Treatment of juvenile goitre with levothyroxine, iodide or a combination of both: the value of ultrasound grey-scale analysis

1992 ◽  
Vol 127 (4) ◽  
pp. 301-306 ◽  
Author(s):  
D Einenkel ◽  
KH Bauch ◽  
G Benker
Keyword(s):  
Thyroid Hormones ◽  
Combined Treatment ◽  
Thyroid Volume ◽  
Volume Reduction ◽  
Treatment Groups ◽  
Treatment Regimens ◽  
Grey Scale ◽  
Follicle Size ◽  
Deficient Area ◽  
Euthyroid Goitre

The effects of oral iodide, levothyroxine and of iodide and levothyroxine in combination were studied in three groups of 30 children, age 13–15 years, with euthyroid goitre. As endpoints of this study, we used thyroid volume reduction, thyroid hormones, thyrotropin and thyroid grey-scale histograms by computerized analysis. The three groups were well matched with respect to mean age, body weight and pretreatment thyroid volumes and thyroid hormones. Mean urinary iodide excretion before treatment was in the range of 30 μg/g creatinine, since the study was conducted in an iodine-deficient area. All three treatment regimens led to significant reductions in thyroid volume within one month. After six months on 100 μg of levothyroxine, thyroid volume had decreased from 14.1±4.2 ml to 8.3±2.6 2.6ml (mean±sd);on 150 μg of iodide, from 18.5±6.2 ml to 8.8±2.7 ml; and on 100 μg of iodide plus 50μg of levothyroxine, from 17.2±3.1 ml to 8.3±2.0 ml. When treatment was discontinued for three months, or the dosage reduced, thyroid volume increased again in the levothyroxine (to 11.3±2.5 ml) but not in the iodide group. Grey-scale values (by ultrasound, computer-aided estimation) after nine months were significantly different between the three treatment groups; no change was observed with levothyroxine, but after 150 μg of iodide as well as after combined treatment with levothyroxine and iodide there were marked decreases of grey-scale values; this is interpreted as reflecting a decrease in follicle size and colloid content of the thyroid which takes place after iodide supplementation. In conclusion, iodide treatment as well as combined treatment with levothyroxine and iodide lead to volume reduction of juvenile goitre which is quantitatively similar but qualitatively superior compared to the effects of levothyroxine alone.

THE ROLE OF BRACHYTHERAPY IN TREATMENT FOR ESOPHAGEAL CANCER

2017 ◽  
Vol 63 (4) ◽  
pp. 660-665
Author(s):  
Yelena Tyuryaeva
Keyword(s):  
Esophageal Cancer ◽  
Critical Review ◽  
Palliative Treatment ◽  
Combined Treatment ◽  
Neoadjuvant Treatment ◽  
Early Esophageal Cancer ◽  
Separate Section ◽  
Treatment Regimens ◽  
Contradictory Data

The article is devoted to various aspects of the use of intraluminal brachytherapy (IB) in treatment for esophageal cancer (EC). A critical review of the use of IB as a component of combined radiotherapy/chemoradiotherapy in neoadjuvant treatment regimens, for definitive CRT, as well as in palliative treatment of non-operable tumors of this localization is given. The contradictory data on the effectiveness of brachytherapy with locally distributed, inoperable EC are summarized. A separate section relates to the prospects for incorporating brachytherapy into combined treatment of early esophageal cancer. Carried out analysis testifies to the necessity of standardization of summary and daily doses of irradiation depending on the indications to the IB.

scholarly journals Standardized grey scale ultrasonography in Graves' disease: correlation to autoimmune activity

1999 ◽  
pp. 332-336 ◽  
Author(s):  
U Schiemann ◽  
R Gellner ◽  
B Riemann ◽  
G Schierbaum ◽  
J Menzel ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Antithyroid Drug ◽  
Thyroid Volume ◽  
Control Group ◽  
Graves Disease ◽  
Laboratory Findings ◽  
Grey Scale ◽  
Antithyroid Drug Treatment ◽  
Student’S T ◽  
A Prospective Study

OBJECTIVE: Graves' disease leads to thyroid enlargement and to reduction of tissue echogenicity. Our purpose was to correlate grey scale ultrasonography of the thyroid gland with clinical and laboratory findings in patients with Graves' disease. DESIGN: Fifty-three patients with Graves'disease were included in our study, 100 euthyroid volunteers served as control group. Free thyroxine (FT(4)), TSH and TRAb (TSH receptor antibodies) values were measured and correlated with sonographic echogenicity of the thyroid gland. METHODS: All patients and control persons underwent ultrasonographical histogram analyses under standardized conditions. Mean densities of the thyroid tissues were determined in grey scales (GWE). RESULTS: Compared with controls with homogeneous thyroid lobes of normal size (25.6 +/- 2.0GWE, mean +/- S.D.) echogenicity in patients with Graves' disease was significantly lower (21.3 +/- 3. 3GWE, mean +/- S.D., P < 0.0001). Among the patients with Graves' disease significant differences of thyroid echo levels were revealed for patients with suppressed (20.4 +/- 3.1 GWE, mean +/- S.D., n=34) and normalized TSH values (22.5 +/- 3.6GWE, mean +/- S.D., n=19, P < 0.02). Significantly lower echogenicities were also measured in cases of persistent elevated TRAb levels (19.9 +/- 2.9GWE, mean +/- S.D., n=31) in comparison with normal TRAb levels (22.9 +/- 3.5 GWE, mean +/- S.D., n=22, P < 0.0015). No correlation could be verified between echogenicity and either still elevated or already normalized FT(4) values or the thyroid volume. In coincidence of hyperthyroidism and Graves' ophthalmopathy (19.7 +/- 3.5GWE, mean +/- S.D., n=23) significantly lower echogenicity was measured than in the absence of ophthalmological symptoms (22.3 +/- 3.3GWE, mean +/- S.D., n=30, P < 0.016). Patients needing active antithyroid drug treatment revealed significantly lower thyroid echogenicity (20.3 +/- 3.1 GWE, mean +/- S.D., n=40) than patients in remission (23.7 +/- 3.4 GWE, mean +/- S.D., n=13, P < 0.001). Statistical evaluation was carried out using Student's t-test. CONCLUSIONS: Standardized grey scale histogram analysis allows for supplementary judgements of thyroid function and degree of autoimmune activity in Graves' disease. Whether these values help to estimate the risk of recurrence of hyperthyroidism after withdrawal of antithyroid medication should be evaluated in a prospective study.

Herbal Medicine and Acupuncture Combined Treatment Attenuates Colitis in Rats

2021 ◽  
pp. 1-18
Author(s):  
Yu-Mi Lee ◽  
Seung-Ho Seo ◽  
Seong-Young Cho ◽  
Dong-Hee Choi ◽  
Min-Woo Cheon ◽  
...  
Keyword(s):  
Herbal Medicine ◽  
Acupuncture Treatment ◽  
Activity Index ◽  
Combined Treatment ◽  
Group Analysis ◽  
Microbial Control ◽  
Body Weight Loss ◽  
Disease Activity Index ◽  
Simultaneous Treatment ◽  
Treatment Groups

This study aimed to verify the efficacy of a combined treatment of Jakyakgamcho-tang (JGT) and acupuncture (CV12, ST25, CV4) on colitis induced by dextrane sulfate sodium (DSS). Changes in immuno-mediated factors and metabolites were investigated. Colitis symptoms such as body weight loss and elevated disease activity index were alleviated by the combined treatment. Moreover, treatment with JGT and acupuncture restored the disturbed architecture of colon by suppressing inflammatory cytokine levels of IFN-[Formula: see text] ([Formula: see text]), IL-5 ([Formula: see text]), and IL-13 ([Formula: see text]) compared with the DSS group. Analysis of metabolic profiles of serum revealed that treatment groups were clearly separated from the DSS group, suggesting that JGT and acupuncture treatment altered serum metabolites. Furthermore, treatments caused opposite metabolite patterns for dimethylbenzimidazole, 1,5-anhydro-D-glucitol, proline, phosphate, glycolic acid, aspartic acid, tryptophan, phthalic acid, ornithine, and glutamic acid compared with the DSS group. The combined treatment group induced more effective metabolite patterns than the JGT group, implying that acupuncture treatment can restore metabolic changes caused by DSS induction. These results indicate that the simultaneous treatment of JGT administration and acupuncture procedure provides better management of the immune function and inflammatory expression of colitis than a single treatment. It is assumed that intestinal microbial control can be achieved by acupuncture stimulation as well as by taking herbal medicine.

Refinement and reduction through application of a quantitative score system for estimation of TB-induced disease burden using computed tomography

2018 ◽  
Vol 52 (6) ◽  
pp. 599-610 ◽  
Author(s):  
Sally A Sharpe ◽  
Donna Smyth ◽  
Anthony McIntyre ◽  
Fergus Gleeson ◽  
Mike J Dennis
Keyword(s):  
Computed Tomography ◽  
Disease Burden ◽  
Test Model ◽  
Score System ◽  
Global Epidemic ◽  
Treatment Groups ◽  
Additional Tool ◽  
Treatment Regimens ◽  
Improved Outcomes ◽  
Quantitative Score

Until validated correlates of protection are identified, animal models remain the only way to test the efficacy of the new vaccines and drugs urgently needed to fight the global epidemic caused by infection with Mycobacterium tuberculosis. Non-human primates (NHP) offer the most relevant models of human tuberculosis (TB) and are central to the development process for new interventions. Efficacy evaluations are dependent on the capability of the test model to discriminate improved outcomes between treated groups after experimental exposure to M. tuberculosis and therefore the ability to measure TB-induced disease burden is central to the process. We have developed a score system that allows us to quantify the disease burden induced in macaques by infection with M. tuberculosis, based on the extent and features of disease visible on computed tomography (CT) images. The CT determined disease burden was then verified against that obtained using an established pathology-based approach. Trials of the system as a tool to measure disease burden have shown the approach capable of revealing differences between treatment groups in order to: (a) characterise outcome of infection and enable model refinement; (b) demonstrate the efficacy of drug treatment regimens by showing differences in outcome between test groups. Initial trials suggest that the imaging-based score system provides a valuable additional tool for the measurement of TB-induced disease burden that offers the opportunity to apply both refinement and reduction within studies.

scholarly journals Comparative study utilizing different post-breeding treatment regimens in cyclic Arabian mares

2021 ◽  
pp. 2863-2868
Author(s):  
Khalid Mohammed Karam ◽  
Ahmed Saed Alebady ◽  
Haitham O. Alhilfi ◽  
Dhia Hussain Al-Delemi
Keyword(s):  
Treatment Regimen ◽  
Normal Saline ◽  
Prophylactic Treatment ◽  
Treatment Protocols ◽  
Treatment Groups ◽  
Treatment Regimens ◽  
Reproductive Management ◽  
Natural Breeding ◽  
Uterine Lavage ◽  
Age Category

Background and Aim: Post-breeding treatment is the most common practice in the reproductive management of mares. Oxytocin, uterine lavage, and intrauterine (I/U) antibiotic are usually used as prophylactic therapy. This study aimed to determine the most efficient prophylactic treatment regimen among six treatment protocols applied during natural breeding of cyclic Arabian mares. Materials and Methods: The current study was conducted on cyclic Arabian mares that were subdivided into three age categories (n=968): Category I (5-10 years, n=380), Category II (11-15 years, n=361), and Category III (≥16 years, n=227). Six prophylactic treatments were applied after 4 h of breeding. According to the treatment regimen, treated mares (n=483) were divided into six treatment groups: A (n=80), treated with I/U antibiotic (1 g gentamicin); B (n=81), I/U lavage (normal saline 500 mL); C (n=83), intramuscular (I/M) oxytocin (10 IU); D (n=82), I/U antibiotic and I/M oxytocin; E (n=78), I/U lavage and I/M oxytocin; and F (n=79), I/U lavage with I/U antibiotic and I/M oxytocin. Non-treated mares were classified as controls (n=485). Ultrasonography was performed to monitor pregnant mares 30 and 60 days after mating, and mares were followed until foaling. Results: Pregnancy and foaling results reveals that in age Category I, treatment with oxytocin alone or oxytocin with I/U lavage showed the highest pregnancy and foaling rates (p<0.01). In age Category II, the highest pregnancy and foaling rates were observed in lavage treatment (p<0.01), whereas, in age Category III, the good pregnancy and foaling rates were monitored in treatment with oxytocin and I/U lavage (p<0.01). Conclusion: Treatment with systemic I/M oxytocin is ideal in early age group mares (5-10 years of age). However, irrespective of the age categories, all mares exhibited high pregnancy and foaling rates after treatment with systemic I/M oxytocin and I/U lavage with normal saline (0.9%) 4 h post-breeding.

scholarly journals 509. Clinical Characteristics and Outcomes in Patients Infected with SARS-CoV-2 Treated with Remdesivir, Tocilizumab, and/or Dexamethasone at a Mid-Atlantic Hospital Consortium

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S356-S357
Author(s):  
Nellie Darling ◽  
Kristen R Kent ◽  
Gavin Clark ◽  
Xue Geng ◽  
Marybeth Kazanas ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Length Of Stay ◽  
Ventilatory Support ◽  
Combination Group ◽  
Delivery Device ◽  
Research Support ◽  
Material Support ◽  
Treatment Groups ◽  
Treatment Regimens ◽  
All Treatment

Abstract Background Treatment strategies for COVID-19 have evolved based on clinical trials. We performed a retrospective analysis to determine treatment outcomes for Remdesivir (RDV), Tocilizumab (TOCI), and/or Dexamethasone (DEX) in a representative population from the Mid-Atlantic region. Methods A retrospective chart review was performed for patients admitted to MedStar hospitals within the D.C./Baltimore corridor from 03/01/2020 to 12/31/2020, and diagnosed with COVID-19 using a NP SARS-CoV-2 RT PCR assay. The MedStar Pharmacy Database was utilized to stratify based on any combination of RDV, TOCI, DEX treatment. Our primary endpoints included O2 delivery device, length of stay (LOS), and mortality. Results A total of 2488 patients were included. Overall, the average age of patients was 62yrs, 53% male, and the majority of patients were of Black (54%) or White (27%) race. The average length of stay was 11 days (SD = 12) with a mortality of 14%. Using univariate analyses, all combinations of RDV, TOCI, and DEX treatment regimens were evaluated. Patients who received DEX required the most ventilatory support on Day 1 (5%, p&lt; 0.001) compared to all other groups. These same patients, however, did not go on to have higher ventilatory needs (17%, p&lt; 0.001) compared to the group which ultimately required the most ventilatory support, TOCI plus DEX (94%, p&lt; 0.001) at Day 28 of treatment. TOCI use alone was associated with a 4% to 63% (p&lt; 0.001) increase in need for ventilatory support over the course of 28 days (Figure 1). The shortest LOS was seen in those treated with DEX alone (9.5 days, p&lt; 0.001). Longer LOS outcomes were associated with all treatment groups which included TOCI use (19 to 22 days, p&lt; 0.001, Figure 2). Mortality was similarly higher among all treatment groups which contained TOCI (30% to 62.5%, p&lt; 0.001, Figure 3) when compared to those with RDV and/or DEX use alone (10% to 14%, p&lt; 0.001). Barplot of Oxygen Delivery Device at Admission and within 28 Days among Treatments Figure 1. Largest increase in ventilatory support from Day 1 of treatment (left) to Day 28 of treatment (right) was seen among TOCI and DEX (0% to 93.8%), RDV and TOCI (0% to 72.2%) and TOCI alone (3.7% to 63.4%). Figure 2. LOS was higher among all treatments containing TOCI (p&lt;0.001), with the highest being the combination group of RDV, TOCI, and DEX (22.4 days, p&lt;0.001). Figure 3. Treatment regimens containing TOCI accounted for the highest mortality rates as seen in TOCI and DEX use (62.5%), RDV and TOCI (44.4%), and TOCI use alone (30.4%). Conclusion Our study demonstrates that “real-world” clinical outcomes for patients with COVID-19 treated with Remdesivir, Tocilizumab, and Dexamethasone are consistent with what has been reported in clinical trials. The higher mortality associated with Tocilizumab treatment may reflect the use of this agent in critically ill patients with COVID-19. Disclosures Princy N. Kumar, MD, AMGEN (Other Financial or Material Support, Honoraria)Eli Lilly (Grant/Research Support)Gilead (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)GSK (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)Merck & Co., Inc. (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)

scholarly journals Stress Cardiomyopathy Due to Exogenous Thyrotoxicosis From T3 Supplementation

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A955-A955
Author(s):  
Kirsten E Shaw ◽  
Anya Jamrozy
Keyword(s):  
Ejection Fraction ◽  
Thyroid Hormones ◽  
Alternative Medicine ◽  
Medical Diagnosis ◽  
Stress Cardiomyopathy ◽  
American Thyroid Association ◽  
Treatment Regimens ◽  
Medical Groups ◽  
Physician Awareness ◽  
Artery Disease

Abstract Background: Wilson’s Temperature Syndrome (WTS) refers to a constellation of nonspecific symptoms, some of which include a low-normal body temperature, headaches, and fatigue. WTS was rejected by the American Thyroid Association as a valid medical diagnosis in 2005. Originally proposed in 1990 by Dr. E Denis Wilson, the etiology was theorized to be an impaired ability to convert T4 to T3, although this was not corroborated in thyroid lab abnormalities. Despite being publicly rebuffed as a true medical diagnosis, WTS has continued to gain traction amongst certain alternative medical groups and is treated with T3 supplementation. The development of a stress cardiomyopathy due to T3 supplementation is rare. Extrapolating from endogenous thyroid mediated stress cardiomyopathy and T4 supplementation induced stress cardiomyopathy, the pathophysiologic mechanism is likely excessive sympathetic activation. Clinical Case: A 58-year old female with no prior cardiac history presented to the emergency department with chest pain. Physical exam revealed a euvolemic appearing women, with intact and symmetric distal pulses, and a normal cardiac exam without murmurs or other abnormal heart sounds. There were no abnormal lung sounds. Her O2 sats were normal on room air. EKG and CXR were unremarkable. Her troponin was elevated (3.7 ng/mL, n&lt; 0.034 ng/mL) and her BNP was elevated (4,568 pg/mL, n&lt; 150 pg/mL). The patient was given aspirin and started on therapeutic heparin given concern for NSTEMI. Echocardiogram revealed an ejection fraction of 30% with hypokinesis of the entire apex and mid ventricle, raising concern for a stress cardiomyopathy. Coronary angiogram was performed which demonstrated no coronary artery disease. The patient underwent a cardiac MRI which confirmed a stress cardiomyopathy. Meanwhile, her laboratory workup was completed which revealed an undetectable TSH, a low T4 (0.53 ng/dL, n 0.7-1.8 ng/dL), and an elevated T3 (6.37 pg/mL, n 1.71-3.71 pg/mL). Patient endorsed taking oral liothyronine (T3) at doses of 5-40 mcg BID over the past 6 weeks per her alternative medicine provider for treatment of WTS. Her stress cardiomyopathy was presumed to be due to her exogenous thyrotoxicosis from T3 supplementation. She was counseled on the importance of cessation of T3 supplementation, and was started on heart failure medications. On hospital day 3, her T3 normalized to 2.73 pg/mL, and T4 remained low (0.4 pg/mL). Follow-up echocardiogram four months later demonstrated an ejection fraction that had improved to 45%. Conclusion: This case highlights the importance of physician awareness of alternative medicine diagnoses and treatment regimens that affect thyroid hormones and may cause harm to patients. This case is an important reminder of the effect thyroid hormones have on coronary vasculature, myocytes and myocardial function.

scholarly journals Corallopyronin A for short-course anti-wolbachial, macrofilaricidal treatment of filarial infections

2020 ◽  
Vol 14 (12) ◽  
pp. e0008930
Author(s):  
Andrea Schiefer ◽  
Marc P. Hübner ◽  
Anna Krome ◽  
Christine Lämmer ◽  
Alexandra Ehrens ◽  
...  
Keyword(s):  
Adult Worm ◽  
Neglected Tropical Diseases ◽  
Combined Treatment ◽  
Wuchereria Bancrofti ◽  
Drug Candidate ◽  
Treatment Regimens ◽  
Short Course ◽  
Filarial Nematodes ◽  
Product Profile

Current efforts to eliminate the neglected tropical diseases onchocerciasis and lymphatic filariasis, caused by the filarial nematodes Onchocerca volvulus and Wuchereria bancrofti or Brugia spp., respectively, are hampered by lack of a short-course macrofilaricidal–adult-worm killing–treatment. Anti-wolbachial antibiotics, e.g. doxycycline, target the essential Wolbachia endosymbionts of filariae and are a safe prototype adult-worm-sterilizing and macrofilaricidal regimen, in contrast to standard treatments with ivermectin or diethylcarbamazine, which mainly target the microfilariae. However, treatment regimens of 4–5 weeks necessary for doxycycline and contraindications limit its use. Therefore, we tested the preclinical anti-Wolbachia drug candidate Corallopyronin A (CorA) for in vivo efficacy during initial and chronic filarial infections in the Litomosoides sigmodontis rodent model. CorA treatment for 14 days beginning immediately after infection cleared >90% of Wolbachia endosymbionts from filariae and prevented development into adult worms. CorA treatment of patently infected microfilaremic gerbils for 14 days with 30 mg/kg twice a day (BID) achieved a sustained reduction of >99% of Wolbachia endosymbionts from adult filariae and microfilariae, followed by complete inhibition of filarial embryogenesis resulting in clearance of microfilariae. Combined treatment of CorA and albendazole, a drug currently co-administered during mass drug administrations and previously shown to enhance efficacy of anti-Wolbachia drugs, achieved microfilarial clearance after 7 days of treatment at a lower BID dose of 10 mg/kg CorA, a Human Equivalent Dose of 1.4 mg/kg. Importantly, this combination led to a significant reduction in the adult worm burden, which has not yet been published with other anti-Wolbachia candidates tested in this model. In summary, CorA is a preclinical candidate for filariasis, which significantly reduces treatment times required to achieve sustained Wolbachia depletion, clearance of microfilariae, and inhibition of embryogenesis. In combination with albendazole, CorA is robustly macrofilaricidal after 7 days of treatment and fulfills the Target Product Profile for a macrofilaricidal drug.

Effects of small doses of bovine TSH on serum levels of free and total thyroid hormones, their degradation products, and diiodotyrosine

1985 ◽  
Vol 108 (2) ◽  
pp. 211-216 ◽  
Author(s):  
G. Benker ◽  
C. Splittstößer ◽  
H. Meinhold ◽  
Th. Olbricht ◽  
D. Reinwein
Keyword(s):  
Thyroid Hormones ◽  
Degradation Products ◽  
Thyroid Volume ◽  
Serum Levels ◽  
Direct Stimulation ◽  
Absolute Increase ◽  
Free Thyroid Hormones ◽  
Measurable Parameter ◽  
Small Doses ◽  
Bovine Tsh

Abstract. Bovine TSH was administered iv to 10 normal volunteers in doses of 2.5, 7.5, 15 and 30 mU/kg. Brisk elevations of serum diiodotyrosine occurred already after the smallest dose (mean, + 183%) while larger doses had only slight additional effects. T3 rose much higher than T4 (+71% compared to +23% after 15 mU bTSH/kg), and free thyroid hormones exhibited changes similar to total T3 and total T4. The mean absolute increase in serum fT3 ranged from 2.03 to 9.04 pmol/l and proved to be an easily measurable parameter for the TSH effect. Dose-response effects were seen for the increases of fT4, fT3 and T3. TBG and rT3 did not change but the degradation product 3,3'-T2 showed large increments of serum levels. There was no correlation between the response of T3 and T4, fT3 and fT4, or diiodotyrosine and any of the other parameters of thyroid function. The interindividual differences in the magnitude of thyroid hormone response to TSH were considerable, and there was no relationship between this response and thyroid volume by ultrasound. We conclude that direct stimulation of the thyroid gland with bTSH in small doses leads to consistent increases of thyroid hormones, especially T3 and fT3, that the response varies between individuals, and that the precursor diiodotyrosine is released together with thyroid hormones.

Suppression of serum thyrotropin with thyroxine in patients with Graves' disease: effects on recurrence of hyperthyroidism and thyroid volume

1997 ◽  
Vol 136 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Johannes Pfeilschifter ◽  
Reinhard Ziegler
Keyword(s):  
Beneficial Effect ◽  
Combined Treatment ◽  
Thyroid Volume ◽  
Suppressive Therapy ◽  
Graves Disease ◽  
Serum Concentrations ◽  
Recent Onset ◽  
Suppressive Dose ◽  
Second Year ◽  
One Year

Abstract Based on findings that thyroxine may have a beneficial effect on the recurrence of Graves' hyperthyroidism, we prospectively studied the effects of a TSH suppressive treatment with thyroxine on the course of Graves' disease in fifty patients with recent onset of hyperthyroidism. After the normalization of serum tri-iodothyronine (T3) and thyroxine (T4) concentrations, one group of patients was randomly assigned to a combined treatment with carbimazole and a TSH suppressive dose of T4 for 12 months, followed by another 12 months of TSH suppressive therapy alone. The other group of patients also received carbimazole for one year, but T4 was only added as indicated to normalize elevated TSH serum concentrations, and patients received no therapy during the second year. By the end of the second year, a relapse of hyperthyroidism had occurred in 43% of the patients with and in 45% of the patients without suppressive T4 treatment. In those patients without a relapse of hyperthyroidism, initial thyroid size significantly (P = 0·01) decreased with time in both treatment groups. However, patients on suppressive T4 treatment tended to have a greater reduction in thyroid volume than patients with normal TSH serum concentrations (P = 005). In conclusion, we were unable to detect a preventive effect of exogenous TSH suppression on the recurrence of hyperthyroidism. However, our data suggest that TSH suppressive treatment may have a beneficial effect on thyroid enlargement in Graves' disease. European Journal of Endocrinology 136 81–86

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