Thyroid gland disorders

2020 ◽  
pp. 289-312
Author(s):  
Gary Butler ◽  
Jeremy Kirk
Keyword(s):  
Thyroid Gland ◽  
Lymphocytic Infiltration ◽  
Thyroid Stimulating Hormone ◽  
Hormone Deficiency ◽  
Graves Disease ◽  
Childhood And Adolescence ◽  
Inborn Errors ◽  
Autoimmune Hypothyroidism ◽  
Thyroid Hormone Metabolism ◽  
Drug Of Choice

• The thyroid gland produces all of the T4 and 20% of T3. • Congenital hypothyroidism is caused by: ◦ anatomical defects: agenesis/dysgenesis, ectopic, sublingual ◦ inborn errors of thyroid hormone metabolism ◦ secondary (pituitary thyroid-stimulating hormone (TSH)) or tertiary (hypothalamic thyrotropin-releasing hormone) deficiency ◦ iodine deficiency (commonest cause worldwide of hypothyroidism, patients are usually euthyroid). • Genetic causes are rare. • In most countries worldwide, newborn TSH screening is performed at 0–5 days of age. Treatment with l-thyroxine is (usually) lifelong. • Neonatal thyrotoxicosis due to transplacental passage of thyroid-stimulating immunoglobulins (TSIs) from mothers with thyrotoxicosis/Graves’ disease and may require antithyroid drugs (ATDs). • Acquired autoimmune hypothyroidism in children and adolescents: ◦ is caused by lymphocytic infiltration of the thyroid gland (Hashimoto’s disease/thyroiditis) • raised thyroid peroxidase antibodies are diagnostic • treatment is with l-thyroxine. • Hyperthyroidism (Graves’ disease, Hashimoto’s stimulatory phase (Hashitoxicosis)): ◦ is caused by autoantibodies to the TSH receptor (TSI, or TRAbthyrotropin receptor antibody) ◦ the first-line drug of choice is the ATD carbimazole ◦ thyroidectomy or radioiodine treatment can be considered for drug-resistant cases or after relapse. • Thyroid cancer is rare in childhood and adolescence, usually presenting with a nodule, but can be part of the multiple endocrine neoplasia syndromes.

Manifestation of Graves’ disease, resulting from radiosurgical treatment of acromegaly, in a patient with panhypopituitarism

2019 ◽  
Vol 65 (2) ◽  
pp. 101-106
Author(s):  
Ludmila I. Astafyeva ◽  
Pavel L. Kalinin ◽  
Tatyana A. Kienia ◽  
Valentin V. Fadeyev
Keyword(s):  
Radiation Therapy ◽  
Pituitary Adenoma ◽  
Thyroid Stimulating Hormone ◽  
Hormone Deficiency ◽  
Graves Disease ◽  
Free T4 ◽  
Disease Manifestation ◽  
Secondary Hypothyroidism ◽  
Residual Tissue ◽  
High Level

Cases of thyrotoxicosis associated with a previous case of secondary hypothyroidism are extremely rare. This article presents a rare clinical case of Graves disease manifestation in a patient with secondary hypothyroidism after radiosurgical treatment of acromegaly. A 38-year old woman presented with acromegaly and endo-supra-laterosellar pituitary adenoma. After non-radical removal of the pituitary adenoma, radiosurgical treatment of the of the residual tissue of the pituitary tumor in the cavernous sinus area was performed. After 14 months of radiation therapy, the acromegaly was in remission; after 24 months of radiation therapy, panhypopituitarism developed (secondary hypothyroidism, adrenal insufficiency, hypogonadism, and growth hormone deficiency). Furthermore, 1.5 years after the panhypopituitarism was diagnosed, the manifestation of Graves disease was also noted, requiring thyrostatic and radioactive iodine treatments. Diagnostic criteria for secondary hypothyroidism are low levels of the thyroid hormones free T4 and free T3, with a reduced, normal or slightly elevated level of thyroid stimulating hormone (TSH). The criterion for the development of thyrotoxicosis in the context of the secondary hypothyroidism was the persistent increase in the level of free T4 despite adequate drug therapy with levothyroxine. In the case report, the patients diagnosis of Graves disease was confirmed by the presence of a high level of antibodies to the TSH receptor.

scholarly journals Graves Disease in Infancy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A929-A930
Author(s):  
Kara A Beliard ◽  
Srinidhi Shyamkumarb ◽  
Mabel Yau ◽  
Cassie Mintz ◽  
Robert Rapaport
Keyword(s):  
Thyroid Gland ◽  
English Literature ◽  
Receptor Gene ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Free T4 ◽  
Ocular Changes ◽  
Clinical Signs And Symptoms

Abstract Background: Graves disease (GD) is the most common cause of hyperthyroidism worldwide. The usual age of presentation is between 20-30 years, and it is more common in females. Transient hyperthyroidism does occur in infants born to mothers with GD, however, the novo GD in infants is extremely rare. We are aware of only four cases of GD in children under the age of 2 years old previously reported in the literature, with the youngest being of 18 months. Although rare, the complications can be devastating, so identifying and treating GD in infants is vital. We describe an infant who presented at 12 months of life with poor weight gain. Patient Findings: A 12-month old female patient presented with weight loss, tachycardia, diaphoresis and hypertension. She had a palpable thyroid gland without ocular changes. She was found to have an undetectable Thyroid Stimulating Hormone (TSH) with an elevated free T4 of 2.1 ng/dL (normal 0.80 - 1.50 ng/dL). She was stabilized in the intensive care unit with beta-blocker and methimazole. The diagnosis of GD was subsequently confirmed with an extremely elevated elevated Thyroid Stimulating Immunoglobulins (TSI) titer of 263 Iu/L (normal 0.00-0.55 IU/L), her TSH receptor gene was normal. At 34 months of age, her TSI titer is still elevated at 34 IU/L and she still requires methimazole to maintain a euthyroid state. She is growing and developing appropriately. Conclusion: To our knowledge, this report describes the youngest child to be diagnosed with GD in the English literature. Only four patients between the ages of 18 - 24 months have been described. Autoimmune diseases are rare in infants, the reason for which GD developed at such a young age remains unclear. Clinical signs and symptoms of hyperthyroidism in infants can be subtle and easily missed: increased growth velocity, failure to gain weight, autonomic changes, and irritability. Most patients have an enlarged thyroid gland, and some have ocular changes. The major long-term complications of undiagnosed hyperthyroidism include craniosynostosis and permanent neurocognitive damage. A high index of suspicion is needed for the recognition and prompt treatment of GD in infants, leading to better clinical outcome.

The relationships between surgical histometry, outcome and pre-treatment in Graves' disease

1981 ◽  
Vol 98 (1) ◽  
pp. 43-49 ◽  
Author(s):  
T.J. Wilkin ◽  
A. Gunn ◽  
M. Al Moussa ◽  
T. E. Isles ◽  
J. Crooks ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Surgical Technique ◽  
Total Thyroidectomy ◽  
Diagnostic Criteria ◽  
Operative Treatment ◽  
Thyroid Tissue ◽  
Lymphocytic Infiltration ◽  
Graves Disease ◽  
Pre Treatment ◽  
The Relationship

Abstract. Quantitative histometric methods were used to established the relationship between the extent of thyroid lymphocytic infiltration at operation, and outcome exactly 18 months later in 50 surgically-treated Graves' disease patients prepared by carbimazole and triiodothyronine. Periods of pre-operative treatment, surgical technique, histometric analysis and diagnostic criteria were all standardised. Controls (107) were obtained from the forensic laboratory. Thirty-seven patients became euthyroid, but there was no relationship between outcome and epithelial or lymphoid content of the thyroid gland. Neither was there any correlation between the size of lymphoid infiltrate and epithelial mass of the resected thyroids, suggesting that simple lymphocyte infiltrations do not replace thyroid tissue as once thought. The variation in thyroid epithelial content was nearly 3-fold, so that a surgeon, even if able accurately to judge the anatomical mass of the remnant, would still have little or no idea of its functional mass. The scatter of epithelial content was even greater in glands from patients prepared for surgery by propranolol alone (38 glands, variation × 5.5) or propranolol and iodide (32 glands, variation × 5.9). Outcome after sub-total thyroidectomy for Graves' disease seems unrelated to the lymphocyte content of the gland and it is questionable to what extent the surgeon can either predict or control the outcome of thyroidectomy in individual Graves' disease patients.

scholarly journals Coexistence of Autoimmune Hyper- and Hypothyroidism in a Kindred with Reduced Sensitivity to Thyroid Hormone

2020 ◽  
Vol 9 (5) ◽  
pp. 263-268
Author(s):  
Yasmine Abdellaoui ◽  
Dimitra Magkou ◽  
Sofia Bakopoulou ◽  
Ramona Zaharia ◽  
Marie-Laure Raffin-Sanson ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormone Receptor ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Free Triiodothyronine ◽  
Autoimmune Thyroid Diseases ◽  
Autoimmune Thyroid ◽  
Autoimmune Hypothyroidism ◽  
First Time ◽  
Receptor Antibodies

Introduction: Resistance to thyroid hormone beta (RTHβ) is a rare disease with an autosomal dominant transmission. Diagnosis may be challenging especially in patients with hyper- or hypothyroidism. Case Presentation: A 31-year-old male patient with suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine and free triiodothyronine, along with high thyroid receptor antibodies was diagnosed with Graves’ disease. Benzylthiouracil was started. One month later, reduced sensitivity to thyroid hormones was suspected because of persistently high thyroid hormone levels contrasting with high TSH level. Molecular analysis highlighted a 10c.1357C>T p.P453S mutation in the thyroid hormone receptor beta gene (THRB). RTHβ was diagnosed. Several relatives also had RTHβ (the mother, the young son, and 2 out of 3 siblings). Autoimmune hypothyroidism was present in the mother, whereas 2 out of 3 siblings had asymptomatic autoimmunity. Discussion/Conclusion: Both Graves’ disease and autoimmune hypothyroidism were described in patients with RTHβ. We show here for the first time that autoimmune hypo- and hyperthyroidism may coexist in kindred with RTHβ. Seven previously published cases of Graves’ disease and RTHβ were retrieved and analyzed. Treatments and thyroid hormone level targets are discussed as well as the possible link between RTHβ and autoimmune thyroid diseases.

Autoimmune switch from hyperthyroidism to hypothyroidism in Graves’ disease

2020 ◽  
Vol 13 (11) ◽  
pp. e236465 ◽  
Author(s):  
Preethi Padmanaban ◽  
Rohit Jain
Keyword(s):  
Young Woman ◽  
Thyroid Stimulating Hormone ◽  
Reproductive Age ◽  
Tsh Receptor ◽  
Graves Disease ◽  
Optimal Management ◽  
Blocking Antibody ◽  
Receptor Blocking ◽  
Autoimmune Hypothyroidism

We report a case of a 21-year-old young woman who was initially diagnosed with hyperthyroidism secondary to Graves’ disease and spontaneously switched to hypothyroidism in a year. While most autoimmune hypothyroidism is due to Hashimoto’s disease, in her case, we suspect that her hypothyroidism is due to a switch of antibody dominance from thyroid stimulating hormone (TSH) receptor-stimulating antibody (TS Ab) to TSH receptor-blocking antibody (TB Ab). Switching from dominant TS Ab activity to dominant TB Ab activity is a rare phenomenon. Optimal management of this condition is not known. Loss of follow-up and medication non-adherence has made medical management in this young woman of reproductive age further challenging.

scholarly journals Neonatal stimulation of the thyroid gland with iodine or suppression during adolescence with triiodothyronine changes the prevalence of autoimmune thyroiditis in BB rats

2004 ◽  
pp. 375-382 ◽  
Author(s):  
ML Hartoft-Nielsen ◽  
AK Rasmussen ◽  
A Kaas ◽  
U Feldt-Rasmussen ◽  
K Buschard
Keyword(s):  
Thyroid Gland ◽  
Autoimmune Thyroiditis ◽  
Lymphocytic Infiltration ◽  
Thyroid Stimulating Hormone ◽  
Female Rats ◽  
Male Rats ◽  
Bb Rats ◽  
Neonatal Stimulation ◽  
Stimulation Of

OBJECTIVE: Changes in the functional state of beta cells by neonatal stimulation or adolescent suppression have reduced the incidence of type 1 diabetes mellitus in animal models. The aim of this study was to evaluate the effect of manipulation of the activity of the thyroid gland by neonatal stimulation or by adolescent suppression on the prevalence of spontaneous autoimmune thyroiditis (AIT) in rats. METHODS: Bio-Breeding/Worcester (BB) rats were treated neonatally with sodium iodine (NaI) or thyroid stimulating hormone (TSH), or during adolescence by triiodothyronine (T(3)), and the lymphocytic infiltration in the thyroid gland was evaluated. RESULTS: Neonatal treatment with NaI decreased the prevalence of AIT to 32+/-9% compared with 66+/-5% in the controls (P<0.002), mainly caused by a reduction among the female rats (13+/-9% vs 52+/-8%, P<0.006). TSH had no effect. Post neonatal suppression of the thyroid gland by T(3) had a biphasic response. Early in adolescence the overall prevalence was 14+/-7% compared with 66+/-5% in the controls (P<10(-5)); for female rats AIT was prevented (0+/-0%) compared with 52+/-8% in the controls (P<0.0003) and in male rats the values were 29+/-13% compared with 80+/-6% in the controls (P<0.001). Treatment with T(3) later in adolescence increased the overall prevalence to 81+/-7% compared with 66+/-5% in the controls (not significant). For female rats the prevalence increased to 78+/-9% compared with 52+/-8% in the controls (P=0.04). The degree of thyroiditis among the affected animals was similar in all groups. CONCLUSION: Neonatal stimulation of the thyroid gland by iodine or early adolescent suppression by T(3) reduced the prevalence of AIT whereas T(3) given later increased the prevalence of thyroiditis in rats. Thyroid activity at various ages seems to be of importance for the development of autoimmune thyroiditis.

scholarly journals Graves’ Disease

2021 ◽  
Author(s):  
Vasudha Bakshi ◽  
Gollapalli Rajeev Kumar
Keyword(s):  
Thyroid Gland ◽  
Hormone Receptor ◽  
Treatment Options ◽  
Positive Family History ◽  
Current Treatment ◽  
Thyroid Stimulating Hormone ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Autoimmune Thyroid ◽  
Stimulating Hormone

Graves’ disease (GD) is an autoimmune thyroid disorder where autoantibodies are produced against TSH (Thyroid Stimulating Hormone) receptor causing thyrotoxicosis. It is characterized by goiter, ophthalmopathy, and occasionally pretibial myxedema. The autoimmune mechanism causing disease is not well understood and it is complex. It involves multifactorial etiology involving environmental and genetic factors. Smoking and positive family history contributing to the development of GD. GD can be diagnosed based on the clinical manifestation and demonstrating low concentration of TSHs, high TRab (Thyroid Stimulating Hormone receptor autoantibodies), and high FT4 (Free thyroxine) concentration. Current treatment options aimed at stable restoration of euthyroidism by following different modalities of suppressing thyroid gland using antithyroid drugs, removing/ablating thyroid gland by surgery, and radioactive iodine treatment with iodine- 131.

scholarly journals PERSONALIZED THYROID HYPOFUNCTION THERAPY STRATEGY

2021 ◽  
Vol 77 (3) ◽  
pp. 120-125
Author(s):  
Nonna Kravchun ◽  
Inna Dunaieva ◽  
Olexander Kozakov
Keyword(s):  
Thyroid Gland ◽  
Subclinical Hypothyroidism ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Thyroid Stimulating Hormone ◽  
Hormonal Changes ◽  
Drug Of Choice ◽  
Stage Of Development ◽  
Therapy Strategy ◽  
Clinical Consequences

In the current conditions, coronavirus infection is often the cause of the development of inflammatory and autoimmune diseases of the thyroid gland. One of these diseases can be subclinical hypothyroidism — the initial stage of development of manifest hypothyroidism. Signs of hypothyroidism include weight gain, edema, decreased mental activity, increased drowsiness, dry skin, bradycardia, cardiomyopathy, constipation, muscle cramps, and paraesthesia. Because SG is asymptomatic by definition, 25–50% of patients have slow but characteristic signs of hypothyroidism, manifested by disorders of many organs and systems. Unfortunately, in most cases, such clinical manifestations are assessed retrospectively after the detection of characteristic hormonal changes. The expediency of treating both subclinical hypothyroidism and manifest hypothyroidism is evaluated individually, especially for the elderly, depending on the level of Thyroid-Stimulating Hormone and the presence of comorbid pathology. Synthetic levothyroxine remains the drug of choice for all forms of hypothyroidism. The generally accepted starting dose of levothyroxine for adult 13 patients, according to the recommendations of ATA, is considered a dose of 1.6–1.8 mcg/kg of body weight. Eutirox is a drug that has a unique line of 6 dosages in increments of 25 mcg of Levothyroxine and now the drug has an updated composition that fully ensures the balanced functioning of the thyroid gland. The updated composition is completely bioequivalent to the previous composition with similar tolerability. The increased requirements for the composition of the active substance, which was achieved in the updated composition of Eutirox, has advantages for patients, since hormone fluctuations will be minimized and this will help to avoid the development of adverse clinical consequences.

Thyroid hormone metabolism

2018 ◽  
pp. 25-59
Author(s):  
Helen E. Turner ◽  
Richard Eastell ◽  
Ashley Grossman
Keyword(s):  
Thyroid Hormone ◽  
Anterior Pituitary ◽  
Thyroid Stimulating Hormone ◽  
Hormone Resistance ◽  
Hormone Metabolism ◽  
Endocrine Disease ◽  
Autoimmune Hypothyroidism ◽  
Thyroid Hormone Metabolism ◽  
Tsh Secretion ◽  
Hormone Homeostasis

This chapter describes the thyroid gland, its associated hormones, and metabolism. Thyroid function is regulated most importantly by thyroid-stimulating hormone (TSH), also called thyrotropin. In turn, TSH secretion from the anterior pituitary is stimulated by the hypothalamic factor thyrotropin-releasing hormone (commonly abbreviated as TRH). It investigates genetic thyroid disorders, thyroid hormone resistance, autoimmune hypothyroidism, and Graves’ disease. The chapter lists the modalities of thyroid imaging, including ultrasound and radionuclide imaging (RNI), and describes indications of endocrine disease, like goitre, nodules, and malignancy. It describes thyroid hormone homeostasis and conditions affecting homeostasis. It also describes clinical features, causes, and management for disorders including hypothyroidism, hyperthyroidism, thyroiditis, thyroid nodules, and cancer.

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