Showing papers in "Thyroid in 1989"

Unusual complications of antithyroid drug therapy: four case reports and review of literature.

Abstract: Two cases of propylthiouracil-associated acute hepatitis, one case of fatal methimazole-associated hepatocellular necrosis and one case of propylthiouracil-associated lupus-like syndrome are described. The literature related to antithyroid drug side effects and the mechanisms for their occurrence are reviewed and the efficacy and complications of thyroidectomy and radioiodine compared to those of antithyroid drugs. It is concluded that in most circumstances 131I is the therapy of choice for hyperthyroidism.

Visual, brainstem auditory and somatosensory evoked potential abnormalities in thyroid disease.

Abstract: In order to investigate the neurophysiological effects of thyroid hormones, sixteen hypothyroid and twenty-seven hyperthyroid patients were studied for changes in visual, brainstem auditory and somatosensory evoked potentials. Hypothyroidism was associated with prolonged latency and reduced amplitude of visual evoked potential, prolonged latency and prolonged central conduction time of somatosensory evoked potential, and prolonged latency and interpeak latency of brainstem auditory evoked potential. Hyperthyroidism was associated with mild prolonged latency of visual evoked potential; other evoked potentials were normal. The prominent evoked potential abnormalities in hypothyroidism and mild evoked potential change in hyperthyroidism are consistent with a possibility that the central nervous system is more sensitive to a deficiency of thyroid hormone than to an excess.

Relationship between serum thyroglobulin, thyroid volume and serum TSH in healthy non-goitrous subjects and the relationship to seasonal variations in iodine intake.

Abstract: In order to investigate the interrelationship between serum thyroglobulin (Tg), thyroid volume and serum TSH by a sensitive method, 176 healthy euthyroid non-goitrous subjects were studied. Furthermore the seasonal influence, assuming seasonal differences in iodine intake in Denmark, was studied in 13 healthy male volunteers. A weak correlation between serum Tg and thyroid volume was found only in female non-goitrous subjects. No correlations between serum Tg, thyroid volume, free T4 and free T3 indices, T3/T4 ratio, serum TSH by sensitive method or age were seen. Thyroid volume was increased (P less than 0.01) during the winter without any change in thyroid function or TSH level, whereas serum Tg level in these subjects was significantly lower (P less than 0.02) during the winter compared with the summer. In conclusion, serum Tg showed no correlation with either thyroid volume, super-sensitive TSH or thyroid function in a population of non-goitrous subjects in Denmark. The lack of correlation between increased thyroid volume and decreased serum Tg during the winter compared with the summer is unexplained. It might be hypothesised that short-term changes in iodine intake induce only colloid accumulation (i.e. increased thyroid volume) without changes in the glandular secretion of Tg or thyroid hormones.

Thyroid hormone induced oxygen consumption and glucose-uptake in human mononuclear cells.

Abstract: Cellular oxygen consumption and glucose metabolism were examined in human mononuclear blood cells. The cellular oxygen consumption and glucose uptake were dependent on the number of cells, the temperature and the duration of incubation. Stimulation of the cells by T4 and T3 led to a dose dependent increase of oxygen consumption and glucose uptake, whereas T2 and rT3 had no effect. Thyroxine as well as T3 stimulated the cellular glucose metabolism, but lactate production was independent of T3 and T4 stimulation. The data suggested a direct effect of T4 and T3 on oxidative phosphorylation. Further thyroid hormones and insulin exerted an additive effect on glucose uptake. Our study indicates a direct intracellular effect of T4 independent of its conversion to T3 and a different mechanism for insulin dependent and thyroid hormone glucose uptake.

Transient hypothyroidism after iodine-131 treatment of Graves' disease.

Abstract: One hundred twenty six patients with Graves' disease, 26 with toxic multinodular goiter, and 18 with toxic adenoma were treated with 131I (3-15 mCi), and followed at monthly intervals for six months. Transient hypothyroidism occurred at two months in 22 patients with Graves' disease. In this state TSH levels became elevated in seven patients, but were normal or suppressed in seven. In 17 patients T4 and T3 levels returned to normal without T4 replacement. Five patients developed recurrent thyrotoxicosis, and required repeated doses of 131I. The possibility of transient hypothyroidism in the early months after 131I therapy in Graves' disease should be borne in mind.

GABA inhibits thyroid hormone secretion in the mouse.

Abstract: The enzymes responsible for both the formation and degradation of gamma-aminobutyric acid (GABA) are known to exist in the thyroid gland The thyroid is also equipped with high- and low-affinity uptake mechanisms for GABA We therefore investigated the effects of GABA on basal and TSH-stimulated thyroid hormone secretion in the mouse according to the McKenzie technique Iodine-deficient mice were pretreated with Na125I and thyroxine GABA (1-100 nmol/kg iv) did not affect basal radioiodine levels However, the neurotransmitter inhibited the TSH-induced increase in blood radioiodine levels Thus, the increase after iv injection of TSH at 70 microU/animal (205 +/- 15%) was inhibited by GABA at 10 nmol/kg (to 155 +/- 14%; P less than 005) In contrast, a dose as high as 100 nmol/kg was necessary to inhibit the effect of TSH at its high dose of 350 microU/animal The GABAA-receptor antagonist bicuculline counteracted this inhibitory action of GABA Furthermore, pretreatment with the inhibitor of GABA-degrading enzyme GABA transaminase (gamma-vinyl GABA) impaired the stimulatory effect of TSH on blood radioiodine levels Thus, at 350 microU/animal, TSH increased blood radioiodine levels by 363 +/- 34% in controls vs by only 246 +/- 32% in animals pretreated with gamma-vinyl-GABA (P less than 005) We conclude that GABA is an inhibitor of TSH-stimulated thyroid hormone secretion

Discordant changes in serum anti-TSH receptor antibody and antithyroid microsomal antibody during pregnancy in autoimmune thyroid diseases.

Abstract: Immunological effect of pregnancy on the level of anti-TSH receptor antibody (TRAb) and antithyroid microsomal antibody (MCAb) was examined serially in twelve patients; ten with active Graves' disease treated with antithyroid drugs for some time during pregnancy, one with previous Graves' disease with stimulating type TRAb, and one with primary atrophic hypothyroidism with blocking type TRAb. TRAb was measured by radioreceptor assay (TSH-binding inhibitor immunoglobulin, TBII) and MCAb was determined by radioimmunoassay. Among the ten patients with active Graves' disease, TBII level decreased as pregnancy progressed in seven but increased during pregnancy in three, whereas MCAb level decreased uniformly during pregnancy in all ten patients. However, possible immunosuppressive effect of antithyroid drugs on these antibody levels could not be completely excluded in these patients. On the other hand, in the two consecutive pregnancies of the patient with previous Graves' disease, TBII level increased "spontaneously" to 10-fold the initial value at 30 weeks during the first pregnancy, while it did not show consistent increase or decrease during the second one. Another patient with primary hypothyroidism showed increase in TBII level during pregnancy to 5-fold the initial value at week 28. In contrast to these TBII changes, MCAb levels and immunoglobulin concentrations decreased consistently during pregnancy in these two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypothyroidism and thyroid autoimmunity in acute myocardial infarction (AMI).

Abstract: It has been suggested that subjects with thyroid autoimmunity are more frequently affected by acute myocardial infarction (AMI), than the general population (Lancet ii, 155-158, 1977). Serum thyroid antibodies (microsomal and thyroglobulin) were measured in a cohort of 132 males admitted consecutively to the Coronary Unit of Clinica Medica II Univ. "La Sapienza" of Rome with AMI. In the AMI group the thyroid autoimmunity was twice as frequent as in an age matched random population (9.1 vs 17.4%), but the association was statistically weak (p less than 0.05). In the group over 60 y two cases of overt hypothyroidism were found and none in the control group. The prevalence of 2.5% is higher than that reported in previous surveys carried out in elderly populations. No differences have been demonstrated in concentration of serum cholesterol, triglycerides, apolipoprotein A and B between patients with and without thyroid autoimmunity, although the serum cholesterol of AMI patients and those with asymptomatic thyroiditis was significantly higher than that of the general population. It is concluded that the prevalence of thyroid autoimmunity and hypothyroidism are increased in AMI and migth thus contribute to development of hypercholesterolemia and/or immune mechanisms.

Changes in the properties of the thyrotropin receptor antibody in patients with Graves' disease after radioiodine treatment.

Abstract: We investigated the effect of a single dose of 131I upon thyrotropin receptor antibodies (TRAb) in 21 patients with Graves' disease. The thyrotropin receptor antibodies were assessed by parallel measurements of thyrotropin binding inhibitor immunoglobulin (TBII), thyroid stimulating antibody (TSAb), and thyroid stimulation blocking antibody (TSBAb) in serum by radioreceptor assay, stimulation of adenylate cyclase and inhibition of TSH-stimulated adenylate cyclase activation in FRTL-5 cells, respectively. Prior to radioiodine treatment TBII was detected in all 21 patients and TSAB in 19 patients. After radioiodine treatment TBII activities did not change during 12 months observation period, but in eight patients TSAb activities gradually decreased and were undetectable at the end of a 12 month observation period. Persistence of TSAb was not associated with clinical outcome. Eight patients developed hypothyroidism within 1 year after radioiodine treatment. Three of the hypothyroid patients developed TSBAb, and the appearance of TSBAb coincided with the development of hypothyroidism. These results suggest that TSBAb might develop after radioiodine treatment in a minority of patients with Graves' disease, and that the appearance of TSBAb, in addition to radiation induced thyroid destruction, might be involved in the development of hypothyroidism following radioiodine treatment.

Cellular immunity as a valuable factor for prognostic prediction in patients with Graves' disease under antithyroid drug therapy.

Abstract: Studies were performed on 42 unselected clinically euthyroid patients with Graves' disease under maintenance doses of antithyroid drugs for various clinical parameters to determine the remission rate and to investigate which parameters carry weight in determining the outcome of the disease and could be good predictive factors T3 suppression test was performed in all patients, after which antithyroid drugs were discontinued and outcome of drug therapy was evaluated for 18-24 months Patients were divided into two groups; group A, 12 patients, who stayed in remission and group B, 30, who had recurrence during the first year (05-9 months) after discontinuation of therapy Duration of clinical history was not different between group A (mean 623 months) and group B (596 months), nor euthyroid periods before the test (155 months for group A and 176 months for group B) For thyroid specific parameters T4, T3, RT3U, TSH, thyroglobulin (Tg), thyroid suppressibility after T3 administration and goiter size; and anti-thyroglobulin antibody (TGHA), anti-thyroid microsomal antibody (MCHA), TSH-binding inhibitor immunoglobulins (TBII), thyroid-stimulating antibodies (TSAb), peripheral lymphocytes count and lymphocyte subsets [CD3, CD4, CD8, Leu7 and CD20 (B1)], as immunological parameters were analysed by linear discriminant analysis method to observe the significance in discriminating patients with or without remission and to evaluate the validity for predictive factors (ABSTRACT TRUNCATED AT 250 WORDS)

Changes in serum thyroid hormone and thyroglobulin levels after surgical treatments for toxic and non-toxic goiter.

Abstract: We assessed changes in serum total tri-iodothyronine (TT3), total thyroxine (TT4), free thyroxine (FT4), reverse tri-iodothyronine (rT3), thyroid stimulating hormone (TSH), and serum thyroglobulin (hTg) levels in 20 patients with toxic diffuse goiter who received subtotal thyroidectomy after metabolic control with antithyroid drugs and 22 patients with non-toxic solitary nodular goiter who received lobectomy only In the first 2 days postoperatively the toxic diffuse goiter group had approximately a 50% decrease in the mean serum TT3 concentration, and a 28% decrease in the mean serum TT4 concentration In the same period, the non-toxic nodular goiter group had approximately a 30% decrease in mean serum TT3 concentration, and a 15% decrease in mean serum TT4 concentration The toxic diffuse goiter group and the non-toxic nodular goiter group each had transient elevations of the mean serum rT3 concentration, amounting to 34% and 48% respectively Neither group had any change in the mean serum FT4 level, while both showed a several-fold elevation of serum hTg At the 6th week postoperatively in both groups, the mean serum TT3 level had returned to the preoperative value, the mean serum TT4, rT3 and hTg levels were significantly lower than preoperative values, and the mean serum FT4 level remained unchanged(ABSTRACT TRUNCATED AT 250 WORDS)

A study of thyroidal response to thyrotropin (TSH) in decompensated liver cirrhosis.

Abstract: In order to improve understanding of factors that may contribute to reduced serum T4 in non-thyroidal illnesses, we have studied baseline thyroid function, serum TSH response to thyrotropin-releasing hormone (TRH), and/or increase in thyroidal radioiodine uptake and serum T4 after parenteral administration of TSH in 12 patients with decompensated liver cirrhosis. Ten age and sex matched normal volunteer subjects served as controls. Compared to control subjects, patients with hepatic cirrhosis had significantly lower mean serum total T3 (ng/dl, mean +/- SD, 56 +/- 31 vs. 147 +/- 25, P less than 0.001), total T4 (microgram/dl, 4.3 +/- 1.5 vs. 8.8 +/- 0.74, P less than 0.001), and higher TSH (microU/ml, 3.0 +/- 1.2 vs. 1.6 +/- 0.73, P less than 0.05). Serum TSH response to TRH (400 micrograms I.V.) was abnormal in seven of 12 patients so studied. The peak TSH post-TRH was subnormal in one patient and normal but delayed in six patients. The mean baseline 24 h thyroid 131I uptake was not significantly different between the two groups under study (17 +/- 12% in cirrhosis patients vs. 25 +/- 10% in normal subjects). However, six patients with hepatic cirrhosis had clearly subnormal (less than 15%) 24 h thyroid radioiodine uptake (normal range 15-47%). The mean increase in 24 h thyroid radioiodine uptake and serum T4 at about 40 h after exogenous TSH (0.1 U/kg body weight i.m.) was lower in liver cirrhosis patients than that in normal subjects, but the difference was not significant statistically.(ABSTRACT TRUNCATED AT 250 WORDS)

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

Abstract: 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.

Hyperpigmentation in Graves' disease.

Abstract: Thirty-two consecutive patients presenting with Graves' disease were divided into two groups, black (Group I) and non-black (Group II), and observed for the occurrence of hyperpigmentation. The overall incidence of hyperpigmentation in subjects with Graves' disease was 38 percent, with 12 of 14 Group I patients and 0 of 18 Group II patients demonstrating this finding. Serum thyroxine was higher in Group I than in Group II. We conclude that hyperpigmentation is common in black patients with Graves' disease.

The thallium-201 time activity curve in thyroid cancer: a role for the detection of metastases.

Abstract: The Tl-201 Cl time activity curves were evaluated in 17 patients with histologically proven benign nodules and papillary carcinoma of the thyroid gland. In the dynamic studies, the uptake at the region of interest was counted every 10 sec for 20 min after the intravenous injection of 2mCi Tl-201 Cl. The curves from frame 21 to 100 were transformed to linear plots for clinical evaluation. Papillary carcinoma could not be differentiated from benign lesions by means of the values of the washout rate. However, the "relative washout rate" in papillary carcinoma was lower than that of benign lesions (P less than 0.05). Although the average values of the "relative extrapolated uptake" in papillary carcinoma appeared to be greater than those in benign lesions, the difference was not statistically significant. The difference in the washout rates between lymph node metastases and local recurrences, and pulmonary metastases of the papillary carcinoma was significant (P less than 0.05).

The effect of thyroidectomy on bone mineral content in perimenopausal women.

Abstract: To examine the effects of total thyroidectomy on skeletal mineral content we performed dual photon densitometry of the spine and hip in 18 patients with well differentiated thyroid cancer treated with total thyroidectomy and post-thyroidectomy 131-I thyroid remnant ablation. Study subjects were 18 Caucasian females, 45-55 years old, no more than 3 years post-menopausal, 4-20 years (mean 9.7) post-thyroidectomy and 131-I ablation. All subjects were free of disease by all criteria and receiving slightly supra-physiological doses of thyroxine. These subjects were compared with 16 carefully age and sex matched controls without thyroid disease. Patients and controls did not differ significantly in: age (mean-range) 50.2 (45-55) vs 48.7 (45-54) years, height 165.1 (152.4-177.8) vs 164.6 (157.5-172.7) cm, or weight 76.7 (49.1-122.7) vs 71.3 (54.5-104.5) kg. Neither did they differ in (mean +/- SEM): serum calcium 9.45 +/- 0.44 vs 9.49 +/- 0.36 mg/dl, serum inorganic phosphate 3.51 +/- 0.67 vs 3.60 +/- 0.43 mg/dl, serum creatinine 0.84 +/- 0.14 vs 0.91 +/- 0.11 mg/dl or PTH 151.7 +/- 71.0 vs 162.4 +/- 52.0 pg/ml. The T12 index was significantly greater in patients on exogenous thyroxine, 12.0 +/- 2.3 vs 8.7 +/- 1.3 (p less than 0.005) although TSH values performed with a standard sensitivity rather than a super sensitive TSH assay were not significantly different 1.8 +/- 0.9 vs 3.2 +/- 1.6 microU/ml. Lumbar vertebral (L2-4) mineral content was not different between patients and controls, 1.245 +/- 0.900 g/cm2 vs. 1.238 +/- 0.166 g/cm2.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-bovine TSH antibodies in patients with Graves' disease and primary myxedema.

Abstract: Three patients with Graves' disease and one patients with primary myxedema had serum TSH-binding immunoglobulins of high affinity detected by the TSH binding inhibition immunoglobulin (TBII) assay. These IgGs bound 61%, 33%, 60% and 53% of radiolabeled TSH, respectively, higher than the maximal specific binding (25%) in the TBII assay. Such binding was detected even in the absence of TSH receptor with only small differences in the precipitable radioactivity (61%, 28%, 61%, 54%, respectively, in comparison with the assay non-specific binding 11.3%). The 125I-bTSH binding of IgGs was competitively inhibited by the addition of bTSH, but not inhibited by hTSH. Moreover IgG binding to bTSH was not inhibited by the addition of serial dilutions of TBII positive pooled Graves' IgG (0.1-10 mg/ml) from different untreated patients. The titers of these TSH binding antibodies were not changed during the treatment of Graves' disease. Following guinea pig fat cell membrane receptor purification, the IgG of one patient with Graves' disease revealed TBII activity of 43.7% inhibition of 125I-bTSH binding to the TSH receptor without binding activity of 125I-bTSH in the absence of the TSH receptor. These studies suggest that anti-TSH antibodies and TSH receptor antibodies are present independent of one another in sera of some patients with autoimmune thyroid diseases and anti-TSH antibodies result in false TBII assay results.

The significance of subnormal, detectable TSH values: laboratory and clinical aspects.

Abstract: In order to establish the significance of subnormal, detectable TSH values in the range 0.05-0.3 mU/L by sensitive immunoradiometric assay, we assessed 3150 consecutive tests of thyroid function in which TSH was measured on 1400. Sixty TSH values (4.3%) fell in this range and in 80% of these the result was confirmed on repeat assay. Conditions associated with subnormal detectable TSH values were treated hyperthyroidism (21), nonthyroidal illness (17), euthyroid multinodular goitre (10), T4 therapy for primary hypothyroidism (7), and pituitary disease (5). At follow-up 2-15 months later, a second sample showed that TSH remained in this range in only 9 of 41 patients (22%). These findings show a frequency of TSH values intermediate between normality and the suppressed values of hyperthyroidism sufficient to compromise the value of sensitive TSH measurement as the single initial test of thyroid function. While TSH values in the subnormal detectable range rule out hyperthyroidism, such results may merit follow-up in goitrous patients, in whom such a finding can precede overt hyperthyroidism.

24 h-kinetics of iodide uptake in amiodarone induced hypothyroidism.

Abstract: Amiodarone induced hypothyroidism (AIH) is assumed to result from a failure of the thyroid to escape from the inhibitory effect of inorganic iodine on its organification as a consequence of uninhibited iodide trapping. This hypothesis was supported by the 24h kinetics of radioiodine uptake in a patient with AIH. 131I uptake reached a maximum after 2h and remained unchanged from 2h to 24h. 131I uptake was in the normal range from 1 1/2h to 7h and clearly subnormal after 9h. The normal early 131I uptake was due to the non inhibition of the iodide-concentrating mechanism and the low 24h radioactivity to the decreased iodide organification. These findings presumably explain the mechanism of AIH.

A preliminary trial of high-dose intravenous immunoglobulin to a patient with euthyroid ophthalmopathy.

Abstract: A patient with serious euthyroid infiltrative ophthalmopathy was treated with oral glucocorticoids for five years. The course of the disorder was characterized by recurrent exacerbations during attempts to reduce the dose of systemic glucocorticoids. Intravenous infusion with high-dose immunoglobulin gave immediately favourable regression of the lesion, without side-effects. Possible modes of action of high-dose immunoglobulin treatment are discussed.

Hashimoto's disease, thyroid lymphoma and splenic atrophy.

Abstract: An elderly woman is described who developed Hashimoto's thyroiditis and, subsequently, thyroid lymphoma more than 15 years after the onset of splenic atrophy. This case supports the concept that splenic atrophy predisposes to the development of autoimmune thyroid disease. The relationship between splenic atrophy and autoimmune thyroid disease is reviewed.