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PubMed1996

[Use of 131 iodine for the treatment of hyperthyroidism in adults].

The authors report on their experience with the treatment of hyperthyroidism using radioiodine (RI) over a period of 15 years in 516 patients. RI dosimetry was calculated from thyroid 24 hr uptake and weight, using linearly increasing RI doses (from 40 to 100 microCi/g) with increasing thyroid weight (between 10 and 100 g) for both diffuse (D) and multinodular (MN) toxic goiters. For solitary toxic (ST) nodules, a fixed dose of 250 microCi/g was used. In severe hyperthyroidism, antithyroid drugs (ATD) and KI (15 mg/d) were added 24 hours after RI and given during 1-4 months and 21 days, respectively. Combining RI + ATD/KI therapy allowed for a reduction of RI recirculation and release from the gland and also for more rapid return to a euthyroid status. The results showed that 88% of patients with ST, 68% with D, and 55% with MN were cured with a single dose of RI. Furthermore, the incidence of late hypothyroidism was relatively low, reaching 7% in ST, 36% in D, and 28% in MN after a follow-up period of fifteen years. Annual follow-up, however, showed that an additional 2.7% of patients (3.5% of D; 1.6% of MN; 2.4% of ST) exhibited--per year--an exaggerated TSH response to TRH even though these patients remained clinically and biochemically euthyroid (normal circulating basal hormones and TSH levels). In conclusion, 1) low doses RI combined with ATD/KI yielded a high success rate: less than 30% of patients required more than 1 dose and only 30% became hypothyroid after prolonged follow-up; 2) abnormalities of TRH test were not infrequent in patients with D and MN goiters, as well as ST nodules, thereby fully justifying the need for careful and prolonged follow-up of all hyperthyroid patients receiving RI therapy.

Adult↗
PubMed1996

[Blood glucose and insulin responses to oral glucose in hyperthyroidism].

Because thyroid hyperfunction "per sè" can induce impaired glucose tolerance in 2-57% of patients, we have studied glycaemic and insulinaemic response to oral glucose load (OGTT) in this condition. Glycaemic and insulinaemic curves after oral glucose (100 g), the respective secretory areas (AUC-G and AUC-IRI) have been determined in 13 hyperthyroid patients (8 Graves disease, 4 multinodular toxic goiters and 1 Plummer's adenoma) and in 16 healthy control subjects. AUC-G, AUC-IRI and median values of G and IRI in most of considered times have resulted significantly greater in hyperthyroid patients. This study has confirmed the impact of thyroid hyperfunction on carbohydrate metabolism, but has not proved an impaired insulin secretion as previously reported in Literature. In conclusion, we believe that: a) hyperthyroidism is associated with greater circulating levels of G and IRI, b) hyperinsulinaemia in addition to hyperglycaemia suggests that insulin-resistance is underlying in this condition.

Administration, Oral↗
PubMed1997

Gastric emptying in hyperthyroidism.

OBJECTIVES: We undertook a prospective study to survey gastric emptying of a solid meal in patients with hyperthyroidism until euthyroidism was reached after pharmacological treatment with thiamazole. METHODS: Eleven women (aged 33.2 +/- 3.2 SE yr) with recently diagnosed hyperthyroidism participated in the study. Thyroid function parameters and gastric emptying were examined on three occasions, before treatment, during the third week of treatment, and after euthyroidism was restored. The control group was composed of 12 age-matched healthy women (aged 34.5 +/- 2.3 yr). Gastric emptying of a 390-kcal 99mTc-labeled solid meal was continuously recorded under a gamma camera over 90 min. A power-exponential model was used for analysis of the gastric emptying course. Three gastric emptying parameters were computed: t1/2, the gastric half-emptying time, S, the curve shape parameter, and K, the slope of the curve. RESULTS: Pretreatment solid phase gastric emptying of the patients was not statistically significantly different from that of the healthy control subjects: t1/2, 82.8 +/- 4.9 vs 93.5 +/- 6.0 min; S, 0.996 +/- 0.103 vs 1.032 +/- 0.064; and K, 8.42 +/- 0.47 vs 7.64 +/- 0.39 min(-1) x 10(-3). Gastric emptying during the third week of treatment did not change in comparison with pretreatment gastric emptying: t1/2, 84.3 +/- 8.2 min; S, 1.014 +/- 0.123; and K, 8.92 +/- 1.12 min(-1) x 10(-3). On the other hand, a slight increase in rate of gastric emptying was observed after the restoration of euthyroidism (t1/2, 74.6 +/- 5.8 min, and K, 9.65 +/- 0.76 min(-1) x 10(-3), p < 0.05 vs healthy control subjects for both parameters), but no significant change was observed in the shape parameter (S, 0.980 +/- 0.066). CONCLUSIONS: In women with hyperthyroidism, gastric emptying of solids does not differ significantly from that observed in age-matched healthy control subjects and remains unaffected during pharmacological treatment. After restoration of euthyroidism, a slight but statistically significant increase in the rate of gastric emptying occurs in patients as compared with healthy control subjects.

Adult↗
PubMedDate not supplied

High prevalence of asymptomatic hypothyroidism and hyperthyroidism in hospitalized elderly females.

To investigate the prevalence of asymptomatic hypothyroidism and hyperthyroidism in hospitalized people, we performed thyroid function tests on a group of 2545 elderly patients consecutively observed in a General Hospital in Rome, during a six year period. The rate of asymptomatic hypothyroidism was as high as 0.71% in female patients and only 0.20% in male patients. In asymptomatic hyperthyroid subjects the prevalence rate was 0.58% in females and 0.20% in males. On the whole, prevalence rate of asymptomatic thyropathies resulted 0.94%, showing a clear difference in sex (women 1.29% and men 0.40%). The asymptomatic thyropathies screening of hospitalized elderly women may result in a very low cost diagnosis of many new cases of hypothyroidism and hyperthyroidism.

Aged↗
PubMed1997

[Choice of therapy in unifocal functional autonomy of the thyroid gland with hyperthyroidism].

Over the last 20 years, unifocal functionally autonomous nodes (UFA) of the thyroid have accounted for more than one third of all patients with hyperthyroidism in the former iodine-deficient and goiter-endemic region of Bern. This situation calls for a special diagnostic approach, i.e. etiologic diagnosis of any solitary nodule and careful consideration of therapy in contrast to regions with iodine excess where UFA is very rare, such as the USA. Therapy is recommended even where hyperthyroidism is still latent (blocked TRH test, normal TT3 and TT4) and reliably leads to subjective and objective improvement even in oligosymptomatic individuals. The safe and easy radioiodine therapy (RIT) is preferred in elderly patients with associated conditions. Surgical resection is recommended chiefly where malignancy is suspected or RIT is technically inappropriate. Both methods produce prompt eradication of the source of hyperthyroidism. The most frequent complication is hypothyroidism requiring lifelong follow-up.

Adolescent↗
PubMed1997

Should the primary treatment of hyperthyroidism be surgical?

OBJECTIVE: To review the results of the surgical treatment of all types of hyperthyroidism (Graves' disease, toxic nodular goitre, and toxic solitary adenoma). DESIGN: Retrospective study. SETTING: University hospital and private hospital, Greece. SUBJECTS: 400 Consecutive patients who were operated on between 1982 and 1991. INTERVENTION: Near total/total thyroidectomy in 226 patients with toxic nodular goitre and 87 patients with Graves' disease. Subtotal thyroidectomy in 25 patients with Graves' disease (early period of the study); lobectomy with resection of the isthmus of the thyroid in 62 patients with a solitary toxic adenoma. MAIN OUTCOME MEASURES: Mortality, morbidity and patients' self assessment of the results of operation (symptoms, scar, ophthalmopathy). RESULTS: There was no mortality. Morbidity included 2 postoperative bleeds that required reoperation; 2 patients developed permanent unilateral vocal cord paralysis and 2 had permanent hypoparathyroidism. In 27 of the 400 patients (7%) a thyroid carcinoma was found in the resected specimen. No patient had persistent or recurrent hyperthyroidism 2 to 10 years after operation. Of the 49 patients with Graves' disease and opthalmopathy at the time of operation, 35 (71%) reported improvement in their ophthalmopathy and 14 (29%) reported no improvement. No patient had worsening of their exophthalmos; 388 (97%) were satisfied with their incision; and 360 (90%) reported a significant improvement in their preoperative symptoms (tachycardia, weakness, anxiety, and pressure in the neck). CONCLUSIONS: We suggest that the primary treatment of all types of hyperthyroidism should be surgical.

Adult↗
PubMed1976

Hyperthyroidism in Graves disease. Current trends in management and diagnosis.

The radioimmunoassay for T3 is now widely available and is a useful diagnostic tool for hyperthyroidism, especially in T3-thyrotoxicosis. It is an essential tool in the management of hyperthyroidism that persists after treatment with normal T4 serum levels or, in euthyroid cases, with low T4 serum levels. In these conditions, it reflects the metabolic state more accurately than serum levels of T4. A promising new test is the response of radioimmunoassayable TSH to protirelin (TRH) administration. An absent response indicates pituitary suppression and thyroid autonomy as seen in frank hyperthyroidism or euthyroid Graves disease, treated or untreated. It is safer and quicker than the conventional T3 suppression test of thyroid radioactive iodine uptake and may replace it at least partly in the future.

Adult↗
PubMed1976

Gonadal radiation dose and its genetic significance in radioiodine therapy of hyperthyroidism.

Published estimates of radiation dose to the gonads from 131I therapy of Graves' disease vary widely, largely because of differences in assumptions regarding the details of iodine kinetics. The calculations described in this paper show that hyperthyroid patients treated with 10 mCi of 131I will usually receive a total radiation dose to the ovaries or testes of less than 3 rad. Several common roentgenographic diagnostic procedures may involve a greater radiation dose and a greater genetic hazard than does the usual 131I treatment for hyperthyroidism. It is important to minimize total exposure to radiation, but it seems unreasonable to deny 131I treatment for hyperthyroidism to young men and nonpregnant young women on the grounds of genetic hazard alone.

Female↗
PubMedDate not supplied

Skeletal calcium retention in hyperthyroidism and in vitro calcitonin inactivation.

Studies on patients with severe hyperthyroidism revealed an increased skeletal avidity for calcium, expressed in terms of net retention, after a three-hour i.v. load of 10mg Ca/kg body weight. For the same hyperthyroid subjects the calcitonin inactivating potency of the sera was tested in vitro. The results were expressed as restant hypocalcemic potency of the calcitonin after incubation with the serum fractions. In hyperthyroid subjects two fractions in dilutions of 1:10 reduced the hypocalcemic activity of calcitonin by 75%. In normals this activity appeared only in one fraction. All these results suggest a prompt calcitonin release during calcium infusion which is however less efficient, probably because of the increased amount of calcitonin inactivating factor present in sera. The serum inactivating factor generally contributes to the short-time activity of calcitonin both in normals and in some clinical states with bone calcium imbalance.

Bone and Bones↗
PubMed1998

Effects of hypothyroidism and hyperthyroidism on serum glycoproteins in experimental rats.

Hypothyroidism and hyperthyroidism were induced in adult female Sprague Dawley rats by feeding 0.05% propylthiouracil and 0.0012% L-thyroxine in drinking water. Contents of protein-bound hexose, fucose, hexosamine and sialic acid in serum were estimated in experimental rats. The results showed an increase in the protein bound hexose, fucose, hexosamine and sialic acid levels in hypothyroid rats and decrease in hyperthyroid rats. The increased content of serum glycoproteins in hypothyroid rats might possibly have come from disruptions of membranes. Depleted glycoproteins in hyperthyroid animals might be due to increase in depolymerisations of glycoproteins and accelerated secretion of glycoproteins with urine.

Animals↗
PubMed1998

[Iodine-induced hyperthyroidism after cadexomer iodine treatment of leg ulcers].

The article consists in two case reports of eldery patients who developed hyperthyroidism after cadexomer iodine treatment of small leg ulcers. The first was an 87-year-old woman who developed anxiety, hoarseness and tachycardia after five months treatment of a 12 cm2 leg ulcer with 350 g cadexomer iodine. Her serum level of free thyroxine (FT4) was 23.1 pmol/l (normal range, 11.7-28.0), and that of thyroid-stimulating hormone (TSH) 0.01 mIU/l (normal range, 0.1-3.0). She had had a nodular goitre for thirty years. The second was an 86- year-old woman who developed depression and confusion after three months' treatment of an 8 cm2 leg ulcer with 170 g cadexomere iodine. Her serum level of FT4 was 30.0 pmol/l, and that of TSH 0.005 mIU/l. Both patients underwent Tc99m pertechnetate scanning and iodine uptake measurement with a view to treating the hyperthyroidism with radio-iodine. However, as iodine uptake was inhibited in both cases, radio-iodine treatment was impossible, and symptomatic treatment and antithyroid drugs had to be used. Thus, it is concluded that topical treatment with cadexomer iodine can induce hyperthyroidism difficult to manage clinically as the treatment options are limited, which should be borne in mind when cadexomer iodine treatment is considered.

Administration, Topical↗
PubMed1998

[Surgical procedure for hyperthyroidism in children and adolescents].

The high recurrence rate of hyperthyroidism after drug therapy in Graves disease and the high incidence of differentiated thyroid cancer in autonomously functioning thyroid nodules are the most common indications for surgical treatment in children and adolescents (less than 18 years old). Between April 1986 and March 1998, 101 adolescents were operated on: 24 children (23.8%) for Graves disease, 9 adolescents (8.9%) for autonomously functioning thyroid nodules. Surgery for hyperthyroidism is recommended in children and adolescents because of the low morbidity, the guarantee that this approach will successfully treat hyperthyroidism and the necessity for histological exploration.

Adolescent↗
PubMed1999

Hyperthyroidism of Graves' disease: evidence for only unilateral involvement of the thyroid gland in a 31-year-old female patient.

Hyperthyroidism of Graves' disease (Morbus Basedow) is known to involve the thyroid gland in toto, unlike Graves' ophthalmopathy which clinically may either be unilateral or bilateral. We report a 31-year-old Caucasian female patient who presented with unilateral goiter and clinical and laboratory evidence for hyperthyroidism. High-resolution ultrasonography of the thyroid gland revealed a morphology indicative of an autoimmune thyroid disease strictly limited only to the right lobe. 123I-scintiscanning showed a homogenous but several fold increased uptake of the radionuclide in the right lobe of the thyroid gland, whereas the uptake in the left lobe did not differ from the uptake in normal controls. Cytology of the fine needle aspirate of the right lobe revealed a remarkable inflammatory background mainly by presence of lymphocytes, a finding which was not seen in the cytology of the left lobe. Furthermore, both serum antibodies to TSH-receptors and thyroid peroxidase were significantly increased. Consequently, hyperthyroidism of Graves' disease with the involvement of only one lobe of the thyroid gland was diagnosed.

Adult↗
PubMedDate not supplied

Ablative or non-ablative therapy for Graves' hyperthyroidism in patients with ophthalmopathy?

In our view there are no properly controlled trials which support a beneficial effect on ophthalmopathy from surgical or radioiodine-based deliberate ablation for hyperthyroidism. The theoretical basis for this approach can be questioned and we still know too little about the pathogenesis of ophthalmopathy to draw any firm conclusions about the likely effects of ablation. There are established risks with ablation. Like the majority of European thyroidologists, we prefer antithyroid drugs for the initial treatment of hyperthyroidism complicated by Graves' ophthalmopathy and individualise treatment for recurrent hyperthyroidism based on the patient's preference, but do not recommend ablation routinely in presence of eye signs.

Graves Disease↗
PubMed1992

Antithyroid drug and Graves' hyperthyroidism. Significance of treatment duration and TRAb determination on lasting remission.

OBJECTIVE: To investigate the significance of treatment with antithyroid drugs longer than 12 months on lasting remission in Graves' hyperthyroid patients, and to study clinical and laboratory parameters of prognostic value. PATIENTS: Fifty-two untreated Graves' hyperthyroid patients were assigned at random to two therapeutic groups. They were treated with carbimazole during 12 and 24 months in Group I (n = 28) and Group II (n = 24), respectively. MEASUREMENTS: Serum levels of FT4, T3, sTSH and TSH receptor antibody (TRAb) were measured before starting treatment and at regular intervals during treatment and follow-up after drug withdrawal. We compared the relapse rate in both groups of patients, at short (2-yr) and long-term (5-yr) periods after drug withdrawal. Also, we compared clinical and biochemical parameters between patients who stayed in remission and who had relapse. RESULTS: At the end of the short-term period, relapse had occurred in 13 (46.4%) Group I patients and in 13 (54.1%) Group II patients, p = 0.36. At the end of the long-term period, relapse had occurred in 24 (85.7%) Group I and 20 (83.3%) Group II patients, p = 0.78. No difference could be observed between patients who had stayed in remission and who had suffered relapse, within the 5-yr follow-up period regarding to goiter size, frequency of ophthalmopathy, TSH and TRAb levels. CONCLUSIONS: The high relapse rate observed could be due to high iodine intake in our country. In this study and in a review of the available data, we have been unable to find any rational basis for courses of antithyroid drugs longer than twelve months for the treatment of Graves' hyperthyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

[Drug treatment of immune hyperthyroidism (Basedow disease). Patient selection, long-term follow-up and prevention of recurrence].

Since theraphy of Graves' disease is not directed towards the cause of the disease, medical theraphy is still the first choice and symptomatically effective in treating hyperthyroidism. Antithyroid drugs are effective in restoring euthyroidism in >90% of the patients durning 4-6 weeks, but 30-50% of the patients experience relapse after withdrawal. Previous prospective randomized studies evaluated prognostic parameters and the use of levothyroxine for prevention of relapse of hyperthyroidism. Recent studies have addressed the period after withdrawal amd focused on the natural course of disease. The results of a recent prospective randomized and controlled multicenter study were as follows: supplementation of levothroxine does not prevent relapse of hyperthyroidism. Basal TSH (4 weeks after withdrawal of antithyroid drugs) is the best prognostic marker. Smoking and positive TSH-receptor-antibodies at the end of antithyroid theraphy are other risk factors.

Antithyroid Agents↗
PubMed1992

Alteration of renal function in hyperthyroidism: increased tubular secretion of creatinine and decreased distal tubule delivery of chloride.

In 77 untreated patients (16 males and 61 females, aged 12 to 65 years) with hyperthyroid Graves' disease, and in 107 control subjects (36 males and 71 females, aged 13 to 78 years), blood urea nitrogen (BUN), serum creatinine (Scr) levels, and BUN to Scr ratios (BUN/Scr) were determined. In 53 patients, the determinations were performed before treatment and after restoration of euthyroidism by treatment with an antithyroid drug. In addition, in seven untreated patients and seven normal subjects, renal clearances of creatinine (Ccr), urea nitrogen (Cun), inulin (Cin), and p-aminohippurate (CPAH) were also determined. The distal tubule delivery of chloride (DTD) and the distal fractional chloride reabsorption (DFCR) were also measured in these subjects: DTD = (CH2O + Ccl)/Cin x 100, and DFCR = CH20/(H20 + Ccl) x 100, where CH20 and Ccl stand for clearances of H2O and chloride, respectively. BUN was significantly elevated, while Scr was significantly depressed, in untreated patients with hyperthyroid Graves' disease. Accordingly, the BUN/Scr was markedly elevated. Restoration of euthyroidism accompanied the normalization of all these abnormalities. Ccr and Cun were significantly elevated, but Cin (glomerular filtration rate [GFR]) was slightly, but insignificantly, elevated in the patients. As a result, the ratios Ccr/Cin and Cun/Cin were significantly greater in the patients than in controls (Ccr/Cin, 1.42 v 1.00; Cun/Cin, 0.92 v 0.68). The amounts of urinary creatinine and urea nitrogen (UN) excretion were decreased and increased, respectively, and DTD was significantly depressed, but DFCR was unchanged in the patients. We conclude that BUN is elevated, Scr is depressed, and the BUN/Scr is increased in hyperthyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Decreased nerve growth factor levels in hyperthyroid Graves' ophthalmopathy highlighting the role of neuroprotective factor in autoimmune thyroid diseases.

Nerve growth factor (NGF), which is a neurotrophic factor, is involved in autoimmune and inflammatory processes. Serum NGF levels were investigated in 131 patients with autoimmune (95 with Graves' disease, of whom 57 had ophthalmopathy, 19 with Hashimoto's thyroiditis) and nonimmune thyroid diseases (17 with toxic nodular goitre), and 20 controls. NGF levels were measured via enzyme-linked immunosorbent assay. Twenty-nine positive cases for NGF were detected: 21 cases in Graves' disease, 7 cases in Hashimoto's thyroiditis, no case in toxic nodular goitre and one case in controls. NGF levels were higher in patients with Graves' disease and particularly with Hashimoto's thyroiditis compared with controls (1786.47+/-34.79 pg/ml and 1996.27+/-77.71pg/ml vs 1579.16+/-57.45pg/ml, P<0.049 and P<0.0001, respectively). Increased NGF levels associated with Graves' hyperthyroidism and correlated with FT(3) (P<0.01). Patients with the presence of antibodies against TSH receptor showed higher NGF levels than those with no antibodies (1938.61+/-56.44pg/ml vs 1712.12+/-54.22pg/ml, P<0.009). Decreased NGF levels were demonstrated in hyperthyroid Graves' ophthalmopathy compared with those without eye symptoms (1746.65+/-51.98pg/ml vs 1910.47+/-55.62pg/ml, P<0.036). NGF may be involved in the pathomechanism of autoimmune thyroid diseases. Decreased NGF levels in hyperthyroid Graves' ophthalmopathy highlight the importance of NGF in the neuroprotection of orbital tissues.

Adult↗