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PubMed1994

[Intravenous or oral 131I treatment of hyperthyroidism and thyroid cancer?].

The purpose of this study was to determine differences in 131I biokinetics after oral or intravenous treatment of hyperthyroidism (0.81 GBq) or differentiated thyroid cancer (1.85 GBq) following thyroidectomy. 20 patients with differentiated carcinoma and 20 patients with hyperthyroidism were studied. In each group 10 patients were treated perorally and 10 patients intravenously. The integrated whole-body activities during therapy were significantly lower, by an average 23% (cancer) and 45% (hyperthyroidism) than after oral application. It is most likely that these differences between oral and intravenous application are due to the higher serum activity after intravenous therapy. It is concluded that a higher activity dose of 131I must be given orally to achieve the same target dose as after intravenous application.

Administration, Oral↗
PubMed1993

Paradoxical effect of neuromedin B and thyroxin on thyrotropin secretion from isolated hyperthyroid pituitaries.

Neuromedin B (NB) is a bombesin-like peptide that we recently characterized as a physiological autocrine inhibitor of thyrotropin (TSH) secretion. We now report the effect of NB, thyroxin (T4) and NB + thyroxin on basal and THR (50 nM)-stimulated TSH release from isolated hemipituitaries of hyperthyroid rats. To induce hyperthyroidism, 20 rats were treated with 0.03% methimazole for one month and then received T4, 4 micrograms/100 g body weight, sc, daily for 7 days. Each experimental group consisted of 7 to 9 hemipituitaries. TSH was measured using a rat TSH kit provided by NIDDK. Basal TSH release was paradoxically increased in the presence of 0.1 microM T4 or 0.1 microM NB and even two times higher in the presence of both (Control: 30.0 +/- 4.2 ng/ml; T4: 58.6 +/- 5.6 ng/ml; NB: 53.4 +/- 6.1 ng/ml; T4 + NB: 90.4 +/- 8.5 ng/ml). The percent increment above basal TSH levels after TRH was higher only in the presence of NB (Control: 44.5 +/- 8.2%, NB: 105.3 +/- 18.8%; P < 0.05). Altered responsiveness in hyperthyroidism and direct modification of the intracellular metabolism of T4 are mechanisms that could explain this paradoxical effect.

Animals↗
PubMed1993

Early complications of radioiodine treatment for hyperthyroidism.

Three patients were described with undesirable early complications of low dose radioiodine treatment for hyperthyroidism. The first patient with Graves' disease developed an extreme and permanent hypothyroidism within only few months after receiving this therapy. The second patient with a hyperactive nodular goiter and mild hyperthyroidism had an immediate important exacerbation of the symptoms of hyperthyroidism shortly after a low dose treatment. In the third patient with Graves' disease but without preexisting eye disease a therapy-resistant endocrine ophthalmopathy occurred two months after radioiodine administration.

Aged↗
PubMed1993

[Treatment of hyperthyroidism during pregnancy: experience with 19 cases].

Untreated hyperthyroidism in pregnant women is associated with a high incidence of maternal and fetal complications. Thus, its treatment is mandatory, ideally using PTU because it has lesser transplacental passage. From 1987 and 1991 we have attended 19 hyperthyroid pregnant women. Of these, 18 had diffuse and 1 nodular goiter and in 10, thyrotoxicosis preceded pregnancy. PTU was used in 17 women (7 received it along the whole pregnancy), five had to be operated due to poor response, one received propranolol and one patient was not treated due to lack of attendance. Cesarean section was performed in 12 women, 5 had vaginal delivery, one had a miscarriage at the 20th week of pregnancy due to a neurological malformation and one patient was lost from control before delivery. The newborn of the untreated woman had a neonatal thyrotoxicosis and the resting 16 did not show evidence of thyroid disfunction. Newborns from mothers receiving PTU until delivery had significantly lower rT3 levels and non significant changes in T4 and T3. At the end of the observation period, 8 patients were euthyroid, 3 hypothyroid (2 after 131-l and 1 after surgery), 4 continued on PTU and 4 were lost from control. It is concluded that the outcome of pregnancy may be uneventful in hyperthyroid women provided that there is a close and adequate follow up.

Adult↗
PubMed1994

Ability of two new thyrotropin (TSH) assays to separate hyperthyroid patients from euthyroid patients with low TSH.

We evaluated the ability of new thyrotropin (TSH) assays to separate hyperthyroid (n = 50) patients from clinically euthyroid subjects with low TSH values (nodular goiter, n = 20, and nonthyroidal illness, n = 22). Only patients whose serum TSH was < 0.1 mIU/L by immunoradiometric assay were included. We used a new immunofluorometric method based on time-resolved fluorescence (TR-IFMA) and a new immunochemiluminometric assay (ICMA) to measure TSH in serum. Although the differences between the hyperthyroid patients and the euthyroid patients differed from each other by both methods (P = 0.0012 for TR-IFMA and P < 0.0001 for ICMA), there was no cutoff point that could definitely separate the groups. Thus, it is not possible to draw any definite conclusions on whether a patient is hyperthyroid or not, solely on the basis of TSH concentration measured with these new TSH assays.

Adult↗
PubMed1993

[Psychosomatic aspects of hyperthyroidism with special reference to Basedow's disease. An overview].

The following paper deals with the current research in hyperthyroidism, with special accent to Graves' disease. Besides severe psychological trauma a breakdown of neurotic defense mechanism on the ground of a special personality structure was thought to be the trigger of the disease. The metabolic changes became the main point of interest. The influence of thyrostatic, surgical and radioactive therapies on psychological symptoms, was investigated. Thereby, the previously anticipated emotional factors became less significant in the aetiology of the disease. A recent study (Paschke 1990) suggests that patient with hyperthyroidism have, even in an euthyrotic state, an increased vulnerability to anxiety provoking situations. At this point it is not clear, due to the retrospective nature of the study, whether the vulnerability exists prior to the unset of the disease or is a result of the metabolic disorder. Both thyroxin and TRH are being successfully used in the treatment of major depression. TRH acts as a neurotransmitter in the autonomic nervous system and can be demonstrated in the peripheral lymphocytes. However, the exact mechanisms of action of thyroxin and TRH are still unknown. Graves' disease is an autoimmune disease, that can be caused by specific HLA antigens. Thereby, a changed subpopulation of lymphocytes can be demonstrated, as well as there disturbed functions. A correlation between high scores for anxiety and depression on one hand and the occurrence of an abnormal T4/T8 ratio on the other hand, have been reported in a small number of cases (Paschke 1990). The psychological symptoms in hyperthyroidism are similar to the symptomatology of neurotic anxiety and the anxious depressive syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1993

[Immunogenic and non-immunogenic hyperthyroidism--a comparison].

In a retrospective study 161 hyperthyroid patients without treatment were divided into 74 with immunogenic hyperthyroidism (IMH) and 87 with non-immunogenic hyperthyroidism (NIMH). The frequency of complaints and the mean hormone concentrations were significantly higher in IMH and the median thyroid volume was significantly smaller. Diffusely reduced sonographic echoes were observed in only 50% of patients with IMH compared to 5% of those with NIMH. Homogeneous distribution of 99mTc in the thyroid was observed scintigraphically in 95% of patients with IMH and in only 3% of those with NIMH. Although the median of global thyroid uptake of 99mTc was significantly higher in IMH there was a broad overlap between the two groups. The mean hormone production is higher in IMH than in NIMH. In order to separate IMH and NIMH, several criteria have to be employed which differ concerning their diagnostic significance.

Humans↗
PubMed1993

Quick diagnosis of hyperthyroidism with semiquantitative 30-minute technetium-99m-methoxy-isobutyl-isonitrile thyroid uptake.

Ten normal volunteers and 14 patients with hyperthyroidism had pinhole thyroid imaging 30 min after an intravenous injection of 10 mCi 99mTc-MIBI. Technetium-99m-MIBI thyroid uptake was calculated by the formula: [total counts with a region of interest (ROI) over the whole thyroid gland] divided by [(mean counts of every pixel in the neck soft tissue) x (total number of pixels in ROI over the whole thyroid gland)]. The results showed that the 30 min 99mTc-MIBI thyroid uptake ratios had positive relationships with the 24 hr 131I-thyroid uptake (r = 0.79), and that the patients with hyperthyroidism had significantly higher 30 min 99mTc-MIBI thyroid uptake than the normal volunteers (5.31 +/- 0.78 s.e.m. versus 2.35 +/- 0.14 s.e.m., p < 0.005 using the Mann-Whitney U-test). Technetium-99m-MIBI thyroid uptake may be useful for the rapid diagnosis of hyperthyroidism.

Adult↗
PubMed1977

Lithium: modification of behavioral activity and brain biogenic amines in developing hyperthyroid rats.

Daily treatment of neonatal rats with 1-triiodothyronine for 30 days increased locomotor activity as well as the synthesis and presumably, release of brain norepinephrine, dopamine and 5-hydroxytryptamine. Whereas administration of lithium carbonate (60 mg/kg) to normal rats for 10 days, beginning from the 20th day of age, produced no significant effect, this antimanic drug significantly decreased the observed increase in spontaneous locomotor activity in l-triiodothyronine-treated rats. Lithium treatment in normal rats increased the activity of striatal tyrosine hydroxylase, but produced no significant effect on the endogenous levels of norepinephrine and dopamine in several discrete brain regions examined. Lithium, enhanced deamination of catecholamines as evidenced by increased level of 3,4-dihydroxyphenylacetic acid and monoamine oxidase activity in normal rats. The activity of catechol o-methyltransferase was decreased to 82 and 59% in midbrain and crebral cortex of normal rats, respectively. Furthermore, chronic treatment with lithium increased endogenous levels of tryptophan, tryptophan hydroxylase, 5-hydroxytryptamine and its metabolite, 5-hydroxyindoleacetic acid, in normal animals. In contrast to the effects seen in normal rats, admininstration of lithium in l-triiodothyronine-treated animals significantly decreased tyrosine hydroxylase as well as dopamine and its metabolite, 3,4-dihydroxyphenylacetic acid, suggesting that this antimanic drug reduced the synthesis and turnover of dopamine. However, the steady-state levels of norepinephrine were raised in hypothalamus, pons-medulla, midbrain and striatum of lithium-treated hyperthyroid rats. As seen in normal animals, lithium in l-triidothyronine-treated rats increased trytophan, tryptophan hydroxylase and 5-hydroxytryptamine levels, but decreased the concentration of 5-hydroxyindoleacetic acid. The results show that the suppressed behavioral activity seen in lithium-treated hyperthyroid rats may be associated with decreased synthesis of norepinephrine and dopamine in the brain. Finally, the effects exerted by lithium on the brain catecholamine metabolizing system of young hyperthyroid rats were not similar to those seen in normal rats of the corresponding age group.

Animals↗
PubMed1993

Coexisting hyperthyroidism and primary hyperparathyroidism.

The simultaneous occurrence of hyperthyroidism and primary hyperparathyroidism is rare in the absence of previous neck irradiation. We report two cases from our institution. Hypercalcemia secondary to hyperthyroidism is common and may obfuscate the diagnosis of concomitant primary hyperparathyroidism. Therefore the continued presence of hypercalcemia in a patient with successfully treated hyperthyroidism should lead the physician to search for primary hyperparathyroidism. Treatment of these concomitant disease processes consists of combined thyroidectomy and parathyroidectomy.

Adult↗
PubMed1995

Separation of autonomous function from cell density in non-immunogenic hyperthyroidism. I. Quantification by double-isotope parametric scintigraphy.

UNLABELLED: A new quantitative subtraction method of thyroid scans is proposed which shows that regional function (F) by far exceeds regional cellularity or cell density (C) in potentially toxic thyroidal areas of non-immunogenic hyperthyroidism (NIH). METHODS: A multistep processing of radioiodine and MIBI thyroid scans of patients with non-immunogenic hyperthyroidism led to normalized images of regional function excess and of perinodular enhancement. Two numeric factors were derived from regions of interest: Q (cell density ratio) comparing MIBI uptake in autonomous and suppressed areas and T (toxicity index): the maximal F/C contrast. RESULTS: Q never exceeded 61; T, however, expanded toxicity levels over a range of 6-8735 with toxic adenomas (median = 165) and with hot areas of multifocal functional autonomy (median = 15). T was weakly correlated to serum TT3 (r = 0.41), but not to autonomous tissue mass, ultrasonographic or cytologic criteria. CONCLUSIONS: T is governed by inherent features of autonomous tissue and the response of the imbedded thyroid tissue to TSH stimulation. This standardized technique consolidates experiences from visual analysis; the huge T range mirrors the natural evolution from compensated autonomy towards hyperthyroid, decompensated stages.

Diagnosis, Differential↗
PubMedDate not supplied

[Therapeutic indications in hyperthyroidism (author's transl)].

The administration of synthetic antithyroid drugs or of l131, and subtotal resection of the thyroid gland remain the treatments of hyperthyroidism. Precise criteria will determine the choice. Surgery is the treatment of large goitres, of associated ophthalmic disorders and of recurrence after medical treatment. Drugs are indicated at the first occurrence of hyperthyroidism in young subjects with a small goitre; it will also be used as a preparation for surgery associated to Lugol and Levothyroxine. Finally l131 is indicated in medium size hyperthyroid goitres in patients over 45 years. Each treatment has advantages and drawbacks which must be taken into account for the therapeutic choice and the follow-up.

Antithyroid Agents↗
PubMed1996

Successful treatment of recurrent non-immune hydrops secondary to fetal hyperthyroidism.

BACKGROUND: Non-immune fetal hydrops is a heterogeneous disorder with a mortality rate of 50-98%. Resolution of non-immune fetal hydrops is rare but has been reported to occur spontaneously or after targeted therapeutic measures. CASE: A euthyroid gravida with Graves disease presented with a history of three prior perinatal deaths between 26 and 28 weeks' gestation, all associated with fetal hydrops. In the current pregnancy, the fetus developed hydrops at 24 weeks' gestation. Fetal hyperthyroidism, with high-output cardiac failure, was diagnosed with fetal blood sampling. After maternal therapy with propylthiouracil, resolution of the non-immune hydrops were documented and a healthy neonate subsequently delivered to term. The neonate developed transient hyperthyroidism after delivery, which required treatment for 10 weeks. CONCLUSION: Non-immune hydrops occurring as a result of fetal hyperthyroidism with high output cardiac failure is treatable with propylthiouracil.

Adult↗
PubMed1996

Separation of autonomous function from cell density in non-immunogenic hyperthyroidism--II. quantified comparison before and after radioiodine therapy.

Regional autonomous cell mass (Q: cell density ratio) and function (T: toxicity index) were compared by double isotope parametric thyroid scintigraphy (Als et al., Nucl. Med. 1995; 34) in 53 patients with non-immunogenic hyperthyroidism before and after radioiodine therapy (aRIT) and showed a break-down (medians) of Q: 4.3-->1.0 (toxic adenomas: TA), 2-->1.1 (multifocal functional autonomies: MFA)(p < 0.0001) as of T: 96-->1.7 (TA), 15-->1.1 (MFA) (p < 0.001). Five functional aRIT patterns resulted: euthyroidism (n = 37, 70%), at half with scarred/non-scarred autonomous areas (low/higher T, respectively), primary hypothyroidism (n = 4), residual hyperthyroidism (n = 7), secondary hyperthyroidism (n = 5). The last two groups with persistent subnormal TSH values were clearly separated by divergent T, thyroxine and triiodothyronine levels. A resulting T > 1 may represent a clinically sub-critical mass of residual autonomous tissue. This new technique facilitates individual pretherapeutic evaluations and aRIT quality control.

Follow-Up Studies↗
PubMed1976

[Aminopeptidases in the serum and urine of patients with hyperthyroidism].

In patients with hyperthyroidism the serum activities of the leucine aminopeptidase (LAP) and the alanine aminopeptidase (AAP) as well as the alanine aminopeptidase excretion in the urine were determined. A significantly increased activity of the leucine aminopeptidase in the serum and an increased excretion of alanine aminopeptidase in the urine were found. The AAP in the serum did not show a significant increase of activity. On account of the changes in the serum and in the urine before and during therapy a low-grade participation of the hepatobiliary and renal systems which are clinically not uppermost is to be assumed. Increased excretion of AAP and hyperthyroidism coincide nearly without exception in out patients. Correlation-statistical investigations make it probable to regard the increased excretion of AAP in the urine as an indirect parameter of the peripheral metabolism in hyperthyroidism.

Adult↗
PubMed1977

Surgical treatment of hyperthyroidism in children.

During the past ten years, subtotal thyroidectomy for hyperthyroidism was performed upon 43 children at Childrens Hospital of Los Angeles. There were no deaths, no recurrent laryngeal nerve injuries and no permanent hypoparathyroidism. During the one to ten year follow-up period, one patient had recurrent hyperthyroidism develop and was treated with 131I. Twenty-five patients are hypothyroid and require thyroid supplement; 14 are euthyroid and receiv no medication. Postoperative thyroid function did not correlate well with gland remnant size, degree of fibrosis or the extent of lymphoid follicle formation. Lymphocytic infiltration was more severe in patients who had hypothyroidism develop postoperatively. Transient hypocalcemia developed in 22 patients. The effectiveness and safety of the surgical treatment for hyperthyroidism in children is reaffirmed, and it is advocated for consideration over 131I or prolonged medical therapy.

Adolescent↗
PubMed1996

Altered metabolism of folates and lipids in hyperthyroid and hypothyroid rats.

Effect of excess folate on the metabolism of folate and plasma lipids in thyroid stressed animals was studied. Administration of excess dietary folate to hyperthyroid rats did not affect the decreased in vivo histidine oxidation in these animals, but it increased the hepatic tetrahydrofolate content. Hypothyroid rats had higher plasma total cholesterol (TC), high density lipoprotein cholesterol (HDLC) and trigylcerides (TG) with no change in post heparin lipolytic activity (PHLA). In hyperthyroidism both TC and HDLC were decreased in plasma and PHLA levels were elevated. On administration of excess dietary folate to hyperthyroid rats HDLC levels were not altered but PHLA and TC levels became near normal, while TG levels remained elevated.

Animals↗
PubMed1996

[Edema as clinical manifestation of hyperthyroidism. Report of 2 cases].

We report two cases of hyperthyroidism clinically associated to edema, in which no usual causes for the latter were found. Correction of the hyperthyroidism state was associated with complete resolution of edema. The fact that one of the cases consisted of a farmacologically induced hyperthyroidism points to a direct effect of the thyroid hormone itself as the origin of this complication. The de novo occurrence of edema can be due to thyroid hyperfunction as the only underlying cause, the presence of other associated factors such as heart failure, hypoproteinemia or dermopathy not being necessary for its development.

Edema↗