Surgery for Immunogenic Hyperthyroidism

2009 ◽  
Vol 97 (02/03) ◽  
pp. 292-296
Author(s):  
H.-D. Röher ◽  
F. A. Horster ◽  
A. Frilling ◽  
P. E. Goretzki ◽  
J. Witte
Keyword(s):  
Immunogenic Hyperthyroidism

Rezidivrisiko nach thyreostatischer Behandlung immunogener und nicht-immunogener Hyperthyreosen

1990 ◽  
Vol 29 (01) ◽  
pp. 1-6 ◽  
Author(s):  
E. Voth ◽  
N. Dickmann ◽  
H. Schicha ◽  
D. Emrich
Keyword(s):  
Relapse Rate ◽  
Urinary Iodine ◽  
Young Patients ◽  
Antithyroid Drugs ◽  
Urinary Iodine Excretion ◽  
Old Patients ◽  
Primary Disease ◽  
Iodine Excretion ◽  
Immunogenic Hyperthyroidism

Data of 196 patients treated for hyperthyroidism exclusively with antithyroid drugs were analyzed retrospectively concerning the relapse rate within a follow-up period of four years. Patients were subdivided for primary or recurrent disease, and for immunogenic or non-immunogenic hyperthyroidism, respectively. In immunogenic as well as in non-immunogeriic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p <0.001 and 83%, p <0.001, respectively). In patients with primary disease, clinical, biochemical and scintigraphic parameters were tested with respect to their capability of predicting a relapse. For immunogenic hyperthyroidism the highest relapse rates were observed in young patients and in those with large goitres, whereas for non-immunogenic hyperthyroidism they were highest in old patients, in those with nodular goitres and in those without an increased urinary iodine excretion at the time of diagnosing hyperthyroidism.

scholarly journals Változások a pajzsmirigybetegségek radiojódkezelésében

2016 ◽  
Vol 157 (3) ◽  
pp. 83-88
Author(s):  
András Konrády
Keyword(s):  
Multinodular Goiter ◽  
Radioiodine Therapy ◽  
Treatment Protocol ◽  
Treatment Results ◽  
Radioiodine Uptake ◽  
Risk Patients ◽  
Toxic Multinodular Goiter ◽  
Prospective Trials ◽  
Immunogenic Hyperthyroidism ◽  
Recombinant Human Thyrotropin

Radioiodine therapy for benign and malignant thyroid diseases was introduced about 70 years ago, however, there is still a lack of consensus regarding indications, doses and procedure. This review covers treatment results in immunogenic hyperthyroidism including the problem of orbitopathy. Radioiodine therapy for toxic and non-toxic multinodular goiter is also discussed with striking possibility of enhanching the radioiodine uptake. In this respect the recombinant human thyrotropin should be mentioned. Thyroid cancer treatment protocol has changed, too, due to ineffectivity in low-risk patients. More attention is needed to the carcinogenecity of radioiodine. The numerous problems mentioned above require large and well-designed prospective trials to resolve the fundamental questions. The author emphasizes that radioiodine dose should be administered in doses as low as reasonably achievable. Orv. Hetil., 2016, 157(3), 83–88.

Ergebnisse der Radiojod-Behandlung von Patienten mit immunogener und nicht-immunogener Hyperthyreose bei Anwendung unterschiedlicher Herddosen

1988 ◽  
Vol 27 (03) ◽  
pp. 98-104 ◽  
Author(s):  
C. R. Pickardt ◽  
K. Mann ◽  
D. Engelhardt ◽  
C. M. Kirsch ◽  
P. Knesewitsch ◽  
...  
Keyword(s):  
High Rate ◽  
Graves Disease ◽  
Normal Thyroid Function ◽  
Number Of Patients ◽  
Late Morbidity ◽  
Immunogenic Hyperthyroidism ◽  
Rate Of Success ◽  
High Degree ◽  
Recurrent Hyperthyroidism

The aim of this study was to check the efficacy of radioiodine (131I) therapy (RIT) in a large number of patients (n = 506) suffering from immunogenic or non-immunogenic hyperthyroidism (Graves’ disease, Plummer’s disease). Since there is no causal cure for immunogenic hyperthyroidism RIT provides, like all other modalities, only a moderate rate of success which is clearly dose-related. Applying 60 Gy, normal thyroid function can be achieved in only 54% of the cases. A dose of 150 Gy succeeds in 86% of the cases. The solitary decompensated autonomous adenoma (DAA) can be eliminated surgically as well as by RIT with a high degree of success (95%). Contrary to surgery, RIT does not have any noticeable early or late morbidity. The high rate of success of RIT in patients with DAA could be confirmed in two groups with different follow-up periods (16 and 65 months). As expected, the rate of hypothyroidism increased from 11 % in the early group to 23% in the late group. Multinodular autonomous adenomas can be eliminated successfully using RIT as well. The concept to apply a dose of 400 Gy to the total functional autonomous tissue as determined by ultrasound yields better results (95%) than 150 Gy to the whole thyroid gland as measured by ultrasound (88%). The rate of hypothyroidism as shown by these results (up to a maximum of 62% after RIT of Graves’ disease using 150 Gy) is the lesser evil compared to remaining or recurrent hyperthyroidism since these patients can be treated with thyroid hormones without problems.

scholarly journals Does Marine Lenhart Syndrome really exist?

2021 ◽  
Vol 4 (5) ◽  
pp. 01-05
Author(s):  
Essien Francis ◽  
Jacocks Charles ◽  
Elkins Blake ◽  
Tate Joshua
Keyword(s):  
Thyroid Nodules ◽  
Graves Disease ◽  
Autoimmune Phenomenon ◽  
Common Causes ◽  
Toxic Multinodular Goiter ◽  
Immunogenic Hyperthyroidism ◽  
Plummer's Disease ◽  
Definition Of ◽  
Plummer’S Disease ◽  
Primary Hyperthyroidism

Primary hyperthyroidism is the result of overproduction of thyroid hormone resulting in the classic symptoms of tachycardia, weight loss, diaphoresis, and hyperdefecation. There are multiple common causes to include Graves’ disease, toxic multinodular goiter, and solitary toxic adenomas. Marine Lenhart Syndrome (MLS) is a rare cause of hyperthyroidism, caused by a coexistence of constitutively active thyroid nodules and Graves’ disease. In the original document of Marine and Lenhart, there is no distinction made between the autoimmune phenomenon of Graves’ disease and the solitary toxic nodule of Plummer’s disease. Rather they are both considered to be the manifestation of the same disease. However, in the current era of radionuclide technology, a clear distinction of MLS can be seen with diffuse uptake in the thyroid gland and focused enhancement in the toxic nodules. Therefore what was previously described as one entity is now distinct as Graves’ disease and Plummer’s disease. It is also becoming increasingly clear within the literature that there is also a new phenomenon of post-radioiodine immunogenic hyperthyroidism in patients with toxic nodules and elevated autoantibodies. Therefore in order to properly treat and manage patients, a new definition of MLS may need to be proposed.

Ergebnisse der Radiojodtherapie der manifesten Hyperthyreose und der autonomen Struma mit Euthyreose

1990 ◽  
Vol 29 (04) ◽  
pp. 158-165 ◽  
Author(s):  
G. Berding ◽  
H. Schicha
Keyword(s):  
Thyroid Surgery ◽  
Dose Calculation ◽  
Additional Treatment ◽  
High Rate ◽  
Antithyroid Drugs ◽  
High Recurrence Rate ◽  
Graves Disease ◽  
Applied Dose ◽  
Immunogenic Hyperthyroidism ◽  
One Year

In 200 patients follow-up examinations were performed up to one year after radioiodine therapy (RITh) with individual dose calculation. The mean applied dose was significantly lower in patients with immunogenic hyperthyroidism (Graves’ disease) as compared to patients with non-immunogenic hyperthyroidism (disseminated/multifocal autonomy, HYDA). In Graves’ disease the rate of recurrent hyperthyroidism was significantly higher and that of posttreatment hypothyroidism lower. Considering the high recurrence rate in Graves’ disease a higher dose, e. g. 150 Gy, seems to be appropriate. In patients with HYDA who received antithyroid drugs during RITh, recurrence of hyperthyroidism appeared slightly more, and posttreatment hypothyroidism slightly less, frequent. The efficiency of RITh was not significantly reduced by additional treatment with antithyroid drugs. Posttreatment hypothyroidism in patients with euthyroid goiter and disseminated/multifocal autonomy (EUDA) occurred significantly more frequent if the basal TSH level was ≥0.5 µlE/ml before therapy. The goiter size was reduced independent of the basal TSH level. In this group protection by thyroxine could avoid posttreatment hypothyroidism without impairing the reduction of goiter. In HYDA patients after thyroid surgery recurrence appeared less, and in those with EUDA posttreatment hypothyroidism significantly more, frequent. A lower dose seems to be suitable in patients who underwent thyroid surgery before. In patients with focal autonomy after RITh no recurrence of hyperthyroidism was observed. In 9% a suppressed basal TSH level indicating persistent autonomy was seen. Posttreatment hypothyroidism in focal autonomy appeared only in patients without manifest hyperthyroidism before RITh and was significantly more frequent in this group as compared to the other groups of patients. In patients with focal autonomy who developed hypothyroidism the dose calculation was based on a significantly higher volume of the adenoma. In 3 cases cystic parts of the adenoma were not subtracted. This caused a higher radiation dose to the paranodular tissue, which might have been one reason for the high rate of posttreatment hypothyroidism in this group of patients.

Improving treatment outcomes for Graves’ disease patients with inactive forms of Graves’ orbitopathy through an increased dose of radioiodine therapy

2020 ◽  
Vol 59 (03) ◽  
pp. 260-268 ◽  
Author(s):  
Janika Gosmann ◽  
Diana Willms ◽  
Eberhard Bell ◽  
Mathias Schreckenberger ◽  
Arnulf Willms
Keyword(s):  
Radioiodine Therapy ◽  
Research Question ◽  
Graves Disease ◽  
Main Research ◽  
Inactive Form ◽  
Patient Groups ◽  
Graves Orbitopathy ◽  
Immunogenic Hyperthyroidism ◽  
Iodine 131 ◽  
First Time

Abstract Introduction While surgical treatment is preferred for Graves’ disease with active forms of GO, there are various concepts for treating inactive forms of GO. The goal of radioiodine therapy is to resolve immunogenic hyperthyroidism by damaging the thyroid cells.The effects of the radioiodine dose on an associated inactive GO remain unclear, however. Methodology We conducted a retrospective analysis of 536 patients who received first-time radioiodine therapy to treat Graves’ hyperthyroidism. Patients without GO always received 200 Gy of iodine-131. Before the introduction of a differentiated treatment concept, patients with GO also received 200 Gy, while afterwards they received 300 Gy. For further analysis, we formed three patient groups based on GO diagnosis and administered radiation dose and compared their results. The main research question focused on the effect of an increased dose on Graves’ orbitopathy. The sub-questions addressed the resolution rate achieved with the higher dose as well as the development of GO in patients who received radioiodine therapy. Results The results show that GO symptoms were improved after radioiodine treatment in 68.5 % of patients treated with 300 Gy but only in 47.5 % of the patients treated with 200 Gy (p = 0.003). While in the 300 Gy group, hyperthyroidism was resolved in 93.2 % of patients, this was achieved in only 68.8 % of patients in the 200 Gy group (p </= 0.001). Discussion Especially with an inactive form of GO profit from their hyperthyroidism being quickly and sufficiently resolved. This is achieved significantly better by administering 300 Gy instead of 200 Gy. For this reason, data analysis supports a differentiated dose concept that provides 300 Gy for patients with GO and 200 Gy for patients without GO.

Separation of Autonomous Function from Cell Density in Non-Immunogenic Hyperthyroidism

1996 ◽  
Vol 35 (01) ◽  
pp. 12-19 ◽  
Author(s):  
H. Rosier ◽  
Maria Listewnik ◽  
Claudine Als
Keyword(s):  
Cell Density ◽  
Critical Mass ◽  
Cell Mass ◽  
Density Ratio ◽  
Primary Hypothyroidism ◽  
Autonomous Function ◽  
Before And After ◽  
Immunogenic Hyperthyroidism ◽  
And Function ◽  
Double Isotope

SummaryRegional 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 prethera-peutic evaluations and aRIT quality control.

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