 days, in association with carbimazole, led to persistent clinical and biological improvement in 8 to 16 days. In the first case, the course was complicated by neurological intolerance (blood lithium 0.98 mEq/l) which responded to the temporary interruption of treatment and by a transient escape of thyroid function from the effects of lithium which disappeared after a slight adjustment in the dose. In the second case, the course under treatment was favourable from the outset. Thus in forms of hyperthyroidism in which usual forms of treatment are inadequate and where there is a risk of "acute crises", lithium may be valuable as adjuvant therapy. If the dose is regularly modified in order to obtain a daily blood lithium level of less than 0.60 mEq/l, and on condition of close clinical, electrocardiographic and ionic surveillance, cardiac and renal failure and neuropsychiatric disturbances do not prevent the use of lithium, which the authors feel to be of irreplaceable value.

Aged↗
PubMedDate not supplied

[Respiratory coefficient and the metabolic effect of an oleic acid emulsion in white rats in the process of experimental hyperthyroidism development].

RQ changes were studied in rats, depending on the degree of the organism saturation with triiodthyronin, and the metabolic action of free acid (FA). Animals with a relative hyperthyroidism had an increased RQ as compared with the control. RQ was decreased in the animals with a high degree of hyperthyroidism. FA injection was followed by a decrease of RQ and the body temperature elevation. These changes progressed with the advance of hyperthyroidism.

Animals↗
PubMed1981

Regulation of lipolysis in hyperthyroidism.

The investigation (Fig. 1) clearly shows that the ability of isoprenaline in particular and, to a less extent, of noradrenaline to increase the accumulation of cyclic AMP and thus also the rate of lipolysis is enhanced in hyperthyroidism. No evidence was found of changes in the sensitivity to either beta 1- or alpha -adrenergic agonists. Although further studies are needed, the findings supported the idea that the augmented cyclic AMP accumulation is due to changes below the receptor level. Second, a significant decrease was observed in the apparent Vmax of the PDE with apparent low Km. Third, metabolic disturbances closer to the lipolytic system may exist. Some indirect evidence for this hypothesis was the finding of relatively more rapid lipolysis in relation to the cyclic AMP level in hyperthyroidism. The investigations have raised a number of questions about the nature of the metabolic changes in hyperthyroidism. The findings suggest that there are multiple abnormalities, localized at different levels of mechanisms regulating lipid mobilization. Investigations of subcutaneous tissue fragments in man seem to offer good opportunities for exploring these abnormalities.

Adrenergic alpha-Agonists↗
PubMed1981

Recurrent apathetic hyperthyroidism.

A patient experienced three separate episodes of apathetic hyperthyroidism. Each time, this clinical picture appeared after the patient had been euthyroid for one to three months and within one to three weeks of discontinuing antithyroid drug therapy. This rapid recurrence of apathetic hyperthyroidism represents evidence against the concept that this disorder represents "burnt-out," or exhaustion of, body reserves in long-standing, untreated hyperthyroidism. Initial recognition and diagnosis of thyrotoxicosis was delayed by contamination of her serum from therapeutic radioactive iodine and possible interference with thyroxine radioimmunoassay. The solution to this problem with double isotope counting is discussed.

Aged↗
PubMedDate not supplied

[The thyroxine hyperthyroidism (author's transl)].

24 of all patients observed between 1974 and 1976 suffering from thyrotoxicosis were found to have increased blood thyroxine (T4) levels without increased triiodothyronine ones. T4 hyperthyroidisms represented 3.5% of all hyperthyroidisms observed; they were in relation with Grave's disease (18 patients) or toxic nodular (6 patients); clinical pictures were quite usual; old age, severe illnesses, amiodarone and corticoids treatments, iodine excess, were sometimes being incriminated, but often no particular cause could be found. Preferential T4 secretion or impaired peripheral T4 conversion are two possible mechanisms of T4 hyperthyroidism.

Adult↗
PubMed1984

Is thyroid scintigraphy necessary before I-131 therapy for hyperthyroidism? Concise communication.

To assess the value of routine thyroid scintigraphy in the differential diagnosis of hyperthyroidism and as a guide to I-131 therapy, we prospectively examined 100 consecutive hyperthyroid patients referred for a 24-hr radioiodine uptake and I-131 therapy. The nuclear medicine physician recorded his preimaging diagnostic impression and therapeutic plan for each patient. After the [ 99mTc ] pertechnetate image, the patient was reassessed to determine whether the image induced any change in the diagnosis or therapeutic plan. Seventy-nine of 80 patients with diffuse goiter to palpation, had scintigrams demonstrating no discrete focal defects and were diagnosed as Graves' disease; thus the scintigram did not contribute useful information. In 17 of 20 patients with uninodular or multinodular goiters, the image was necessary to clarify the final diagnosis and therapeutic plan. Thus, selective use of thyroid scintigraphy should decrease the number of scintigrams performed before I-131 therapy for hyperthyroidism, without compromising diagnostic accuracy or therapeutic success.

Adult↗
PubMed1984

[Behavior of vitamin A, beta-carotene, retinol binding protein and prealbumin in the plasma of hypo- and hyperthyroid subjects].

Plasma concentrations of beta-carotene and retinol, determined by HPLC, and of transport proteins, ascertained by immunodiffusion technique, in hypo and hyperthyroid subjects are reported. In hypothyroid subject a considerable increase in carotene was noted. This was not the case for retinol. In hyperthyroids both beta-carotene and retinol levels were found to be normal. Transport protein (PA and RBP) levels were found to be lower only in cases of hyperthyroidism but unchanged for hypothyroids. According to the Authors the results show that the alteration in plasma carotene levels to be found in hypothyroid subjects is not the direct consequence of a lack of thyroid hormone in the metabolism of vitamin A but the indirect effect of thyroid disease.

Adult↗
PubMed1984

Modulation by glycerol of hepatic glycero-3-phosphate concentration, ketogenesis, and output of triglyceride and glucose in perfused livers from hyperthyroid and euthyroid rats.

Decreased glycero-3-phosphate (glycero-3-P) concentration, decreased output of triglyceride and glucose, increased output of apolipoprotein A-I, and increased ketogenesis were observed with isolated perfused livers from triiodothyronine-treated rats in comparison to livers from euthyroid animals. Infusion of glycerol produced a concentration-dependent accumulation of glycero-3-P in perfused livers from hyperthyroid and euthyroid rats, which was considerably enhanced in the euthyroid group. The antiketogenic effect of glycerol in livers from triiodothyronine-treated rats was accompanied by increased output of glucose and triglyceride, while no change in the output of apolipoprotein A-I was observed. The reduction of ketogenesis (49%) in euthyroid livers by glycerol was not accompanied by increased triglyceride output, while with the largest amount of glycerol infused, decreased output of apolipoprotein A-I was seen. Output of triglycerides by livers from hyperthyroid rats correlated with hepatic concentration of glycero-3-P and was maximal at a glycero-3-P concentration (0.5 mumol/g), similar to that observed in livers from euthyroid rats in the absence of glycerol. Availability of glycero-3-P appears to be rate-limiting for synthesis and secretion of triglyceride by livers from hyperthyroid animals, whereas the glycero-3-P concentrations in euthyroid livers were sufficient to support maximal production of triglyceride limited only by the supply of free fatty acid.

Animals↗
PubMed1984

[Subacute myopathy revealing hyperthyroidism].

Progressively increasing muscle weakness of the proximal regions of the lower limbs over a period of two months in a 57-year-old woman was found to be due to an undiagnosed hyperthyroidism. Total relief from muscle weakness was obtained when euthyroidism was restored. In spite of its rarity, hyperthyroidal myopathy should be suspected in all cases of acquired myopathic disorders in adults inasmuch treatment of the hyperthyroidism leads to recovery.

Female↗
PubMedDate not supplied

Diagnosis and treatment of hyperthyroidism in elderly patients.

The clinical signs of hyperthyroidism in the elderly are often atypical and have an insidious onset. The hyperkinetic form and the exophthalmic syndrome are rare. Apathetic thyreotoxicosis occurs, with few exceptions, in the elderly. Part of the clinical signs of hyperthyroidism may be erroneously attributed to the normal aging process. Most authors consider radioiodine as the treatment of choice in elderly hyperthyroid patient.

Age Factors↗
PubMedDate not supplied

[Amiodarone and hyperthyroidism. Several guidemarks for the practitioner].

The prevention and diagnosis of amiodarone-induced hyperthyroidism are largely based on clinical signs: a personal or family history of thyroid disorders, or an abnormality detected on palpation of the thyroid gland, are contraindications for amiodarone treatment. At that stage it is useless to determine hormone levels, since they do not permit screening of any cell metabolism abnormality. Weight loss accompanied by tachycardia is suggestive of amiodarone-induced hyperthyroidism. Amiodarone-induced hyperthyroidism will regress in 2 to 6 months after treatment discontinuation.

Amiodarone↗
PubMed1983

Propranolol and hyperthyroidism: sequential changes in serum iodothyronine (T4, T3, rT3) concentrations during therapy until clinical remission.

The sequential clinical and laboratory (serum T4, T3 and rT3 concentrations) effects of propranolol were studied in 21 hyperthyroid patients. The amount of propranolol required to achieve clinical compensation ranged from 240 to 400 mg/day. For two patients, 480 mg/day, the maximal dose used, did not produce clinical compensation. The only significant changes in serum iodothyronines was detected in the 9 patients compensated with 240 mg/day. T3 decreased from 362 to 299 ng/dl (P less than 0.05) and the rT3/T3 molar ratio increased from 3.4 to 6.5 (P less than 0.025). The increases of rT3 from 113 to 168 ng/dl and of the rT3/T4 molar ratio from 6.7 to 10.8 were not statistically significant (P = 0.052). A slight decrease of serum T3 and increase of serum rT3 occurred during the first or second week in the other patients but the changes were not sustained over the whole period of treatment. These results show that the effects of propranolol on hyperthyroidism were independent of its transitory effects on the peripheral metabolism of thyroid hormones, thus providing further support for the current view that the clinical improvement of hyperthyroid patients on propranolol therapy is probably due to beta-adrenergic receptor blockade. A small percentage of thyrotoxic patients may not show clinical improvement even when propranolol doses of more than 400 mg/day are used.

Adolescent↗
PubMed1978

Decreased ratio of serum T3:rT3 in patients with hyperthyroidism.

In 14 hyperthyroid patient serum T4:rT3 ratio was significantly lower (399 +/- 20) than in the control subjects (572 +/- 20; p less than 0.001). A similar pattern was found for serum T3:rT3 ratio. In the hyperthyroid group the ratio was significantly lower (10.5 +/- 0.5) than in the control group (12.5 +/- 0.6; p less than 0.05). The data suggest that in hyperthyroidism the organism might shift conversion of T4 from biologically active T3 to poorly calorigenic rT3. It seems possible that the proportionately increased generation of rT3 than that of T3 may be a defence mechanism of the body, as it was found in systemic illnesses and starvation.

Adult↗
PubMed1983

Psychiatric presentations of hyperthyroidism.

Hyperthyroidism is often confused with psychiatric illnesses. Undiagnosed hyperthyroidism sometimes results in inappropriate use of psychotropic medications. Delay in therapy markedly worsens the prognosis for recovery, but complications can be prevented by early treatment. Prompt recognition of hyperthyroidism through thyroid function screening is good medical practice in the evaluation of patients with psychiatric symptoms.

Adult↗