scholarly journals Presentation and Outcome of Severe Graves’ Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A842-A843
Author(s):  
Priya Mohan Babu ◽  
Suhani Bahl ◽  
Florin Capatana ◽  
Khaliq Hamdan ◽  
Ishrat Khan ◽  
...  
Keyword(s):  
Thyroid Hormones ◽  
Treatment Initiation ◽  
Treatment Regime ◽  
Definitive Treatment ◽  
Dose Titration ◽  
Graves Disease ◽  
Detection Range ◽  
Multisystem Involvement ◽  
Significant Difference ◽  
Large Goitre

Abstract Introduction: Subjects with “severe” Graves’ disease (GD) are known to have adverse outcomes. They have multisystem involvement (orbitopathy, dermopathy), more severe clinical features, large goitres and a higher relapse rate. Also, their response to thionamides is slower. There is a developing consensus that early definitive treatment improves prognosis in them. Methods: We retrospectively analysed the electronic case records and biochemistry databases of all subjects seen in our University Health Board between January 2017 and October 2019 with GD. Severe GD was defined by (1) a thyrotropin receptor antibody (TRAb) value greater than 10U/l (normal range: less than 0.9), (2) with any one of the following - (a) free thyroxine (T4) above 50pmol/l (reference range 9-19.1), (b) a combination of T4 more than 40 pmol/l with triiodothyronine (T3) above the detection range of the assay (46.1 pmol/l), (c) the presence of a large goitre, (d) active Graves’ orbitopathy (GO) or (e) dermopathy. We compared subjects with severe GD to those who did not fulfil the above criteria i.e. non-severe GD. Results: 176 GD subjects were seen during this period - 52 (29.5%) with severe and 124 (70.5%) with non-severe GD. However, 19 severe and 26 non-severe GD subjects were on active thionamide treatment at the time of analysis, and complete details were unavailable in 41 subjects. There was a significant difference in the following features between the severe and non-severe GD groups respectively (1) their median age (39 vs.52 years), (2) median TRAb levels (25.5 vs.18.5 U/l) (3) higher prevalence of GO (38.5 vs.13.3%) and active GO (15.4 vs.0%), (4) the presence of moderate/large goitre (51.3 vs.3.3%), (5) higher number failing to normalize biochemically within the first 6 months after treatment initiation (53.9 vs.39%), (6) the presence of a family history, and (8) a higher number requiring definitive treatment within 12 months of starting treatment (9.6vs.0.81%)(p=0.001-0.026 for the above). There was no difference between the two groups in gender, treatment regime i.e. dose titration regime or block and replacement regime, number biochemically normalizing within 12 months, and those who had more than 18 months of treatment and their relapse rates (55 vs. 59.1%, p=0.84). Conclusions: We have shown that those with severe GD were younger, have higher TRAb concentrations with multisystem involvement, and delayed initial normalization of thyroid hormones. A greater number of them require definitive treatment within 12 months of treatment initiation. However, the majority in both groups normalize thyroid hormones within 12 months irrespective of the treatment regime used. Early definitive treatment is required in a significantly higher percentage of subjects with severe GD and needs to be considered in them.

scholarly journals 2022 European Thyroid Association Guideline for the management of pediatric Graves’ disease

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Christiaan F Mooij ◽  
Timothy D Cheetham ◽  
Frederik A Verburg ◽  
Anja Eckstein ◽  
Simon H Pearce ◽  
...  
Keyword(s):  
Treatment Options ◽  
Behavioral Changes ◽  
Definitive Treatment ◽  
Dose Titration ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Large Goiter ◽  
Management Recommendations ◽  
Receptor Antibodies ◽  
Serum Tsh

Hyperthyroidism caused by Graves’ disease (GD) is a relatively rare disease in children. Treatment options are the same as in adults – antithyroid drugs (ATD), radioactive iodine (RAI) or thyroid surgery, but the risks and benefits of each modality are different. The European Thyroid Association guideline provides new recommendations for the management of pediatric GD with and without orbitopathy. Clinicians should be alert that GD may present with behavioral changes or declining academic performance in children. Measurement of serum TSH receptor antibodies is recommended for all pediatric patients with hyperthyroidism. Management recommendations include the first-line use of a prolonged course of methimazole/carbimazole ATD treatment (3 years or more), a preference for dose titration instead of block and replace ATD, and to avoid propylthiouracil use. Where definitive treatment is required either total thyroidectomy or RAI is recommended, aiming for complete thyroid ablation with a personalized RAI activity. We recommend avoiding RAI in children under 10 years of age but favor surgery in patients with large goiter. Pediatric endocrinologists should be involved in all cases.

scholarly journals Comparison of Block and Replace Regime and Titration Regime in Graves’ Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A838-A838
Author(s):  
Cho Mar
Keyword(s):  
Side Effects ◽  
Clinical Endocrinology ◽  
Dose Titration ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Significant Difference ◽  
Increasing Trend ◽  
Euthyroid Status ◽  
Hospital Visits

Abstract In Graves’ disease (GD), medical treatment is still the cornerstone in its management and there were some studies done on comparison of the block and replace regime and titration regime of the antithyroid drugs (ATDs). In Myanmar, titration regime is mostly practiced for management of GD. In daily clinical practice, frequent hospital visits are needed in titration regime and loss of follow-up is an obstacle in patients treated with titration regime. A hospital based randomized clinical trial was conducted and aimed to compare the proportion of attainment of euthyroid status between block and replace regime and titration regime in patients with recently diagnosed GD. A total of 117 patients; 58 patients in block and replace regime and 59 patients in titration regime, who met the inclusion criteria were included. The results showed that euthyroid status was observed in increasing trend during the study period for both regimes but there was no significant difference of achieving euthyroid status between the regimes at the end of 12 months. Regarding side effects of ATDs, skin rash and pruritus were more frequently occurred during the first 3 months of ATDs but no significant difference was noted between the regimes at the end of study. There was also no case of serious side effects such as agranulocytosis and hepatotoxicity up to the end of 12 months. The results of the study pointed out that block and replace regime was comparable to dose titration regime in attaining euthyroid status. As a conclusion, block and replace regime can be applied as an alternative option where titration regime is not feasible. Reference: (1) Abraham et al., 2005; A systematic review of drug therapy for Graves’ hyperthyroidism. Eur J Endocrinol. 153: 489-98. (2) Vaidya et al., 2014; Block & replace regime versus titration regime of antithyroid drugs for the treatment of Graves’ disease: a retrospective observational study. Clinical Endocrinology. 81: 610–613.

scholarly journals Blood Micronutrient and Thyroid Hormone Concentrations in the Oldest-Old

2000 ◽  
Vol 85 (6) ◽  
pp. 2260-2265 ◽  
Author(s):  
Giovanni Ravaglia ◽  
Paola Forti ◽  
Fabiola Maioli ◽  
Barbara Nesi ◽  
Loredana Pratelli ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Oldest Old ◽  
Serum Zinc ◽  
Blood Levels ◽  
Elderly Age ◽  
Blood Concentrations ◽  
Significant Difference ◽  
Plasma Retinol ◽  
Age Range

Several micronutrients are involved in thyroid hormone metabolism, but it is unclear whether their marginal deficits may contribute to the alterations in thyroid function observed in extreme aging. The relationships among blood concentrations of thyroid hormones and selenium, zinc, retinol, and α-tocopherol were studied in 44 healthy Northern Italian oldest-old subjects (age range, 90–107 yr), selected by the criteria of the SENIEUR protocol. Control groups included 44 healthy adult (age range, 20–65 yr) and 44 SENIEUR elderly (age range, 65–89 yr) subjects. Oldest-old subjects had higher TSH (P < 0.01) and lower free T3 (FT3)/freeT4 (FT4) ratio, zinc, and selenium serum values (P < 0.001) than adult and elderly control subjects. No significant difference was found for plasma retinol and α-tocopherol values. The associations between micronutrients and thyroid hormones were evaluated by multivariate analysis. In oldest-old subjects, plasma retinol was negatively associated with FT4 (P = 0.019) and TSH serum levels (P = 0.040), whereas serum zinc was positively associated with serum FT3 (P = 0.010) and FT3/FT4 ratio (P = 0.011). In younger subjects, no significant association was found among thyroid variables and micronutrients. In conclusion, blood levels of specific micronutrients are associated with serum iodothyronine levels in extreme aging.

Lack of effects of circulating thyroid hormone levels on serum leptin concentrations

1997 ◽  
pp. 659-663 ◽  
Author(s):  
S Corbetta ◽  
P Englaro ◽  
S Giambona ◽  
L Persani ◽  
WF Blum ◽  
...  
Keyword(s):  
Thyroid Hormones ◽  
Standard Deviation Score ◽  
Protein Product ◽  
Primary Hypothyroidism ◽  
Central Hypothyroidism ◽  
Serum Leptin ◽  
Thyroxine Therapy ◽  
Significant Difference ◽  
Before And After ◽  
Thyroxine Replacement Therapy

Leptin is the protein product of the ob gene, secreted by adipocytes. It has been suggested that it may play an important role in regulating appetite and energy expenditure. The aim of this study was to evaluate a possible interaction of thyroid hormones with the leptin system. We studied 114 adult patients (65 females and 49 males): 36 were affected with primary hypothyroidism (PH), 38 with central hypothyroidism (CH) and 40 with thyrotoxicosis (TT). Patients with CH were studied both before and after 6 months of L-thyroxine replacement therapy. Body mass index (BMI; kg/m2), thyroid function and fasting serum leptin were assessed in all patients. Since BMI has been proved to be the major influencing variable of circulating leptin levels, data were expressed as standard deviation score (SDS) calculated from 393 male and 561 female controls matched for age and BMI. No difference in SDS was recorded between males and females whatever the levels of circulating thyroid hormones. In males, no significant difference was recorded among the SDSs of PH (-0.36 +/- 1.2), TT (-0.35 +/- 1.2) and CH (0.01 +/- 1.4) patients. Females with PH had an SDSs significantly lower than TT females (-0.77 +/- 1.0 vs -0.06 +/- 1.2; P < 0.02), while no significant differences between CH (-0.34 +/- 0.7) and TT females or between CH and PH females were observed. SDS in CH patients after 6 months of L-thyroxine therapy significantly varied only in females (0.25 +/- 1.4). In conclusion, circulating thyroid hormones do not appear to play any relevant role in leptin synthesis and secretion. However, as females with either overt hypo- or hyper-thyroidism or central hypothyroidism after L-thyroxine therapy show differences in their SDSs, a subtle interaction between sex steroids and thyroid status in modulating leptin secretion, at least in women, may occur.

scholarly journals Rescue pre-operative treatment with Lugol’s solution in uncontrolled Graves’ disease

2017 ◽  
Vol 6 (4) ◽  
pp. 200-205 ◽  
Author(s):  
Jan Calissendorff ◽  
Henrik Falhammar
Keyword(s):  
Heart Rate ◽  
Thyroid Hormone ◽  
Side Effects ◽  
Definitive Treatment ◽  
Graves Disease ◽  
Free T4 ◽  
Hormone Levels ◽  
Free T3 ◽  
Adherence To Medication ◽  
Thyroid Hormone Levels

Background Graves’ disease is a common cause of hyperthyroidism. Three therapies have been used for decades: pharmacologic therapy, surgery and radioiodine. In case of adverse events, especially agranulocytosis or hepatotoxicity, pre-treatment with Lugol’s solution containing iodine/potassium iodide to induce euthyroidism before surgery could be advocated, but this has rarely been reported. Methods All patients hospitalised due to uncontrolled hyperthyroidism at the Karolinska University Hospital 2005–2015 and treated with Lugol’s solution were included. All electronic files were carefully reviewed manually, with focus on the cause of treatment and admission, demographic data, and effects of iodine on thyroid hormone levels and pulse frequency. Results Twenty-seven patients were included. Lugol’s solution had been chosen due to agranulocytosis in 9 (33%), hepatotoxicity in 2 (7%), other side effects in 11 (41%) and poor adherence to medication in 5 (19%). Levels of free T4, free T3 and heart rate decreased significantly after 5–9 days of iodine therapy (free T4 53–20 pmol/L, P = 0.0002; free T3 20–6.5 pmol/L, P = 0.04; heart rate 87–76 beats/min P = 0.0007), whereas TSH remained unchanged. Side effects were noted in 4 (15%) (rash n = 2, rash and vomiting n = 1, swelling of fingers n = 1). Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. Conclusion Treatment of uncontrolled hyperthyroidism with Lugol’s solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Side effects were limited. Lugol’s solution could be recommended pre-operatively in Graves’ disease with failed medical treatment, especially if side effects to anti-thyroid drugs have occurred.

EFFECT OF THE COMBINATION OF DEXAMETHASONE AND SODIUM IPODATE ON SERUM THYROID HORMONES IN GRAVES' DISEASE

1983 ◽  
Vol 19 (5) ◽  
pp. 619-627 ◽  
Author(s):  
E. ARTEAGA ◽  
J. M. LÓPEZ ◽  
J. A. RODRÍGUEZ ◽  
P. MICHAUD ◽  
G. LÓPEZ
Keyword(s):  
Thyroid Hormones ◽  
Graves Disease ◽  
Sodium Ipodate ◽  
Serum Thyroid Hormones

The effect of levothyroxine in comparison with placebo on serum osteocalcin levels in patients with subclinical hypothyroidism

2021 ◽  
Vol 16 ◽  
Author(s):  
Reihaneh Rezaee ◽  
Masoud Mohebbi ◽  
Mozhgan Afkhamizadeh ◽  
Mohammad Ali Yaghoubi ◽  
Mona Najaf Najafi ◽  
...  
Keyword(s):  
Thyroid Hormones ◽  
Subclinical Hypothyroidism ◽  
Intervention Group ◽  
Serum Levels ◽  
Overt Hypothyroidism ◽  
Serum Osteocalcin ◽  
Significant Difference ◽  
Before And After ◽  
Metabolic Conditions ◽  
And Control

Background and Objective: Subclinical hypothyroidism can potentially develop to overt hypothyroidism. Thyroid hormones have substantial roles in metabolism and glucose homeostasis and thus are closely related to determinant factors of metabolic syndromes, such as obesity and insulin resistance. Osteocalcin is considered a predictor of metabolic conditions in thyroid diseases. This study aimed to investigate the effect of levothyroxine vs. placebo on serum osteocalcin levels in patients with subclinical hypothyroidism. Methods: This randomized clinical trial was performed on 30 patients with subclinical hypothyroidism who were referred to the endocrine clinics of Ghaem and Imam Reza hospitals in Mashhad, Iran. After giving informed consent, patients were randomly divided into intervention (50 µg/day levothyroxine for 2 months) and control (placebo) groups. Serum levels of osteocalcin, thyroid hormones, lipid profile, insulin, and fasting glucose, as well as other clinical and anthropometric data, were measured at baseline and at the end of the study. SPSS was used to analyze the data and P<0.05 was considered significant. Results: Mean age in the intervention and control groups was 35.07 ± 9.94 and 31.30 ± 4.30, respectively (P=0.20). There was no significant difference between osteocalcin levels before and after the intervention in either of the groups (P=0.54). TSH level was significantly decreased in the levothyroxine group after the intervention (P<0.01). T4 level was significantly increased in the intervention group (P=0.02). Conclusion: Levothyroxine had no significant effect on increasing the levels of serum osteocalcin in patients with subclinical hypothyroidism. We have registered the trial in the Iranian registry of clinical trials (IRCT) with the registration code IRCT20171129037677N1.

Comparison Between Computed Tomography Angiography and Digital Subtraction Angiography in Critical Lower Limb Ischemia

2019 ◽  
Vol 15 (5) ◽  
pp. 496-503 ◽  
Author(s):  
Hesham Ebrahim Ahmed Al-rudaini ◽  
Ping Han ◽  
Huimin Liang
Keyword(s):  
Digital Subtraction Angiography ◽  
Ct Angiography ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Definitive Treatment ◽  
Digital Subtraction ◽  
Arterial Tree ◽  
Lower Limb Ischemia ◽  
Significant Difference ◽  
Peripheral Arterial

Background:CT Angiography (CTA) of aortoiliac and lower extremity arteries is a relatively recent innovation of CT imaging that has changed after the introduction of multi-detector row scanners.Objective:The study aimed to evaluate the diagnostic accuracy of Multidetector Computed Tomographic Angiography (MDCTA) in the assessment of arterial tree in patients with Peripheral Arterial Occlusive Disease (PAOD), as compared to Digital Subtraction Angiography (DSA).Methods:A single-center nonrandomized prospective study was conducted on 50 patients complaining of peripheral arterial disease (chronic stage) from February 2017 to October 2017. All the patients were exposed to DSA and CTA prior to definitive treatment. The images were then analyzed using maximum intensity projection, volume-rendered, and curved multiplane reformation techniques.Results:All the patients involved in this study were susceptible according to their clinical presentation. The statistical analysis exposed a highly significant difference between CTA and DSA in the assessment of stenosis at the level of Femoropopliteal segment (P<0.01), while for infrapopliteal segment, there was no statistically significant difference between CTA and DSA having 8% versus 14% insignificant stenosis and 62% versus 47% significant stenosis in CTA and DSA, respectively. The overall accuracy of CT angiography in the femoropopliteal segments was 95.20% while in the infrapopliteal segment it was 94.5%.Conclusion:Multidetector CT angiography was found to be a reliable alternative mean for pathoanatomical description of the arterial lesions in critical lower limb ischemia and its subsequent management in comparison to digital subtraction angiography.

Thyroid Stimulating Immunoglobulins: Measurement and Clinical use

1985 ◽  
Vol 69 (2) ◽  
pp. 113-121 ◽  
Author(s):  
C. A. Ollis ◽  
S. Tomlinson ◽  
D. S. Munro
Keyword(s):  
Thyroid Hormones ◽  
Elevated Serum ◽  
Serum Levels ◽  
The Other ◽  
Graves Disease ◽  
Clinical Use ◽  
Hormone Production ◽  
Skin Changes ◽  
Thyroid Stimulating Immunoglobulins ◽  
Eye Involvement

Graves’ disease is the commonest form of hyperthyroidism in which excessive production of thyroid hormones by the hyperplastic overactive thyroid gland produces elevated serum levels of the thyroid hormones tri-iodothyronine (T3) and thyroxine (T4). Many of the manifestations of Graves’ disease, increased basal metabolic rate, increased heart rate, heat intolerance, sweating and nervousness, can be attributed to the peripheral actions of the excess thyroid hormones. The pathogenesis of many of the other dramatic features of Graves’ disease, such as the eye involvement or localized skin changes, is not fully understood, but circulating immunoglobulins with thyroid stimulating activity are almost certainly linked to excess thyroid hormone production and thereby cause the hyperthyroidism.

Suppressor T lymphocyte function in Graves' disease

1982 ◽  
Vol 101 (3) ◽  
pp. 354-358 ◽  
Author(s):  
Bengt Hallengren ◽  
Arne Forsgren
Keyword(s):  
Patient Group ◽  
T Lymphocyte ◽  
Pokeweed Mitogen ◽  
Control Group ◽  
Graves Disease ◽  
Lymphocyte Function ◽  
Euthyroid State ◽  
Hyperthyroid State ◽  
Significant Difference ◽  
Suppressor T Lymphocyte

Abstract. To explore suppressor T lymphocyte function in Graves' disease, studies were performed in one group of patients in the hyperthyroid state and in another group in the euthyroid state after treatment. Peripheral blood lymphocytes were cultured for 1–7 days., Pokeweed mitogen (PWM; 1.25 μg/ml) was added at the initiation of the cultures or after 24 h. The degree of lymphocyte activation was assessed by measurements of the cellular uptake of [3H]thymidine and expressed in counts per minute (cpm). The suppressor lymphocyte function was estimated by a quotient between the maximum cpm values from cultures with and without pre-incubation. For the hyperthyroid group (n = 15) the quotient was 1.00 ± 0.07 (mean ± sem), for the euthyroid patient group (n = 21) 1.12 ± 0.05 and for the healthy control group (n = 21) 1.37 ± 0.08. There was a significant difference between the quotients for the control group and the hyperthyroid (P < 0.01) as well as the euthyroid (P < 0.05) patient group. The quotients for the two groups of patients did not differ significantly. In conclusion, the present study supports the view of a defect in suppressor T lymphocyte function in patients with Graves' disease in the hyperthyroid state and indicates that this defect can persist in the euthyroid state after treatment.

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