Kosten-Effektivitäts-Analyse: Radioiod oder thyreostatische Medikation bei der Primärbehandlung der Immunhyperthyreose

1999 ◽  
Vol 38 (01) ◽  
pp. 7-14 ◽  
Author(s):  
D. Moka ◽  
Birgit Dederichs ◽  
Elke Hunsche ◽  
K. W. Lauterbach ◽  
H. Schicha ◽  
...  
Keyword(s):  
Technetium Uptake

Zusammenfassung Ziel: Die Erstmanifestation einer Immunhyperthyreose wird in Europa überwiegend thyreostatisch, in den USA mehrheitlich mit Radioiod definitiv behandelt. Diese beiden Alternativen wurden auf dem Hintergrund neuer nationaler Entlassungsrichtwerte nach einer Radioiodtherapie (RITh) verglichen. Methode: Aus Sicht der Gesellschaft entscheiden einerseits die langfristigen Rezidivraten, andererseits die Menge medizinischer Leistungen, der Versicherungsstatus und der Produktivitätsausfall des Patienten (Fehlzeiten, Einkommen) sowie die zeitliche Verteilung der Kosten (Diskontierung) über die Kosten-Effektivität. Lebenszeitbezogen wurden die medizinischen Leistungen auf 30 Patientenjahre hochgerechnet. Die Kosten der RITh basierten auf 300 Patienten, deren Entlassung bei 250 MBq lod-131-Restaktivität angenommen wurde. Ergebnis: Kosteneffektivität der konservativen Behandlung war bei einer Rezidivrate von 50% oder günstiger, bei einem Leistungsumfang gemäß den Empfehlungen der Fachgesellschaften und bei einem Zeiteinsatz des Patienten für eine ambulante Untersuchung von einem Viertel seines Arbeitstages oder kürzer zu erwarten. Sofern diese Annahmen nicht vorlagen, wurde die primäre RITh in 1593 von 1944 durchgeführten Modellrechnungen zur kosteneffektiven Entscheidung. Konservative Therapieversuche der Rezidivhyperthyreose besaßen eine stark kostenhebende Wirkung. Schlußfolgerung: Für die Patienten mit erhöhter Rezidivwahrscheinlichkeit im Falle der konservativen Behandlung (Struma, jüngeres Lebensalter, persistierend erhöhte TSH-Rezeptor-Antikörper beziehungsweise erhöhter Technetium-Uptake) bedeutet die primäre RITH eine kosteneffektive Entscheidung.

scholarly journals POST-CORONAVIRUS DISEASE 2019 DE QUERVAIN’S THYROIDITIS – A CASE REPORT AND LITERATURE REVIEW

2021 ◽  
pp. 4-6
Author(s):  
MOHAMAD SAFWAN ◽  
VIJAYAN KN ◽  
NAJEEB ◽  
JITHU TG
Keyword(s):  
Neck Pain ◽  
Beta Blockers ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
C Reactive Protein ◽  
Free T4 ◽  
Persistent Fever ◽  
Reactive Protein ◽  
Technetium Uptake

De Quervain’s thyroiditis, also known as subacute thyroiditis (SAT), is a self-limiting inflammatory thyroid disease typically occurring a few weeks after a respiratory viral infection. A 29-year-old female with no comorbidities presented with persistent fever, neck pain, and swelling of 10 days duration. She also had tremors, fatigue, and palpitation. A careful enquiry revealed that she had been diagnosed with coronavirus disease 2019 (COVID-19) infection 6 weeks ago and had recovered uneventfully with conservative management. Her laboratories showed leukocytosis, elevated erythrocyte sedimentation rate, and C-reactive protein. Thyroid function tests (TFTs) yielded low thyroid-stimulating hormone, and high T3 and free T4. Ultrasonography neck was suggestive of thyroiditis. Thyroid scintigraphy demonstrated very low technetium uptake which confirmed SAT. Her symptoms ameliorated with nonsteroidal anti-inflammatory drug and beta-blockers and her TFTs improved during follow-up. We report this as emerging sequelae of COVID-19 infection. A persistent fever and neck pain following recent COVID-19 infection should alert clinician toward the possibility of de Quervain’s thyroiditis following severe acute respiratory syndrome coronavirus 2.

Störfaktoren bei der In-vivo-Diagnostik der Schilddrüse

1985 ◽  
Vol 24 (01) ◽  
pp. 7-11
Author(s):  
G. Funke ◽  
K. Lagemann ◽  
K. Anger
Keyword(s):  
Technetium Uptake

ZusammenfassungAn 260 Patienten, die zur Schilddrüsendiagnostik in einer nuklearmedizinischen Universitätsabteilung vorgestellt wurden, und 200 Patienten einer Schilddrüsenpraxis im Kropfendemiegebiet des schwäbischen Oberlands wurde anamnestisch die Vorbelastung der Schilddrüse mit Jod oder Medikamenten erfaßt. An der Klinik fanden sich 54% vorbelastete, davon 30% jodkontaminierte und 20% mehrfach belastete Patienten. In der Praxis waren 18% der Patienten vorbehandelt, die Mehrzahl ausschließlich mit Schilddrüsenhormonen. Der Einfluß dieser Vorbelastung auf den thyreoidalen Technetium-Uptake und die daraus resultierende Einschränkung seiner diagnostischen Aussage werden diskutiert.

Balb/C mice immunized with either xenogeneic or syngeneic TSH produce immunoglobulins with anti-TSH and thyroid-stimulating activities

1991 ◽  
Vol 125 (5) ◽  
pp. 532-537 ◽  
Author(s):  
Chava Ben-David ◽  
Mira Gafny ◽  
Nava Sirkis ◽  
Amirav Gordon ◽  
Jack Gross
Keyword(s):  
Monoclonal Antibody ◽  
Thyroid Disease ◽  
Thymidine Uptake ◽  
Idiotypic Network ◽  
Pituitary Extract ◽  
Splenic Lymphocytes ◽  
Blood Samples ◽  
Freund’S Adjuvant ◽  
Freund's Adjuvant ◽  
Technetium Uptake

Abstract. Balb/C mice were immunized with bTSH (xenogeneic TSH) or extracts of Balb/C pituitaries (containing syngeneic TSH), either intracutaneously with Freund's adjuvant or intrasplenically. After bTSH, all blood samples contained anti-TSH antibodies. Thyroid-stimulating activity was assayed on FRTL-5 cells. Of 80 sera from immunized mice, 33 induced an increase in 99mTcO4 uptake, and 31/79 induced an increase in thyroidal 3[H]thymidine uptake by thyrocytes. With syngeneic TSH, anti-TSH antibodies were found in 10/19 mice. Immunoglobulins increasing thyrocyte technetium uptake were found in 14/19 mice, and immunoglobulins that stimulated thymidine uptake in thyrocyte DNA were detected in 12/19 sera. After immunization with both types of TSH, sera of some mice showed only one of the two bioactivities. Hybridomas were prepared with splenic lymphocytes of the mice immunized with either of the TSH preparations. These secreted TSH-binding immunoglobulins or immunoglobulins which stimulated thymidine or technetium uptake by the thyrocytes. One of the hybridomas from mice immunized with pituitary extract secreted a monoclonal antibody which stimulated thyroidal thymidine uptake, but inhibited bTSH-induced 99mTcO4 uptake. These findings might suggest that the anti-idiotypic network acting on TSH as an antigen could be involved in the pathogenesis of stimulatory antibodies in thyroid disease.

TECHNETIUM UPTAKE IN THE MANAGEMENT OF THYROTOXICOSIS

1978 ◽  
Vol 8 (4) ◽  
pp. 327-333 ◽  
Author(s):  
W. VAN'T HOFF ◽  
G. G. POVER ◽  
PAUL L. DRURY
Keyword(s):  
Technetium Uptake

scholarly journals Initial assessment of the beneficial effect of partial splenectomy in hereditary spherocytosis

Blood ◽  
1993 ◽  
Vol 81 (8) ◽  
pp. 2014-2020 ◽  
Author(s):  
G Tchernia ◽  
F Gauthier ◽  
F Mielot ◽  
JP Dommergues ◽  
J Yvart ◽  
...  
Keyword(s):  
Life Span ◽  
Hereditary Spherocytosis ◽  
Reticulocyte Count ◽  
Clinical Manifestations ◽  
Partial Splenectomy ◽  
Initial Assessment ◽  
Phagocytic Function ◽  
Normal Range ◽  
Rbc Membrane ◽  
Technetium Uptake

Clinical manifestations of hereditary spherocytosis (HS), the most common red blood cell (RBC) membrane disorder, can be abrogated or markedly reduced by splenectomy. However, concerns regarding risks from overwhelming infections after splenectomy have restricted its use, especially in children. This study was designed to determine if partial splenectomy can decrease the hemolytic rate while maintaining phagocytic function of the spleen. Partial splenectomy was performed in 11 children (age 2 to 13) with HS. The effect on hemolytic rate was assessed by comparing the presurgical and postsurgical values for hemoglobin, reticulocyte number, and RBC life span. The residual splenic phagocytic function was assessed using technetium 99m scans and by enumerating the percentage of pitted RBCs in circulation. There were no complications from the surgical procedure in any of the 11 individuals. Following partial splenectomy, hemoglobin increased on the average by 3 g/dL, reticulocyte count decreased by 300 x 10(6)/L, and RBC life span was substantially prolonged. Normal technetium uptake was noted in the splenic remnant and the percentage of pitted RBCs was in the normal range. Partial splenectomy is effective in decreasing the hemolytic rate while maintaining residual splenic phagocytic function of the spleen in HS. We conclude that the use of this procedure as treatment for RBC membrane disorders warrants consideration, especially in infants under 5 years of age who need frequent transfusions.

scholarly journals Initial assessment of the beneficial effect of partial splenectomy in hereditary spherocytosis

Blood ◽  
1993 ◽  
Vol 81 (8) ◽  
pp. 2014-2020 ◽  
Author(s):  
G Tchernia ◽  
F Gauthier ◽  
F Mielot ◽  
JP Dommergues ◽  
J Yvart ◽  
...  
Keyword(s):  
Life Span ◽  
Hereditary Spherocytosis ◽  
Reticulocyte Count ◽  
Clinical Manifestations ◽  
Partial Splenectomy ◽  
Initial Assessment ◽  
Phagocytic Function ◽  
Normal Range ◽  
Rbc Membrane ◽  
Technetium Uptake

Abstract Clinical manifestations of hereditary spherocytosis (HS), the most common red blood cell (RBC) membrane disorder, can be abrogated or markedly reduced by splenectomy. However, concerns regarding risks from overwhelming infections after splenectomy have restricted its use, especially in children. This study was designed to determine if partial splenectomy can decrease the hemolytic rate while maintaining phagocytic function of the spleen. Partial splenectomy was performed in 11 children (age 2 to 13) with HS. The effect on hemolytic rate was assessed by comparing the presurgical and postsurgical values for hemoglobin, reticulocyte number, and RBC life span. The residual splenic phagocytic function was assessed using technetium 99m scans and by enumerating the percentage of pitted RBCs in circulation. There were no complications from the surgical procedure in any of the 11 individuals. Following partial splenectomy, hemoglobin increased on the average by 3 g/dL, reticulocyte count decreased by 300 x 10(6)/L, and RBC life span was substantially prolonged. Normal technetium uptake was noted in the splenic remnant and the percentage of pitted RBCs was in the normal range. Partial splenectomy is effective in decreasing the hemolytic rate while maintaining residual splenic phagocytic function of the spleen in HS. We conclude that the use of this procedure as treatment for RBC membrane disorders warrants consideration, especially in infants under 5 years of age who need frequent transfusions.

Technetium uptake by Sinapis Alba

1986 ◽  
Vol 99 (1) ◽  
pp. 181-185 ◽  
Author(s):  
H. Müller ◽  
Ch. Ter Meer-Bekk
Keyword(s):  
Sinapis Alba ◽  
Technetium Uptake

The appearance in thyroidectomized mice of immunoglobulins that bind TSH and stimulate FRTL-5 thyrocytes

1992 ◽  
Vol 127 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Mira Gafny ◽  
Chava Ben-David ◽  
Nava Sirkis ◽  
Amirav Gordon ◽  
Jack Gross
Keyword(s):  
Thymidine Incorporation ◽  
Model System ◽  
Thymidine Uptake ◽  
Autoimmune Process ◽  
Pump Activity ◽  
Antiidiotypic Antibodies ◽  
Spleen Lymphocytes ◽  
Technetium Uptake ◽  
Sera Samples ◽  
Stimulation Of

The purpose of these studies was to examine whether thyroid stimulating antibodies in Graves' patients could arise as auto-antiidiotypic antibodies to endogenous anti-TSH antibodies. The model system chosen was the thyroidectomized mouse, exhibiting an elevated level of endogenous, circulating TSH. Mice were thyroidectomized by 131I administration. Sera samples were drawn 1 to 14 months later. The following activities were measured in the immunoglobulin (Ig) fractions prepared: (a) TSH binding by elisa techniques, (b) iodide pump activity (as measured by 99mTcO4 uptake) and (c) increased [3H]thymidine incorporation into the DNA of FRTL-5 cells. TSH binding Igs were detected in 29/98 mice thyroidectomized for 7–14 months. Stimulation of technetium uptake was observed in 59/110 mice and stimulated labeled thymidine uptake in 37/102 mice, beginning eight and nine months after thyroidectomy, respectively. Of the positive animals, 51 showed a single stimulating activity. The incidence and the serum titers of Igs that stimulate technetium uptake increased significantly with time. Indeed, in the group tested 14 months post-thyroidectomy, 75% of the sera were positive for this antibody with a mean titer eightfold higher than the controls. Hybridomas were prepared from the spleen lymphocytes of thyroidectomized mice. Of these, 18 produced 99mTcO4 uptake stimulating Igs, 12 [3H]thymidine-uptake stimulating Igs and 18 TSH binding Igs. Most of the hybridomas secreted Igs with a single bioactivity. One monoclonal antibody was isolated which neutralized the bioactivity of bTSH on FRTL-5 cells. 99mTcO4 uptake was decreased by 50% and [3H]thymidine uptake was virtually abolished. These results suggest that the hypothyroid mouse can develop anti-TSH antibodies and thyroid-stimulating antiidiotypic antibodies by an autoimmune process.

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