scholarly journals Hyperthyroidism Times 2: Dual Cause of Thyroid Hormone Excess

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A935-A935
Author(s):  
Yineli Ortiz ◽  
Alegyari Figueroa Cruz ◽  
Luis Norberto Madera Marin ◽  
Gabriel Mora ◽  
Angela Torres ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Thyroid Tissue ◽  
Tsh Receptor ◽  
Antithyroid Drugs ◽  
Decompression Surgery ◽  
Toxic Adenoma ◽  
Management Options ◽  
Surgical Specimen ◽  
Grave’S Disease ◽  
Grave's Disease

Abstract The most common etiology of Hyperthyroidism is due to circulating antibodies that are directed against the thyroid-stimulating hormone (TSH) receptor, known as Grave’s Disease (GD). Another cause is an autonomously functioning thyroid nodule over-producing hormones or Toxic Adenoma. The mechanism of these two pathologies are very distinct, but the question that arises is, can they coexist? This is a case of 44-year-old female who comes to the clinic referred by her ophthalmologist after been diagnosed with severe thyroid-associated orbitopathy currently on steroid therapy. Thyroid ultrasound has done previously showed enlarged homogenous thyroid gland with a single isoechoic nodule of 2.2x1.6x1.9cm with faint peripheral calcifications and vascularity. The patient was presenting with palpitations, heat intolerance, sweating, and discriminatory features such as double vision and left eye exophthalmos. On physical examination, there was no goiter or palpable thyroid nodules, but it was remarkable for left eyelid lag retraction and mild proptosis. Evaluation showed clinical and biochemical hyperthyroidism with TSH: 0.068 mU/ml (n:0.5-5.0mU/ml), FT4: 1.39ng/dl (n:0.87-1.85ng/dl), TSH receptor antibody: <1.10IU/L and thyroid-stimulating immunoglobulin: 0.54IU/L (borderline high). The patient was placed in antithyroid drugs and B-blockers for disease control. Afterward, the patient underwent a thyroid uptake scan reporting toxic adenoma on the left lobe, however even when the biochemical workup of GD is inconclusive, patient clinical findings are highly suggestive of it. Due to the risk of worsening orbitopathy with radioactive iodine therapy, patient was referred for surgical excision of toxic adenoma and total thyroidectomy was decided since residual thyroid tissue may expose the patient to circulating thyroid-stimulating immunoglobulin leading to hyperthyroidism recurrence and put her at risk of associated thyroid excess detrimental complications. Surgical specimen gross pathology biopsy reported the thyroid gland with hyperplastic changes of Grave’s Disease. Severe thyroid-associated orbitopathy was managed with decompression surgery but did not improve, for which an alternative therapeutic approach is decided with novel immunomodulatory agent and recent approved therapy, Teprotumumab. A monoclonal antibody that works on TSHR/IGF-1R signaling complex involved in Thyroid Eye Disease. Is unusual to see two different superimposing thyroid pathologies, but disease presentations can be atypical and can be present concomitantly. In this scenario, several factors must be taken into consideration when choosing an adequate therapy approach. Our case is an example that we need to individualize management options based on guidelines recommendations, patient’s clinical settings and decreased risks of future complications.

scholarly journals Thyrolipoma: A Rare Thyroid Gland Entity

2019 ◽  
Vol 9 (1) ◽  
pp. 24-29
Author(s):  
Pragya Singh ◽  
Mahesh Kumar Mittal ◽  
Sonam Sharma
Keyword(s):  
Thyroid Gland ◽  
Papillary Carcinoma ◽  
Lymphocytic Thyroiditis ◽  
Grave’S Disease ◽  
Amyloid Goiter ◽  
Grave's Disease ◽  
Thyroid Swelling

Fat-containing thyroid swellings are rare with limited differentials including lipomatous goiter, heterotopic thyroid rests, amyloid goiter, lymphocytic thyroiditis, Grave’s disease, adenolipoma, intrathyroid thymic or parathyroid lipoma, encapsulated papillary carcinoma, and liposarcoma etc. We present a case of a 60-year-old euthyroid female with a long standing thyroid swelling radiologically and pathologically diagnosed as thyrolipoma (adenolipoma). Thyrolipomas are occasionally diagnosed. However, these lesions are considered to be benign and are treated surgically.

Radioiodine in the Diagnosis and Therapy of Solitary Hyperfunctioning Thyroid Nodules

1968 ◽  
Vol 07 (01) ◽  
pp. 82-90
Author(s):  
A. Y. Al Hindawi ◽  
Th. N. Al-Hiti ◽  
W. I. Baba
Keyword(s):  
Thyroid Gland ◽  
Thyroid Nodule ◽  
Thyroid Function ◽  
Thyroid Nodules ◽  
Clinical Presentation ◽  
Radioiodine Therapy ◽  
Thyroid Tissue ◽  
Toxic Adenoma ◽  
Diagnosis And Therapy ◽  
High Doses

SummaryThe clinical presentation, the incidence, and the results of radioiodine tests in 80 patients with hyperfunctioning thyroid nodule confirmed by scanning are presented. 52 patients had toxic adenoma and 28 were euthyroid.The value of different radioiodine tests of thyroid function in confirming the diagnosis is discussed.The topographical changes in both hyperfunctioning nodule and suppressed tissue of the thyroid gland following exogenous TSH and radioiodine therapy showed refunctioning of suppressed thyroid tissue.Relatively high doses of radioiodine were required to treat toxic adenoma of the thyroid gland.

scholarly journals Management of Graves’ Disease during Pregnancy: The Key Role of Fetal Thyroid Gland Monitoring

2005 ◽  
Vol 90 (11) ◽  
pp. 6093-6098 ◽  
Author(s):  
Dominique Luton ◽  
Isabelle Le Gac ◽  
Edith Vuillard ◽  
Mireille Castanet ◽  
Jean Guibourdenche ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Tsh Receptor ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Test Results ◽  
Bone Maturation ◽  
Normal Test ◽  
Fetal Thyroid

Abstract Background: Fetuses from mothers with Graves’ disease may experience hypothyroidism or hyperthyroidism due to transplacental transfer of antithyroid drugs (ATD) or anti-TSH receptor antibodies, respectively. Little is known about the fetal consequences. Early diagnosis is essential to successful management. We investigated a new approach to the fetal diagnosis of thyroid dysfunction and validated the usefulness of fetal thyroid ultrasonograms. Methods: Seventy-two mothers with past or present Graves’ disease and their fetuses were monitored monthly from 22 wk gestation. Fetal thyroid size and Doppler signals, and fetal bone maturation were determined on ultrasonograms, and thyroid function was evaluated at birth. Thyroid function and ATD dosage were monitored in the mothers. Results: The 31 fetuses whose mothers were anti-TSH receptor antibody negative and took no ATDs during late pregnancy had normal test results. Of the 41 other fetuses, 30 had normal test results at 32 wk, 29 were euthyroid at birth, and one had moderate hypothyroidism on cord blood tests. In the remaining 11 fetuses, goiter was visualized by ultrasonography at 32 wk, and fetal thyroid dysfunction was diagnosed and treated; there was one death, in a late referral, and 10 good outcomes with normal or slightly altered thyroid function at birth. The sensitivity and specificity of fetal thyroid ultrasound at 32 wk for the diagnosis of clinically relevant fetal thyroid dysfunction were 92 and 100%, respectively. Conclusion: In pregnant women with past or current Graves’ disease, ultrasonography of the fetal thyroid gland by an experienced ultrasonographer is an excellent diagnostic tool. This tool in conjunction with close teamwork among internists, endocrinologists, obstetricians, echographists, and pediatricians can ensure normal fetal thyroid function.

scholarly journals A Case for Lithium Pretreatment Prior to Radioactive Iodine Ablation in Grave’s Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A906-A907
Author(s):  
Aditi Thakkar ◽  
Constance Lee Chen
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Radioactive Iodine ◽  
Hormone Release ◽  
Iodide Uptake ◽  
Radioiodine Uptake ◽  
Grave’S Disease ◽  
Grave's Disease ◽  
Radioiodide Therapy ◽  
Radioactive Iodine Ablation

Abstract Radioactive iodine ablation (RAIA) therapy with Iodine-131 (I-131) is an established treatment for grave’s thyrotoxicosis. However, there is 10 to 20% chance of treatment failure. Lithium, a drug used to treat bipolar disorder, has significant effects on thyroid function. The most clinically relevant is the inhibition of thyroid hormone release. It is also known to inhibit colloid formation, and is involved in blocking organic iodine as well as thyroid hormone release from the thyroid gland without an effect on radioiodine uptake. This leads to increased radioiodine retention in the thyroid gland. Here, we present a case which exemplifies this action of lithium. A 46 year old male with a history of atrial fibrillation and grave’s disease presented to the endocrine clinic. TSH was <0.01 and FT4 was 36. RAI uptake (RAIU) scan showed diffusely increased uptakes with 4 and 24 hour values of 61.2 and 54.6 %. He subsequently underwent RAI ablation with 18 mCi of I 131. He then presented three years later with persistent hyperthyroid symptoms. TSH <0.01 and FT4 4.3. RAIU showed 24-h thyroid uptake of 41%. Patient opted for a second treatment with RAIA and was treated with 30 millicuries of I 131. He however continued to have clinical and biochemical evidence of thyrotoxicosis and was started on methimazole (MMI). Although he was biochemically euthyroid on MMI, he continued to complain of hyperthyroid symptoms such as palpitations, tremors and weight loss. When methimazole was briefly held six months after initiation, TSH was undetectable and FT4 had increased from 0.83 to 1.42. He subsequently underwent a third RAIU off MMI which showed normal 4 and 24 hour uptake, measuring 15.7% and 28% respectively. Patient subsequently opted for third trial of RAI ablation with lithium pretreatment. He declined surgery. He was started on lithium 900mg/day for 6 days, starting on the day of RAI ablation. He underwent RAI ablation with 45 mCi I-131. Patient tolerated the procedure well with subsequent tests indicating hypothyroidism requiring levothyroxine supplementation. Patient’s hyperthyroid symptoms resolved. Several factors affect the efficacy of radioiodide therapy for hyperthyroidism including the short persistence of radioiodide in the thyroid gland. In hyperthyroid Graves’ patients, radioactive iodide uptake is enhanced due to presence of TSH receptor antibody, however, radioiodide is also rapidly discharged because of its increased turnover. Lithium can significantly reduce the release of iodine from the thyroid gland and thus increase iodine retention. There is evidence to suggest that adjuvant lithium can increase thyroidal radioiodine uptake in patients with a low baseline RAIU (< 30%). This case demonstrate that lithium can be used safely prior to RAI therapy in cases of RAI ablation failure even with low baseline RAIU.

AN IMMUNO-ELECTRON MICROSCOPIC STUDY ON INTRACELLULAR LOCALIZATION OF THYROGLOBULIN (TG) IN THE THYROID GLAND IN GRAVE'S DISEASE

1985 ◽  
Vol 35 (3) ◽  
pp. 591-603
Author(s):  
Iwao Nakayama ◽  
Shiro Noguchi ◽  
Hiroto Yamashita ◽  
Nobuo Murakami ◽  
Yuichi Mochizuki ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Microscopic Study ◽  
Electron Microscopic Study ◽  
Intracellular Localization ◽  
Electron Microscopic ◽  
Grave’S Disease ◽  
Grave's Disease

scholarly journals THYROID GLAND DISEASES AND FACTORS, WHICH IMPACT ON ITS POPULATION PREVALENCE

2010 ◽  
Vol 8 (1) ◽  
pp. 42-49
Author(s):  
Svetlana A Shtandel ◽  
Igor R Barilyak ◽  
Vadim V Khaziev ◽  
Irina V Gopkalova
Keyword(s):  
Thyroid Gland ◽  
Iodine Deficiency ◽  
Age Structure ◽  
Nodular Goiter ◽  
Population Age Structure ◽  
Grave’S Disease ◽  
Population Prevalence ◽  
Atomic Station ◽  
Thyroid Gland Cancer ◽  
Grave's Disease

As the factors which impact on the population prevalence of nodular goiter, Grave’s disease and thyroid gland cancer, iodine deficiency, remote consequences of accident on the Chernobyl atomic station, population age structure and selection in modern conditions were studied. Differential fertility indexes, diseases prevalence and population age structure official statistic data were analyzed. It has been shown, that iodine deficiency expressiveness, consequences of accident on the Chernobyl atomic station, population age structure and selection are impact on the nodular goiter, Grave’s disease and thyroid gland cancer population prevalence. 

scholarly journals Marrow hypoplasia: a rare complication of untreated Grave’s disease

2014 ◽  
Vol 58 (9) ◽  
pp. 953-957 ◽  
Author(s):  
Juliana Garcia ◽  
Larissa de França ◽  
Vivian Ellinger ◽  
Mônica Wolff
Keyword(s):  
Bone Marrow ◽  
Case Reports ◽  
Rare Complication ◽  
Antithyroid Drugs ◽  
Fat Tissue ◽  
Blood Tests ◽  
Grave’S Disease ◽  
Tissue Replacement ◽  
Severe Manifestation ◽  
Grave's Disease

Atypical presentation forms of hyperthyroidism are always a challenge to the clinician. We present a female patient with the typical symptoms of thyrotoxicosis, without any thionamides treatment before, associated with pancytopenia, which recovered after euthyroidism state was achieved. Although the major cases of pancytopenia in Grave’s disease are seen as a complication of antithyroid drugs (thioamides), in this case report the alteration in blood tests was associated with untreated hyperthyroidism. In the literature review, we found 19 case reports between 1981 to 2012, but it has been related to a hypercellular bone marrow with periferic destruction. Our case, however, is about a hypocellular bone marrow without fibrosis or fat tissue replacement, which proceeded with a periferic improvement following thyroid treatment. Although rare, pancytopenia, when present, may develop as an unusual and severe manifestation in untreated subjects.

Management of toxic multinodular goitre and toxic adenoma

2011 ◽  
pp. 508-511
Author(s):  
Dagmar Führer ◽  
John H Lazarus
Keyword(s):  
Thyroid Hormones ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Thyroid Tissue ◽  
Tsh Receptor ◽  
Multinodular Goitre ◽  
Toxic Adenoma ◽  
Thyroid Autonomy ◽  
Hot Nodule ◽  
Autonomously Functioning Thyroid Nodules

Toxic adenoma and toxic multinodular goitre represent the clinically important presentations of thyroid autonomy. Thyroid autonomy is a condition where thyrocytes produce thyroid hormones independently of thyrotropin (TSH) and in the absence of TSH-receptor stimulating antibodies (TSAB). Toxic adenoma (TA) is a clinical term referring to a solitary autonomously functioning thyroid nodule. The autonomous properties of TA are best shown by radio-iodine or 99mTc imaging. The classic appearance of TA is that of circumscribed increased uptake with suppression of uptake in the surrounding extranodular thyroid tissue (‘hot’ nodule, Fig. 3.3.11.1). Toxic multinodular goitre (TMNG) is a heterogeneous disorder characterized by the presence of autonomously functioning thyroid nodules in a goitre with or without additional nodules. These additional nodules can show normal or decreased uptake (cold nodules) on scintiscan. TMNG constitutes the most frequent form of thyroid autonomy.

scholarly journals Carbimazole Induced Cholestatic Hepatitis in Grave’s Disease – A Case Report

2016 ◽  
Vol 22 (2) ◽  
Author(s):  
N. S. Neki ◽  
Ankur Jain
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Female Patient ◽  
Antithyroid Drugs ◽  
Common Cause ◽  
Drug Of Choice ◽  
Grave’S Disease ◽  
Grave's Disease ◽  
In Pregnancy ◽  
Propyl Thiouracil

Grave’s disease is the most common cause of hyperthyroidism. Antithyroid drugs are usually well tolerated in majority of patients but serious side effects in the form of allergy, agranulocytosis, aplastic anaemia, vasculitis, hepatitis etc occur in 3 – 12% of treated patients. Carbimazole is extensively used as the drug of choice except in pregnancy, where propylthiouracil is preferred. We report a case of 35 year old female patient with Grave’s disease, who developed cholestatic jaundice following administration of carbimazole for 2 months. Symptoms and laboratory abnormalities subsided on withdrawal of carbimazole and Grave’s thyrotoxicosis was managed with propranolol and propyl-thiouracil.

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