Showing papers on "Propylthiouracil published in 2004"

Propylthiouracil reduces the effectiveness of radioiodine treatment in hyperthyroid patients with Graves' disease.

Abstract: In order to assess the effect of propylthiouracil (PTU) or methimazole (MMI) pretreatment on patient outcome after radioiodine therapy, we examined 100 patients with Graves' disease 3, 6, 9, and 12 months after administration of a 10-mCi standard single dose of 131I. They were assigned to one of three groups: no drug (ND) treatment (30 cases); MMI (45 cases); and PTU (25 cases). Antithyroid drugs (ATD) were withdrawn 15 days before radioiodine administration. The groups were similar concerning age, gender, ATD pretreatment duration, goiter size, and initial serum triiodothyronine (T3), thyroxine (T4), free thyroxine (FT4), antithyroid autoantibody levels, 24-hour radioiodine uptake and 131I dose administered per gram of thyroid tissue. ND and MMI groups presented a similar rate of cure of 73.3% and 77.8% respectively (p = NS). In contrast, the PTU group showed a rate of cure of only 32% (p < 0.05). Logistic regression analysis indicated that PTU administration (p = 0.003) and thyroid size (p = 0.02) were the variables related to radioiodine therapy failure. Our data demonstrate that the chance of 131I treatment failure is higher in individuals using PTU than in patients using MMI or not using any ATD before radioiodine (odds ratio [OR] 5.84; 95% confidence interval [CI] 1.82-18.76) suggesting that PTU should be avoided in the treatment of patients with Graves' disease.

Rapid Preoperative Preparation for Severe Hyperthyroid Graves’ Disease

Abstract: Thyroidectomy (TX) is no longer the preferred choice for the therapy of hyperthyroid Graves’ disease but is an alternative in patients who are noncompliant with or have reactions to antithyroid drugs, have moderate to severe ophthalmopathy, have large goiters, or who refuse 131I therapy and/or long-term antithyroid drug therapy. Seventeen clinically and biochemically severely thyrotoxic patients (16 female, mean age of 35 yr), all but one with large goiters, underwent TX after rapid preparation. The potent inhibitors of the deiodination of T4 to T3, iopanoic acid (IOP) (500 mg twice a day) and dexamethasone (DEX) (1 mg twice a day), were given with propylthiouracil or methimazole, when possible, and β-blockers. Thyroid function tests were obtained before treatment and at TX. All patients were thyrotoxic (mean ± se: T4, 21.6 ± 1.2 μg/dl; free T4 index (FTI), 10.3 ± 0.8; total T3, 510 ± 48 ng/dl). IOP and DEX rapidly lowered T3 values (P < 0.0001; total T3, 147 ± 13 ng/dl) with a smaller but significant (P ...

Protective Effect of Propylthiouracil Independent of Its Hypothyroid Effect on Atherogenesis in Cholesterol-Fed Rabbits PTEN Induction and Inhibition of Vascular Smooth Muscle Cell Proliferation and Migration

Abstract: Background— Propylthiouracil (PTU) is used to treat hyperthyroid patients by its hypothyroid effect. PTU also is found to have potent antioxidant and immunosuppressive effects. These findings suggest that PTU may play a role in the prevention of atherosclerosis. Methods and Results— This study evaluates the effect of PTU on atherosclerotic change in rabbits fed a high-cholesterol diet. The pronounced atherosclerotic lesions in the aortas of rabbits fed a 2% cholesterol diet for 12 weeks were significantly attenuated by the concurrent addition of 0.1% PTU to the drinking water. However, exogenous supplementation of thyroid hormone in hypothyroid PTU-treated rabbits did not abrogate the protective effect of PTU on atherogenesis. Immunohistochemical analysis showed that PTU administration apparently reduced the intimal smooth muscle cell/macrophage ratio in the atherosclerotic plaques of rabbits fed a 2% cholesterol diet. In vitro, the addition of PTU to the medium of cultured rat vascular smooth muscle cell...

Comparison of single daily dose of methimazole and propylthiouracil in the treatment of Graves’ hyperthyroidism

Abstract: Objective The present study was to compare the efficacy of a single daily dose of methimazole (MMI) and propylthiouracil (PTU) in the treatment of Graves' hyperthyroidism. Background Antithyroid drugs, MMI and PTU, are widely used in the treatment of hyperthyroidism. Previous studies in the treatment of hyperthyroidism with a single daily dose of antithyroid drugs have demonstrated a more favourable result with MMI. However, the efficacy of a single daily dose of PTU was inconsistent. In this study, we examined the therapeutic efficacy of single daily doses of MMI and PTU on the change of thyroid hormones and thyrotropin receptor antibodies (TRAb) levels. Methods Thirty patients with newly diagnosed Graves' hyperthyroidism were randomly divided into two groups, each receiving a single dose of either 15 mg MMI or 150 mg PTU daily for 12 weeks. The therapeutic efficacy was determined by serum total triiodothyronine (TT3), total thyroxine (TT4), thyrotropin (TSH), free thyroxine (FT4), and TRAb levels at baseline and at the end of 4, 8 and 12 weeks during the study period. Results There was no significant difference in baseline thyroid function parameters. Serum TT3, TT4 and FT4 levels in the MMI-treated group were significantly lower than those of the PTU-treated group after 4 weeks and through the end of the study. MMI also has superior effect on reducing serum TRAb levels than PTU after 8 weeks and at the end of the study. Conclusion During the 12-week treatment of Graves' hyperthyroidism, a single daily dose of 15 mg MMI was much more effective in the induction of euthyroidism than a single daily dose of 150 mg PTU. In the doses used in this study, MMI is preferable to PTU when a once-daily regimen of antithyroid drug is considered for the treatment of Graves' hyperthyroidism.

A case of propylthiouracil-induced pyoderma gangrenosum associated with antineutrophil cytoplasmic antibody.

Abstract: A 27-year-old woman who had been receiving propylthiouracil for 2 years for Graves’ disease presented with painful ulceration on the lower limbs which had first appeared 2 weeks previously. Well-circu

Plasmapheresis in the treatment of hyperthyroidism associated with agranulocytosis: A case report.

Abstract: Plasmapheresis, also known as therapeutic plasma exchange, is used in the treatment of several disorders. Temporary improvement after plasmapheresis in cases with thyrotoxicosis has been reported. A 55-year-old woman presented with agranulocytosis induced by propylthiouracil and clinical signs of heart failure. Three sessions of plasmapheresis were performed. We observed an improvement of thyroid hormone levels and clinical findings as well. Plasmapheresis can be an option when drug treatment of thyrotoxicosis fails.

Thyroid Hormone Resistance in the Heart: Role of the Thyroid Hormone Receptor β Isoform

Abstract: Several cardiac genes possess thyroid hormone (TH) response elements regulated by TH receptors. Mutation in TR-beta gene causes the human syndrome of resistance to TH, which is characterized by elevated serum concentration of T(4) and T(3) and variable degrees of insensitivity to TH. It is unclear, however, whether a mutant TR-beta could function as a dominant negative in the heart when expressed from the endogenous locus. A well-described resistance to TH (Delta337T) was either introduced into germline of mice (KI-mut) or expressed as a transgene in the heart using a cardiac-specific promoter (KS-mut). Mice were studied at baseline, after 5-propyl-2-thiouracil (PTU) or after PTU and T(3) treatment (PTU + T(3)). PTU + T(3) treatment significantly increased left ventricular mass in all groups compared with baseline measurements, although the increase in left ventricular mass was significantly less in KI-mut animals. Baseline heart rates (HRs) were similar in wild-type (WT) and KI-mut but were lower in KS-mut animals. After TH deprivation (PTU), HR decreased in WT and KI-mut animals; similarly, HR increased in WT and KI-mut after PTU + T(3). In contrast, HR in KS-mut animals did not change after either treatment. Except for cardiac hypertrophy, the presence of a germline TR-beta mutation had surprisingly little effect on cardiac function.

Impact of thyroid hormone deficiency on the developing CNS: cerebellar glial and neuronal protein expression in rat neonates exposed to antithyroid drug propylthiouracil.

Abstract: The developing rat cerebellum is vulnerable to thyroid hormone (TH) deficiency. The present study addresses the molecular mechanisms involved in this response. Specifically, the study focuses on the expression of selected cerebellar proteins that are known to be directly [protein expressing 3-fucosyl-N-acetyl-lactosamine antigen (CD15), neuronal cell adhesion molecule (L1)] or indirectly [glial fibrillary acidic protein (GFAP)], involved in glial-neuronal interactions and thus regulation of cell proliferation and granule cell migration. Cerebellar mass, structure, and protein expression in rat neonates exposed to antithyroid drug propylthiouracil (PTU) from the embryonic day (E) 16 to postnatal day (P) 21 were compared against rat neonates that received replacement of thyroxin (T4) starting on day P1 or untreated controls. Cerebellar proteins were analyzed by quantitative Western blots. PTU-treated rats lagged in growth and showed reduction in cerebellar mass and alterations in cerebellar structure on P15. Daily treatment of neonates with T4 restored normal cerebellum-to-body-mass ratio, cerebellar structure, and cerebellar protein expression. Densitometric analysis of Western blots revealed altered expression of selected proteins in the cerebella of hypothyroid neonates. A decrease of CD15 (46%, p = 0.031) was observed on P10 and was accompanied by a decrease in GFAP expression (64%, p = 0.039). Furthermore, a shift in the developmental GFAP profile was observed in the PTU-treated cerebellum. L1 expression was not significantly affected in the hypothyroid cerebellum. Altered expression of cerebellar proteins is likely to affect cell-cell interactions and consequently cell proliferation and migration and contribute to structural and functional alterations seen in the hypothyroid rat neonates.

p16 expression in psoriatic lesions following therapy with propylthiouracil, an antithyroid thioureylene.

Abstract: Plaque formation is a characteristic finding in patients with psoriasis and reflects cytokine-induced keratinocyte proliferation and/or impaired apoptosis of keratinocytes. Antithyroid thioureylenes such as propylthiouracil (PTU) and methimazole (MMI) are effective in the treatment of plaque psoriasis. Following PTU and MMI treatment, proliferative cell nuclear antigen (PCNA) expression is significantly reduced, suggesting that these medications have an antiproliferative effect. p16 is an antiapoptotic protein that is present in relative abundance in psoriatic plaques and is believed to play a potential role in the persistent senescence and impaired apoptosis of the keratinocytes in the plaque. This study examined p16 expression in biopsy samples of eight patients with plaque psoriasis given 300 mg of propylthiouracil in divided doses for 3 months. Despite significant clinical and histological improvement with PTU treatment, p16 expression was essentially unchanged, suggesting that the beneficial effect of PTU in psoriasis is not mediated through a decrease in p16 expression. The effect of PTU on other antiapoptotic proteins such as bcl-x L remains to be determined.

Serum TNF-α in psoriasis after treatment with propylthiouracil, an antithyroid thioureylene

Abstract: Tumor necrosis factor-α (TNF-α) and its receptors play important roles in the development and persistence of psoriatic plaques. The antithyroid thioureylenes, propylthiouracil and methimazole, are effective in the treatment of patients with psoriasis with a significant number of patients showing clearing or near clearing of their lesions after a several weeks of treatment. The present study examined the effect of treatment with propylthiouracil, given in a dose of 100 mg every 8 hours for 3 months, on the serum levels of TNF-α in 9 patients with plaque psoriasis. Propylthiouracil therapy did not result in a significant decline in serum TNF-α concentrations. The findings suggest that the therapeutic effect of propylthiouracil in psoriasis appears not to be related to any change in the concentration of TNF-α but occurs via an anti-proliferative mechanism as we have previously speculated.

Successful treatment of hyperthyroidism with amiodarone in a patient with propylthiouracil-induced acute hepatic failure.

Abstract: Acute hepatic failure is a rare and potentially lethal complication of propylthiouracil (PTU) use for hyperthyroidism. We present a 20-year-old woman with Basedow-Graves' disease who developed PTU-induced fulminant hepatitis, which progressed to acute hepatic failure with grade III hepatic encephalopathy. Laboratory evaluation ruled out the most common causes of fulminant hepatitis. We treated her hyperthyroidism with amiodarone (average daily dose, 200 mg) for 3 weeks, achieving rapid and persistent euthyroidism, (triiodothyronine [T(3)] levels ranged between 64 and 109 ng/dL) without side effects. Amiodarone treatment did not abolish the thyroid radioactive iodine uptake (RAIU), allowing for subsequent treatment with radioactive iodine. The clinical course was favorable and the patient achieved full hepatic recovery 3 months after the hepatic failure was detected. After an extensive review of the literature, we believe that this is the first communication of the successful use of amiodarone to control hyperthyroidism in a patient with PTU-induced fulminant hepatitis.

Safety of medications and hormones used in the treatment of pediatric thyroid disorders.

Abstract: Levo-thyroxine (L-T4) is used to treat children with any form of hypothyroidism. In fact, L-T4 is the natural hormone and the principal product secreted by the thyroid. It is then converted into T3, the active compound at the tissue level, according to the temporary needs of the organism. Therefore, L-T4 can replace thyroid function in hypothyroid patients on a physiological basis. L-T4 administration is a safe and beneficial treatment that can be easily monitored by the concomitant measurement of TSH and free thyroid hormone levels. Antithyroid drugs (methimazole [MMI], carbimazole [CMI] and propylthiouracil [PTU]) are the initial treatment of choice for most children with hyperthyroidism, which is most commonly caused by Graves' disease. While generally similar in efficacy and safety, there are some differences. MMI and CMI have a longer half-life and so can be given once daily, improving compliance in children. At low doses, there are fewer side effects with MMI and CMI compared to PTU. Drug-related hepatitis and vasculitis are almost exclusively seen with PTU. Beta-adrenergic antagonists are safe adjunctive therapy. In specific situations, e.g., in preparing for thyroid surgery, iodine for a limited time is used to inhibit thyroid hormone secretion and reduce gland vascularity.

[The clinical characteristics of symptomatic propylthiouracil-induced hepatic injury in patients with hyperthyroidism].

Abstract: OBJECTIVE To study the clinical characteristics and factors of symptomatic propylthiouracil (PTU)-induced hepatic injury in patients with hyperthyroidism. METHODS A retrospective study of the patients diagnosed with symptomatic PTU-induced hepatic injury, admitted to Peking Union Medical College (PUMC) Hospital from January 1993 to December 2002, were carried out with regard to clinical characteristics, laboratory findings and management. In addition, a comparative study was carried out in hyperthyroidism with symptomatic, asymptomatic and without PTU-induced hepatic injury at the same time. Symptomatic PTU induced hepatic injury was defined as the development of hepatitis symptoms or jaundice with at least 3-times elevation of liver function test without other causes. RESULTS Nine hundred fourteen patients were admitted to PUMC Hospital from January 1993 to December 2002. Clinically overt symptomatic hepatic injury developed in twelve patients [1.3%, age (30 +/- 9) yr, male:female ratio, 1:11] between 7 and 77days after PTU administration. Abdominal distention and fatigue developed in all patients. Serum level of ALT and total bilirubin (TBil) increased to (531.7 +/- 352.0) 113 - 1425 U/L and 67.6 (17.1 - 567.7) micro mol/L, respectively. Prothrombin time prolonged in three cases and plasma ammonia elevated in one case. The types of hepatic injury were hepatocellular in eight, cholestatic in one and mixed in two. None resulted from viral hepatitis and autoimmune hepatitis. There was significant difference in history of side effects of antithyroid agents, PTU dose and abnormal ratio of serum ALT among patients with symptomatic, asymptomatic and without hepatic injury (P < 0.05). However, there were no statistic differences in age, sex, serum levels of T(4), T(3), and increased thyroglobulin antibody, thyroid peroxidase antibody and thyrotrophin receptor antibody at initial diagnosis. The liver function test normalized in all patients from 14 to 140 days after the PTU withdrawal. CONCLUSIONS Symptomatic hepatic injury usually develops with PTU administration in the first few months, though it is unusual. It may be difficult to predict its development and the patient should be monitored for the liver function in the early stage of PTU administration.

Clinical aspects of hyperthyroidism in hospitalised patients in Albania.

Abstract: The purpose of this study was to evaluate certain clinical aspects of hyperthyroidism in Albania, which is an iodine deficient country, as it is known that iodine intake may influence the type of thyroid hyperfunction. The files of sixty-six patients with thyrotoxicosis who were hospitalised for their disease were retrospectively analysed. 59.1% of these patients suffered from toxic multinodular goiter, 27.3% from Grave's disease (toxic diffuse goiter), 10.6% from toxic adenoma, 1.5% from iodide-induced hyperthyroidism and 1.5% from transient hyperthyroidism due to subacute thyroiditis. There was an increased female to male ratio (83.3% vs 16.7%, respectively, p<0.001). 83.9% of all hyperthyroid patients lived in cities, while 16.1% lived in villages. Ophthalmopathy was found in 11.1% of patients with Graves' disease, and thyrotoxic heart disease was found in 14% of patients with thyrotoxicosis. 71.9% of all patients with hyperthyroidism were treated with propylthiouracil (PTU), while 28.1% of them were treated with methimazole; 67.2% of all these patients also received propranolol hydrochloride, while 32.8% were prescribed atenolol. Compliance was lower than that reported in other studies as only 41% of all patients received their treatment regularly. Side effects from treatment with antithyroid drugs were as follows: 4.1% (2/48) of patients treated with propylthiouracil presented leukopenia with agranulocytosis, and 6.1% of them toxic hepatitis, while 11.1% (2/18) of patients treated with methimazole presented agranulocytosis. In conclusion, the mode of presentation and side effects of hyperthyroidism appears to be different in Albania when compared with other countries, probably as a result of iodine deficiency and/or possibly nutritional status. Compliance with treatment is lower than that reported in other series, while antithyroid drug side effects seem to be more frequent. The latter observation may be due to the fact that only hospitalised patients were analysed in this study.

[Propylthiouracil-induced overt hepatic injury in patients with hyperthyroidism].

Abstract: OBJECTIVE To study the incidence, clinical features and related factors of propylthiouracil (PTU)-induced hepatic injury in patients with hyperthyroidism. METHODS A prospective study were carried out in 70 patients of hyperthyroidism with normal liver function. Every patient was treated with PTU 300 mg/d until the thyroid functions recovered to normal, following by decease and maintenance PTU dose in period of six months. Liver function, including serum levels of alanine aminotransferase (ALT), alkaline phosphatase (ALP), aspartate aminotransferase (AST), total bilirubin (TBIL) and direct bilirubin (DBIL), thyroid function (serum thyroxine, triiodothyronine, free thyroxine, and free triiodothyronine and thyrotropin) and blood routine items were measured before therapy and once a month for six months after PTU therapy was begun. RESULTS Sixty-four cases of 70 patients completed the therapy for 6 months. Hepatic injury developed in 33 patients (51.6%). Asymptomatic, transient hepatic injury was shown in 22 patients (34.4%). Slight symptomatic hepatic injury occured in 6 cases (9.4%) and overt hepatic injury in 5 patients (7.8%) after PTU administration. However, all the patients who developed overt hepatic injury did not stop PTU. Hepatic function returned normal one month after stopping PTU. No one finally suffered from viral hepatitis and autoimmune hepatitis in patients of symptomatic and overt hepatic injury. CONCLUSIONS PTU-induced symptomatic hepatic injury is not rare and usually develops within the first few months of PTU administration. Its clinical course is relatively benign. However, it may be difficult to predict its development, so all patients should be monitored for liver function test during the administration in early stage.

Blood profile of hypothyroid castrated or intact adult female rats

Abstract: The relationship between thyroid-gonads on the blood profile was investigated in adult Wistar female rats. These animals were either castrated or intact and were kept under hypothyroidism, induced by daily administration of propylthiouracil (PTU) during 120 days. Two groups (castrated and intact) were kept in an euthyroid condition and used as controls. It was collected plasma for free T4 dosage and blood for hematological analysis. The significant low values of free T4 in the treated rats confirmed their hypothyroid state. The hypothyroidism caused anemia in the rats with functional gonads. The castration reverted the effects of thyroxine deficit in the erythrogram. Both the hypothyroidism and the hypogonadism showed just a discret effect on the leucogram.

Thyroid cell proliferation in Graves' disease. Use of MIB-1 monoclonal antibody.

Abstract: OBJECTIVE: To measure thyroid cell proliferation in patients with Graves' disease (GD) before and during treatment with antithyroid drugs STUDY DESIGN: Patients were assessed by fine needle aspiration biopsy before (n=20) and after 4 (n=19) and 12 months of treatment (n = 15) with propylthiouracil or methimazole Cell proliferation index (CPI) was estimated by immunocytochemistry using MIB-1 CPI was studied in relation to the cytologic parameters of the smears; clinical parameters, such as Wayne's Clinical Index (WCI) and time without treatment; laboratory parameters, such as 131 I uptake and dosage of serum free thyroxin and thyroidstimulating hormone; and thyroid ultrasound RESULTS: CPI varied from 000% to 2500% before treatment, 000% to 2300% at 4 months and 000% to 1484% at 12 months CPI median values were 650%, 430% and 330%, respectively (before and after 4 months and 12 months of treatment) CPI had a positive correlation with WCI and FT4 at 12 months of treatment CONCLUSION: Thyroid CPI in GD varies from case to case However, due to its decreasing pattern during follow-up and its positive correlation with thyrotoxicosis severity, CPI may indicate the functional status of the gland and contribute to a better understanding of GD

[Thyrotoxic crisis in a patient with Graves' disease].

Abstract: A 33-year-old man presented with diarrhoea, dyspnoea, palpitations, fever and shock. One year and a half before admission, Graves'-hyperthyroidism had been diagnosed, for which he was treated with thiamazole and levothyroxine as block-replacement therapy. A diagnosis of thyrotoxic crisis, precipitated by lack of compliance with antithyroid drug therapy and possibly an underlying infection, was made. Euthyroidism was achieved with propylthiouracil, potassium iodide, corticosteroids and propranolol. However, the propylthiouracil had to be stopped due to agranulocytosis, after which hyperthyroidism recurred. An emergency thyroidectomy was then performed; the patient recovered completely. Thyrotoxic crisis is a rare, potentially life-threatening disease in patients with underlying un(der)treated hyperthyroidism. It is characterised by fever, tachycardia, and neurological and gastrointestinal symptoms.

Propylthiouracil‐induced asthma

Abstract: Propylthiouracil (PTU) is widely used in the treatment of hyperthyroidism. Many side-effects of the drug have been reported, such as transient granulocytopenia, hepatitis and vasculitis. These adverse effects of the drug are of critical importance in the clinical management of patients. Recognition of possible side-effects and delineation of their pathogenesis are of considerable value. In this report, we present a hyperthyroid patient, who developed asthmatic attacks with PTU treatment. A 43-year-old Vietnamese woman complained of insomnia, fatigue, poor appetite, heat intolerance, hand tremors and losing weight (12 lbs) over the last 4 months. She had no history of allergy to drugs or food. She denied neither smoking nor drinking alcohol. Her past medical history was unremarkable, except for two C-sections. On physical exam, she was found to have a diffuse enlargement of the thyroid gland. The laboratory data revealed as follows: leucocytes, 7.1 · 10/mm (normal: 5–10); triiodothyronine uptake (T3-uptake), 41% (normal: 22–37); thyroxine by the radioimmunoassay (T4RIA), 19.9 mcg/dl (normal: 5–15); free thyroxine index (FTI), 8.2 (normal: 1.5–4); triiodothyronine by the radioimmunoassay (T3RIA), 409 ng/dl (normal: 86–187); thyroid-stimulating hormone (TSH), <0.1 mIu/ml (normal: 0.2–5); thyroglobulin (Tg), 28 ng/ml (normal: 0–60); anti-microsomal autoantibodies (AMA), <0.1 U/ml (normal: <0.3); anti-thyroglobulin autoantibodies (ATA), <0.1 U/ml (normal: <0.3). The ultrasonography of thyroid gland revealed a homogenous thyromegaly (right lobe, 5.7 · 1.6 · 2.5 cm and left lobe, 5.2 · 1.7 · 2 cm) and no focal nodule. She was treated with PTU 100 mg, twice a day. Two months later, she experienced the episodic wheezing and dyspnoea. Her thyroid function tests were as follows: T3U of 44.9%, T4RIA of 10.9 mcg/dl, T3RIA of 240 ng/dl, FTI of 4.9, and TSH of 0.02 mIu/ml. Her leucocytes decreased to 4.3 · 10/mm. The pulmonary function tests showed an airflow obstruction with forced vital capacity (FVC) of 0.95 l (38.8% predicted) and forced expiratory volume in 1 s (FEV1) of 0.9 l (43.4% predicted), and there was a partial reversal of the airway obstruction following the administration of inhaled b2 agonist medication, FVC of 1.4 l (57.1% predicted) and FEV1 of 1.32 l (63.5% predicted). Her chest X-ray was unremarkable. She was started on oral theophylline, prednisone and inhaled b2 agonist medications. Her asthma attacks, however, improved since she was rendered in a euthyroid state and discontinued taking PTU. Her thyroid function tests were as follows: T4RIA of 7 mcg/dl, T3U of 32%, FTI of 2.2, T3RIA of 98 ng/dl, TSH of 1 mIu/ml, AMAof<0.1 U/ml, ATAof<0.1 U/ml, and Tg of 11 ng/ml. The development of asthmatic attacks in our hyperthyroid patient might suggest a relationship between these two diseases. Our previous paper (1) has addressed these problems. Nakazama and Kobayashi (2) found no apparent uniform influence on the severity of asthma in patients with both diseases. Moreover, asthmatic attacks occurred after our patient received PTU treatment which might suggest that PTU might have a role in causing asthma. PTU selectively accumulates in neutrophils (3) and binds to myeloperoxidase; the result is a change in the haem structure of the enzyme (4). D’Cruz et al. (5) suggested that PTU could alter myeloperoxidase by oxidation in a minority of susceptible persons. The altered enzymes, possibly still complexed with the drug, could stimulate other neutrophils to degranulate and lead to the release of lytic enzymes and toxic species of oxygen. Many side-effects of the drug have been reported in particular pulmonary cavitation, interstitial pneumonitis, eosinophilic pleuritis, alveolar haemorrhagic, and adult respiratory distress-like syndrome (6). Hypersensitivity vasculitis associated with PTU is a well-documented clinical entity. The disease improved after the discontinuation of PTU therapy or the administration of glucocorticoids (or both), as was found in our patient. In conclusion, the complex occurrence of PTU-induced asthma is rare but possible. These symptoms may be a hypersensitivity phenomenon.

[Current topics on immunological laboratory tests-thyroid diseases].

Abstract: Current topics in the field of thyroid disease are the development of the second generation assay for TSH receptor antibody (TRAb) using recombinant human TSH receptor and the appearance of antineutrophil cytoplasmic antibodies(ANCA) in Graves' disease patients treated with propylthiouracil(PTU). This new TRAb assay is very useful, since the sensitivity and the specificity were almost 100%, respectively, in the diagnosis of Graves' disease. Furthermore, a new coated tube assay for the detection of blocking TRAb has been developed by using TSH/LH receptor chimera. The prevalence of ANCA is high in Graves' disease patients treated with PTU, but the clinical significance of ANCA is under controversy, since only a part of them develop vasculitis, and recently it has been reported that ANCA is frequently positive in Graves' disease patients before the onset of methimazole treatment. The 7th version of guidelines for the diagnosis of thyroid disease have been prepared by the Japan Thyroid Association, and opens to public inspection. They show the importance of immunological laboratory tests in this field.

Effects of antithyroid medication on the flow-volume loop in patients with hyperthyroidism.

Abstract: This prospective study was designed to evaluate the effects of hyperthyroidism on flow-volume loops in nonasthmatic 20 patients with hyperthyroidism. Thyroid related hormones (Total T3, Total T4 and TSH), thyroid gland volumes with ultrasonography, circumference of neck values and flow-volume loops were obtained at the beginning and after three months of antithyroid treatment. Propylthiouracil treatment was followed by a statistically significant decrease in thyroid gland volume and circumference of neck (p< 0.001 and p< 0.001, respectively). The most significant result was improvement of maximum midexpiratory flow rate (MMEFR) after propylthiouracil therapy for three months (p= 0.003). Increases in mean forced expiratory flow after 25% of FVC has been exhaled (FEF25), mean forced expiratory flow after 75% of FVC has been exhaled (FEF75) values were found consistent with the overall improvement in expiratory flow parameters (p= 0.044, p= 0.012 respectively). In conclusion, we speculated that improvement of expiratory flow parameters might be the earlier changes in flow volume loops of patients who were treated with propylthiouracil for hyperthyroidism.