Deliberate self-harm in a patient with hyperthyroidism with acute psychosis

A woman in her 30s with underlying Graves’ disease, who recently completed radioactive iodine treatment, presented with 2 weeks of acutely altered behaviour associated with auditory hallucinations and religious preoccupations. Laboratory investigation demonstrated elevated free thyroxine levels and suppressed thyroid-stimulating hormone levels. Additionally, there was a presence of antithyroid peroxidase antibodies consistent with autoimmune thyroid disease. She responded to antipsychotics and achieved biochemical euthyroidism. Subsequently, antipsychotic was tapered off during outpatient follow-up at the patient’s own request, with supplement thyroxine continuing. After 1 week, acute hallucinations and religious preoccupations re-emerged, driving her to inflict self-injuries by swallowing coins and nails and banging her head against the wall, sustaining laceration wounds. Furthermore, she hammered a roofing nail into the external genitalia, embedded in the symphysis pubis. After supplemental thyroxine was stopped and olanzapine was started, she achieved biochemical euthyroid followed by remission of psychosis within 1 week. This case illustrates the importance of elucidating organic causes of psychosis as they are easily and swiftly reversible.

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THYROID FUNCTION TESTS: A REVIEW

10.36106/ijsr/2502260 ◽

2021 ◽

pp. 73-76

Author(s):

Vasudev Sankhla ◽

Aman Deep

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Radioactive Iodine ◽

Thyroid Stimulating Hormone ◽

Thyroid Function Tests ◽

Function Tests ◽

Tsh Secretion ◽

Line Test ◽

Radioactive Iodine Uptake

Thyroid function tests are one of the most common endocrine panels in general practice because a good understanding of when to order them, indications for treatment are important for the optimal treatment of thyroid dysfunction. Thyroid-stimulating hormone (TSH) should be the rst test to be performed on any patient with suspected thyroid dysfunction and in follow-up of individuals on treatment. It is useful as a rst-line test because even small changes in thyroid function are sufcient to cause a signicant increase in TSH secretion. Thyroxine levels may be assessed in a patient with hyperthyroidism, to determine the severity of hyperthyroxinemia. Antithyroid peroxidase measurements should be considered while evaluating patients with subclinical hypothyroidism and can facilitate the identication of autoimmune thyroiditis during the evaluation of nodular thyroid disease. The measurement of TSH receptor antibody must be considered when conrmation of Graves’ disease is needed and radioactive iodine uptake cannot be done.

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A LONG-TERM FOLLOW UP OF PATIENTS WITH AUTOIMMUNE THYROID DISEASE

Clinical Endocrinology ◽

10.1111/j.1365-2265.1977.tb01994.x ◽

1977 ◽

Vol 6 (1) ◽

pp. 41-48 ◽

Cited By ~ 16

Author(s):

M. S. KHANGURE ◽

P. R. DINGLE ◽

J. STEPHENSON ◽

T. BIRD ◽

R. HALL ◽

...

Keyword(s):

Thyroid Disease ◽

Autoimmune Thyroid Disease ◽

Autoimmune Thyroid ◽

Long Term Follow Up

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Evaluation of the response levels of non-metastatic thyroid cancer patients in the postoperative twelfth month

Medical Science and Discovery ◽

10.36472/msd.v7i8.401 ◽

2020 ◽

Vol 7 (8) ◽

pp. 584-588

Author(s):

Hasan İkbal Atılgan ◽

Hülya Yalçın

Keyword(s):

Thyroid Cancer ◽

Cancer Patients ◽

Radioactive Iodine ◽

Thyroid Tissue ◽

Thyroid Stimulating Hormone ◽

Response To Therapy ◽

Response Level ◽

Excellent Response ◽

Incomplete Response

Objective: Radioactive iodine (RAI) is used to ablate residual thyroid tissue after total thyroidectomy. The aim of this study was to evaluate the response according to the12th-month results of thyroid cancer patients and to investigate the changes in response level during follow-up. Materials and Methods: The study included 97 patients, comprising 88 (90.7%) females and 9 (9.3%) males, with a mean age of 41.68±13.25 years. None of the patients had lymph node or distant metastasis and all received RAI therapy. Thyroid-stimulating hormone (TSH), thyroglobulin (TG), and anti-TG levels and neck USG were examined in the 12th-month. Response to therapy was evaluated as an excellent response, biochemical incomplete response, structural incomplete response, or indeterminate response. Results: In the 12th month, 80 patients (82.47%) had excellent response, 13 patients (13.40%) had an indeterminate response, 3 patients (3.09%) had structural incomplete response and 1 patient (1.03 %) had biochemical incomplete response. Of the 80 patients with excellent response, 15 had no follow-up after the 12th month. The remaining 65 patients were followed up for 31.11±9.58 months. The response changed to indeterminate in the 18th month in 1 (1.54%) patient and to structural incomplete response in the 35th month in 1 (1.54%) patient. The 13 patients with indeterminate responses were followed up for 20.61±6.28 months. Conclusion: The TG level at 12th months provides accurate data about the course of the disease especially in patients with excellent responses. Patients with excellent response in the 12th month may be followed up less often and those with the indeterminate or incomplete responses should be followed up more often.

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Decision aid on radioactive iodine treatment for early stage papillary thyroid cancer: update to study protocol with follow-up extension

Trials ◽

10.1186/s13063-015-0819-6 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 3

Author(s):

Anna M. Sawka ◽

Sharon Straus ◽

Gary Rodin ◽

Kevin E. Thorpe ◽

Shereen Ezzat ◽

...

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Cancer ◽

Study Protocol ◽

Decision Aid ◽

Radioactive Iodine ◽

Early Stage ◽

Papillary Thyroid ◽

Iodine Treatment

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The Antibody Response in Human Autoimmune Thyroid Disease

Clinical Science ◽

10.1042/cs0920529 ◽

1997 ◽

Vol 92 (6) ◽

pp. 529-541 ◽

Cited By ~ 22

Author(s):

Richard S. McIntosh ◽

M. Suhail Asghar ◽

Anthony P. Weetman

Keyword(s):

Antibody Response ◽

Thyroid Disease ◽

Hormone Receptor ◽

Autoimmune Thyroid Disease ◽

Thyroid Stimulating Hormone ◽

Thyroid Peroxidase ◽

Autoimmune Thyroid ◽

Thyroid Autoantigens ◽

Reactive Antibody ◽

Stimulating Hormone

1. The analysis of the antibody response in autoimmune thyroid disease has followed several historical trends. It was the investigation of thyroid-reactive antibody that allowed the initial characterization of the three principle thyroid autoantigens, thyroglobulin, thyroid peroxidase and the thyroid stimulating hormone receptor. 2. Analysis can be grouped under two broad areas: analysis of the physiological and pathological effects of the antibody, and analysis of the structure of the antibodies themselves. This review will focus on the latter. 3. Within recent years there has been a great increase in knowledge of thyroid-reactive antibody structure, principally through the adoption of phage display combinatorial library methodologies. While this latter technique has established some general principles for antibodies to thyroglobin and especially thyroid peroxidase, there is still a substantial gap in our knowledge of the antibody response to the thyroid stimulating hormone receptor. 4. Thyroid peroxidase antibodies have a relatively restricted V-region usage, and there is a correlation between the V-regions used and the epitope on thyroid peroxidase bound. In particular the Vκ light chain, Vκl(O12), is associated with reactivity to one epitope. 5. The purpose of this review is to bring together the latest results concerning the molecular analysis of the antibody response in autoimmune thyroid disease, to highlight areas of ignorance and conflict, and to discuss the methods adopted to circumvent the problems associated with analysis of the antibody response.

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