Thyroid hypoechogenic pattern at ultrasonography as a tool for predicting recurrence of hyperthyroidism after medical treatment in patients with Graves' disease

1992 ◽  
Vol 126 (2) ◽  
pp. 128-131 ◽  
Author(s):  
Paolo Vitti ◽  
Teresa Rago ◽  
Francesco Mancusi ◽  
Stefania Pallini ◽  
Massimo Tonacchera ◽  
...  
Keyword(s):  
Antithyroid Drugs ◽  
Graves Disease ◽  
Study Group ◽  
Thyrotropin Receptor ◽  
Thyroid Ultrasonography ◽  
Normal Thyroid ◽  
End Of Treatment ◽  
The Relationship ◽  
Prediction Of Relapse

An abnormal thyroid echographic pattern characterized by a diffuse low echogenicity has been described in Hashimoto's thyroiditis and Graves' disease. The aim of the present work was to study the relationship between thyroid hypoechogenicity and the outcome of treatment for hyperthyroidism with antithyroid drugs in patients with Graves' disease. The study group included 105 patients who underwent a course of methimazole treatment. Thyroid ultrasonography was carried out at diagnosis, and autoantibodies to thyrotropin receptor (TR-ab) were measured at the end of treatment. During the follow-up after methimazole treatment, 87/105 (83%) patients had relapse of hyperthyroidism and 18/105 (17%) were in remission. Recurrence of hyperthyroidism occurred in 71/76 (93%) patients with thyroid hypoechogenicity and in 16/29 (55%) of those with normal thyroid echogenicity (ϰ2= 19.0; p<0.0001). Positive TR-ab values at the end of methimazole treatment were found in 59/76 (78%) patients with thyroid hypoechogenicity and in 12/29 (41%) patients with normal thyroid echogenicity (ϰ2 = 10.9; p< 0.0001). Sixty-five/87 (74%) patients with relapse of hyperthyroidism and 6/18(3 3%) of those who remained euthyroid were TR-ab-positive at the end of methimazole treatment (ϰ2 = 9.8; p< 0.002). The finding of thyroid hypoechogenicity at diagnosis had higher specificity (0.81) and sensitivity (0.72) with respect to TR-ab positivity at the end of methimazole treatment (0.74 and 0.66 respectively) for the prediction of relapse of hyperthyroidism. Therefore, the evaluation of thyroid echographic pattern can be considered a useful prognostic tool in patients with Graves' disease.

Prognosis

2020 ◽  
pp. 241-247
Keyword(s):  
Coronary Artery Disease ◽  
Poor Prognosis ◽  
B Cell Lymphoma ◽  
Graves Disease ◽  
Papillary Thyroid ◽  
Myxedema Coma ◽  
Follow Up Care ◽  
Artery Disease ◽  
The Relationship

With early diagnosis, timely institution of L-T4 replacement therapy, regular patient follow-up care, and attention to other attendant complications, the prognosis in Hashimoto's thyroiditis (HT) is excellent with patients leading a normal life. Untreated myxedema coma has a poor prognosis and a high mortality rate, particularly in old age. Transient periods of thyrotoxicosis sometimes occur, and rarely full hyperthyroid Graves' disease with active ophthalmopathy. There is an increased prevalence of coronary artery disease in patients with untreated or undertreated HT. The relationship between papillary thyroid carcinoma (PTC) and HT has been controversial. Primary thyroid B-cell lymphoma affects less than one in a thousand persons, and it is more likely to affect those with long-standing autoimmune thyroiditis. Complications of over-replacement with L-T4 should be avoided. This chapter explores the prognosis of Hashimoto's disease.

scholarly journals Prospective Trial of Functional Thyrotropin Receptor Antibodies in Graves Disease

2019 ◽  
Vol 105 (4) ◽  
pp. e1006-e1014 ◽  
Author(s):  
George J Kahaly ◽  
Tanja Diana ◽  
Michael Kanitz ◽  
Lara Frommer ◽  
Paul D Olivo
Keyword(s):  
Predictive Value ◽  
Prospective Trial ◽  
Thyroid Stimulating Hormone ◽  
Luciferase Expression ◽  
Graves Disease ◽  
Thyrotropin Receptor ◽  
Tertiary Referral Center ◽  
Thyrotropin Receptor Antibodies ◽  
Receptor Antibodies

Abstract Context Scarce data exist regarding the relevance of stimulatory (TSAb) and blocking (TBAb) thyrotropin receptor antibodies in the management of Graves disease (GD). Objective To evaluate the clinical utility and predictive value of TSAb/TBAb. Design Prospective 2-year trial. Setting Academic tertiary referral center. Patients One hundred consecutive, untreated, hyperthyroid GD patients. Methods TSAb was reported as percentage of specimen-to-reference ratio (SRR) (cutoff SRR &lt; 140%). Blocking activity was defined as percent inhibition of luciferase expression relative to induction with bovine thyrotropin (TSH, thyroid stimulating hormone) alone (cutoff &gt; 40% inhibition). Main Outcome Measures Response versus nonresponse to a 24-week methimazole (MMI) treatment defined as biochemical euthyroidism versus persistent hyperthyroidism at week 24 and/or relapse at weeks 36, 48, and 96. Results Forty-four patients responded to MMI, of whom 43% had Graves orbitopathy (GO), while 56 were nonresponders (66% with GO; P &lt; 0.01). At baseline, undiluted serum TSAb but not thyroid binding inhibitory immunoglobulins (TBII) differentiated between thyroidal GD-only versus GD + GO (P &lt; 0.001). Furthermore, at baseline, responders demonstrated marked differences in diluted TSAb titers compared with nonresponders (P &lt; 0.001). During treatment, serum TSAb levels decreased markedly in responders (P &lt; 0.001) but increased in nonresponders (P &lt; 0.01). In contrast, TBII strongly decreased in nonresponders (P = 0.002). All nonresponders and/or those who relapsed during 72-week follow-up period were TSAb-positive at week 24. A shift from TSAb to TBAb was noted in 8 patients during treatment and/or follow-up and led to remission. Conclusions Serum TSAb levels mirror severity of GD. Their increase during MMI treatment is a marker for ongoing disease activity. TSAb dilution analysis had additional predictive value.

scholarly journals See-Saw Relationship and its Reversal after Immunotherapy in a Case of Graves’ Disease with Coexisting Myasthenia Gravis

2019 ◽  
Vol 10 (01) ◽  
pp. 136-138 ◽  
Author(s):  
Sathish Kumar Mallikarjuna ◽  
S. Sakthi Velayutham ◽  
P. R. Sowmini ◽  
Malcolm K. Jeyaraj ◽  
S. Arunan
Keyword(s):  
Clinical Practice ◽  
Myasthenia Gravis ◽  
Beta Blockers ◽  
Reciprocal Relationship ◽  
The Other ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Immunomodulatory Effects ◽  
The Relationship ◽  
Unique Association

ABSTRACTThe unique association of myasthenia gravis (MG) with Graves' disease in clinical practice emphasizes that one autoimmune disease can coexist with another or many. The relationship between these two entities has remained controversial till date. Some authors have reported a see-saw relationship between these two entities, MG waning with hyperthyroidism and waxing with treatment of hyperthyroidism. Treatment of both these disorders concurrently may be challenging at times as treatment for one entity may worsen the other. The use of beta-blockers and steroids for Graves' disease may worsen myasthenic weakness. Antithyroid drugs can worsen myasthenia probably by immunomodulatory effects. We report a case of Graves' disease coexisting with MG in a reciprocal relationship which was subsequently reversed after immunotherapy.

scholarly journals Predictive value of maternal second-generation thyroid-binding inhibitory immunoglobulin assay for neonatal autoimmune hyperthyroidism

2014 ◽  
Vol 171 (4) ◽  
pp. 451-460 ◽  
Author(s):  
Juliette Abeillon-du Payrat ◽  
Karim Chikh ◽  
Nadine Bossard ◽  
Patricia Bretones ◽  
Pascal Gaucherand ◽  
...  
Keyword(s):  
First Generation ◽  
Second Generation ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyroid Ultrasound ◽  
Second Trimester ◽  
Neonatal Hyperthyroidism ◽  
Fetal Thyroid ◽  
Current Guidelines

ContextHyperthyroidism occurs in 1% of neonates born to mothers with active or past Graves' disease (GD). Current guidelines for the management of GD during pregnancy were based on studies conducted with first-generation thyroid-binding inhibitory immunoglobulin (TBII) assays.ObjectiveThis retrospective study was conducted in order to specify the second-generation TBII threshold predictive of fetal and neonatal hyperthyroidism, and to identify other factors that may be helpful in predicting neonatal hyperthyroidism.MethodsWe included 47 neonates born in the Lyon area to 42 mothers harboring measurable levels of TBII during pregnancy. TBII measurements were carried out in all mothers; bioassays were carried out in 20 cases.ResultsNine neonates were born with hyperthyroidism, including five with severe hyperthyroidism requiring treatment. Three neonates were born with hypothyroidism. All hyperthyroid neonates were born to mothers with TBII levels >5 IU/l in the second trimester (sensitivity, 100% and specificity, 43%). No mother with TSH receptor-stimulating antibodies (TSAb measured by bioassay) below 400% gave birth to a hyperthyroid neonate. Among mothers of hyperthyroid neonates, who required antithyroid drugs during pregnancy, none could stop treatment before delivery. Analysis of TBII evolution showed six unexpected cases of increasing TBII values during pregnancy.ConclusionMaternal TBII value over 5 IU/l indicates a risk of neonatal hyperthyroidism. Among these mothers, a TSAb measurement contributes to identify more specifically those who require a close fetal thyroid ultrasound follow-up. These results should be confirmed in a larger series.

scholarly journals Myopathy Associated with Treatment of Graves’ Disease

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1016
Author(s):  
Yoon-Kyung Ji ◽  
Shin-Hee Kim
Keyword(s):  
Creatine Kinase ◽  
Adverse Reaction ◽  
Thyroid Function ◽  
Serum Creatine Kinase ◽  
Free Thyroxine ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Pediatric Case ◽  
Antithyroid Treatment

Here, we report a case of an increase in serum creatine kinase (CK) concentration in an 11-year-old girl being treated for Graves’ disease with antithyroid drugs (ATDs). The patient complained of myalgia two weeks after methimazole treatment. Triiodothyronine (T3) and free thyroxine (FT4) levels were normal, but the serum CK level was significantly elevated. After switching to propylthiouracil, the serum CK level decreased to normal, and the myalgia was resolved. The development of myopathy during the treatment of hyperthyroidism may be considered as an adverse reaction of MMI. In this report, we present a rare pediatric case, along with a discussion on the possible causes of myopathy that occurred during the treatment of Graves’ disease. A careful follow-up (serum CK levels and thyroid function) and treatment reassessment should always be considered after antithyroid treatment.

scholarly journals Hyperthyroidism and vascular cell adhesion molecule-1 are associated with a low ankle-brachial index

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yu-Hsuan Li ◽  
I-Te Lee
Keyword(s):  
Cell Adhesion Molecule ◽  
Regression Coefficient ◽  
Ankle Brachial Index ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Vascular Cell Adhesion ◽  
Free T4 ◽  
Vascular Cell ◽  
Cell Adhesion Molecule 1

Abstract We aimed to assess the ankle-brachial index (ABI) in patients with Graves’ disease. In the cross-sectional assessments, 81 patients with drug-naïve Graves’ disease and 235 with euthyroidism were enrolled. ABI and vascular cell adhesion molecule-1 (VCAM-1) levels were assessed. In the prospective follow-up, 32 patients with Graves’ disease were assessed again after antithyroid drugs for at least 4 weeks, and 32 age- and sex-matched controls with euthyroidism were also followed up. Patients with Graves’ disease had a higher VCAM-1 level (1309 ± 292 vs. 1009 ± 168 ng/mL, P < 0.001) and a lower ABI (0.98 ± 0.11 vs. 1.06 ± 0.10, P < 0.001) than those with euthyroidism. ABI was significantly lower in patients with hyperthyroidism and a high VCAM-1 level than in those with euthyroidism and a low VCAM-1 level (regression coefficient: − 0.050, 95% confidence interval [CI] between − 0.080 and − 0.019; P = 0.001). After treatment with antithyroid drugs, the change in free thyroxine (T4) level was inversely associated with the percentage change in ABI (regression coefficient: − 0.003, 95% CI between − 0.005 and − 0.001, P = 0.001). A synergistic effect of VCAM-1 and free T4 on ABI reduction was observed. After a longitudinal follow-up, an increase in ABI was significantly correlated with a decrease in the free T4 level.

A Prospective Study of the Relationship between Relapse of Hyperthyroid Graves’ Disease after Antithyroid Drugs and HLA Haplotype*

1983 ◽  
Vol 57 (4) ◽  
pp. 719-722 ◽  
Author(s):  
HUBERT ALLANNIC ◽  
RENÈE FAUCHET ◽  
YANNICK LORCY ◽  
MONIQUE GUEGUEN ◽  
ANNE-MARIE LE GUERRIER ◽  
...  
Keyword(s):  
Prospective Study ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
A Prospective Study ◽  
The Relationship

scholarly journals Surgical treatment of Graves’ disease: Subtotal thyroidectomy might still be the preferred option

Medicina ◽  
2007 ◽  
Vol 44 (1) ◽  
pp. 22 ◽  
Author(s):  
Urmas Lepner ◽  
Indrek Seire ◽  
Veronika Palmiste ◽  
Ülle Kirsimägi
Keyword(s):  
Thyroid Function ◽  
Significant Proportion ◽  
Subtotal Thyroidectomy ◽  
Graves Disease ◽  
Thyroid Remnant ◽  
Large Goiter ◽  
Significant Difference ◽  
The Relationship ◽  
Recurrent Hyperthyroidism

Objective. The aim of this prospective study was to report our results after thyroidectomy for Graves’ disease. In addition, the relationship between the thyroid remnant and postoperative thyroid function was studied. Material and methods. Forty-nine consecutive patients were operated on for Graves’ disease. The indications for surgery were persistent or recurrent hyperthyroidism after medical treatment in 34 patients (69.4%), mechanical symptoms due to a large goiter in 7 (14.3%), increased ophthalmopathy in 7 (14.3%), and allergy to antithyroid medications in 1 patient (2.0%). Total thyroidectomy (TT) was performed in 28 and subtotal thyroidectomy (STT) in 21 patients. Followup lasted 24 to 70 months. Results. There was no statistically significant difference in the rate of postoperative complications comparing TT and STT. The patients who underwent TT had no recurrence during a mean follow-up of 47 months. After STT, with the mean weight of the thyroid remnant 3.0±1.0 g, there was no relapse of Graves’ disease during a mean follow-up of 52 months. After STT, postoperative hypothyroidism developed in 14 patients (66.7%); 7 patients (33.3%) remained euthyroid during follow-up. Comparison of the euthyroid patients and the hypothyroid patients revealed no difference in the weight of the remnant (3.3 g vs. 2.8 g), but a statistically significant difference occurred in the weight of the resected gland (61.0 g vs. 94.4 g, P=0.026) and in the proportion of the remnant (5.6% vs. 3.3%, P=0.030). Conclusions. Both TT and STT are safe procedures regarding postoperative complication rate. STT with the thyroid remnant of about 3 g allows to permanently cure hyperthyroidism ensuring the euthyroid state in a significant proportion of patients. Postoperative thyroid function after STT is best predicted by the proportion of the remnant.

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