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.

scholarly journals Thyroid Autoantibodies Are Rare in Nonhuman Great Apes and Hypothyroidism Cannot Be Attributed to Thyroid Autoimmunity

Endocrinology ◽  
2013 ◽  
Vol 154 (12) ◽  
pp. 4896-4907 ◽  
Author(s):  
Holly Aliesky ◽  
Cynthia L. Courtney ◽  
Basil Rapoport ◽  
Sandra M. McLachlan
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Autoimmunity ◽  
Great Apes ◽  
Normal Serum ◽  
Thyroid Peroxidase ◽  
Thyroid Autoantibodies ◽  
Free T4 ◽  
Hormone Levels ◽  
Free T3 ◽  
Thyroid Hormone Levels

The great apes include, in addition to Homo, the genera Pongo (orangutans), Gorilla (gorillas), and Pan, the latter comprising two species, P. troglodytes (chimpanzees) and P. paniscus (bonobos). Adult-onset hypothyroidism was previously reported in 4 individual nonhuman great apes. However, there is scarce information on normal serum thyroid hormone levels and virtually no data for thyroid autoantibodies in these animals. Therefore, we examined thyroid hormone levels and TSH in all nonhuman great ape genera including adults, adolescents, and infants. Because hypothyroidism in humans is commonly the end result of thyroid autoimmunity, we also tested healthy and hypothyroid nonhuman great apes for antibodies to thyroglobulin (Tg), thyroid peroxidase (TPO), and the TSH receptor (TSHR). We established a thyroid hormone and TSH database in orangutans, gorillas, chimpanzees, and bonobos (447 individuals). The most striking differences are the greatly reduced free-T4 and free-T3 levels in orangutans and gorillas vs chimpanzees and bonobos, and conversely, elevated TSH levels in gorillas vs Pan species. Antibodies to Tg and TPO were detected in only 2.6% of adult animals vs approximately 10% in humans. No animals with Tg, TPO, or TSHR antibodies exhibited thyroid dysfunction. Conversely, hypothyroid nonhuman great apes lacked thyroid autoantibodies. Moreover, thyroid histology in necropsy tissues was similar in euthyroid and hypothyroid individuals, and lymphocytic infiltration was absent in 2 hypothyroid animals. In conclusion, free T4 and free T3 are lower in orangutans and gorillas vs chimpanzees and bonobos, the closest living human relatives. Moreover, thyroid autoantibodies are rare and hypothyroidism is unrelated to thyroid autoimmunity in nonhuman great apes.

scholarly journals The Effect of Antithyroid Drug Pretreatment on Acute Changes in Thyroid Hormone Levels after 131I Ablation for Graves’ Disease1

2001 ◽  
Vol 86 (7) ◽  
pp. 3016-3021 ◽  
Author(s):  
H. B. Burch ◽  
B. L. Solomon ◽  
D. S. Cooper ◽  
P. Ferguson ◽  
N. Walpert ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Radioiodine Therapy ◽  
Antithyroid Drug ◽  
Antithyroid Drugs ◽  
Free T4 ◽  
Hormone Levels ◽  
Free T3 ◽  
Average Decrease ◽  
Thyroid Hormone Levels ◽  
Acute Changes

Acute changes in thyroid hormone levels before and after radioiodine therapy for Graves’ disease were compared in 42 patients randomized to receive either antithyroid drug pretreatment or no pretreatment. Five patients (11.9%), including 3 in the pretreatment arm and 2 in the no pretreatment arm experienced a late exacerbation of thyrotoxicosis after radioiodine therapy. The majority (19 of 21, 90.5%) of pretreated patients experienced a transient increase in free T4 and free T3 after discontinuation of antithyroid drugs, with little further elevation after radioiodine therapy. After stopping antithyroid drugs and before radioiodine administration, mean serum free T4 values rose from 14.7 ± 6.9 to 21.6 ± 12.1 pmol/L, representing a 46.9% increase, whereas serum free T3 levels rose from 4.9± 1.7 to 8.1 ± 6.3 pmol/L, representing a 65.3% increase. The average pretreated patient experienced a 52.4% increase [95% confidence interval (CI), +26.4% to +78.5%] in free T4 and a 61.8% increase (95% CI, +23.5% to +100.0%) in free T3. Conversely, the majority (19 of 21, 90.5%) of nonpretreated patients experienced a rapid decline in thyroid hormone levels after radioiodine treatment. Over the 14 days after radioiodine therapy mean free T4 values in nonpretreated patients fell from 85.8 ± 60.4 to 58.0 ± 76.5 pmol/L, representing a 32.4% decrease, whereas mean free T3 levels fell from 16.1 ± 8.0 to 10.8 ± 11.1 pmol/L, representing a 32.9% decrease. The average nonpretreated patient experienced a 20.6% decrease (95% CI, −47.3% to +7.0%) in free T4 and a 24.3% decrease (95% CI, −1.2% to −47.4%) in free T3 during this time period. Excluding 2 patients with a late exacerbation after radioiodine, 19 nonpretreated patients experienced a decrease in mean free T4 values from 76.8 ± 46.6 to 36.6 ± 19.8 pmol/L, representing a 52.3% decrease, whereas mean free T3 levels fell from 15.5 ± 7.7 to 7.8 ± 3.6 pmol/L, representing a 49.7% decrease. The average decrease in free T4 levels among this subgroup of patients was 30.1% (95% CI, −4.6% to −55.6%), whereas the average decrease in free T3 was 34.4% (95% CI, −13.7% to −55.1%). High levels of TSH receptor autoantibodies at diagnosis were associated with an acute worsening of thyrotoxicosis after stopping antithyroid drug pretreatment. We conclude that pretreatment with antithyroid drugs does not protect against worsening thyrotoxicosis after radioiodine, but may allow such patients to start from a lower baseline level should an aggravation in thyrotoxicosis occur. The findings support the recommendation that most patients with Graves’ disease do not require antithyroid drug pretreatment before receiving radioiodine.

scholarly journals Characterization of Fetal Thyroid Levels at Delivery among Appalachian Infants

2020 ◽  
Vol 9 (9) ◽  
pp. 3056
Author(s):  
Madison N. Crank ◽  
Jesse N. Cottrell ◽  
Brenda L. Mitchell ◽  
Monica A. Valentovic
Keyword(s):  
Thyroid Hormone ◽  
Demographic Characteristics ◽  
Maternal Body Mass Index ◽  
Thyroid Disorders ◽  
Free T4 ◽  
Hormone Levels ◽  
Free T3 ◽  
Significant Difference ◽  
Fetal Thyroid ◽  
Thyroid Hormone Levels

Thyroid disorders are a frequently encountered issue during pregnancy and a cause of maternal and fetal morbidity. In regions like Appalachia that are particularly susceptible to health disparities, descriptive studies are needed to assist in identifying pathologic derangements. We sought to characterize fetal thyroid hormone levels at delivery and investigate whether or not maternal demographic characteristics affect the prevalence of neonatal thyroid disease. A cross-sectional analysis was conducted on 130 pregnant women recruited from the Tri-State region, incorporating areas of Kentucky, Ohio, and West Virginia. Total triiodothyronine (T3) (p = 0.4799), free T3 (p = 0.6323), T3 uptake (p = 0.0926), total thyroxine (T4) (p = 0.8316), free T4 (p = 0.0566), and Thyroid stimulating hormone (TSH) (p = 0.8745) levels were comparable between urban and rural newborns. We found no effect of hypertension status or nicotine levels on fetal umbilical cord thyroid hormone levels. Maternal diabetic status was associated with lower T4 (p = 0.0099) and free T4 (p = 0.0025) levels. Cotinine affected levels of T4 (p = 0.0339). In regard to maternal Body Mass Index (BMI), there was an increase in total T3 as BMI increased (p = 0.0367) and no significant difference in free T3, T3 uptake, T4, free T4, or TSH. There was a negative correlation between TSH and 1 min Apgar scores (p = 0.0058). Lead and cadmium have been implicated to alter TSH levels, but no correlation was found in our study (r2 = 0.0277). There were no differences in cord blood between urban (37.3 ± 10.3 fmol/ug DNA) and rural (70.5 ± 26.8 fmol/ug DNA) benzo(a)pyrene DNA adducts (p = 0.174). Thyroid disorders present a unique opportunity for the prevention of perinatal morbidity and mortality, since maternal treatment, as well as maternal demographic characteristics, can have direct fetal effects.

scholarly journals THYROID STATUS IN CHILDREN WITH TYPE 1 DIABETES MELLITUS

2021 ◽  
Vol 06 (01) ◽  
pp. 71-72
Author(s):  
Zhanar Nurgaliyeva Zhanar Nurgaliyeva ◽  
Araily Manasbaeva Araily Manasbaeva ◽  
Sakhipzhamal Sabirova Sakhipzhamal Sabirova ◽  
Saiyara Nadyrova Saiyara Nadyrova ◽  
Alfira Muratkhan Alfira Muratkhan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Thyroid Hormone ◽  
Autoimmune Thyroiditis ◽  
Laboratory Data ◽  
Thyroid Status ◽  
Free T4 ◽  
Hormone Levels ◽  
Functional Changes ◽  
Free T3 ◽  
Thyroid Hormone Levels

The mutually aggravating effect of comorbid diseases of diabetes mellitus (DM) and autoimmune thyroiditis (AIT) is of scientific interest to researchers. Timely assessment of the thyroid status in children with DM and correction of thyroid pathology (TP) will improve metabolic control in these patients. Аmong 972 children with DM, 478 (49.2%) were assessed for thyroid status. It is noted that every year the determination of thyroid hormone levels in children increased from 7.6% (in 2014) to 92.1% (in 2019). Among 478 examined children, 319 (66.7%) had significantly revealed thyroid dysfunction. In the structure of thyroid pathologies, the frequency of hypothyroidism was 12.5% (in 11.3% - subclinical form), hyperthyroidism - 4%. functional changes in the concentration of thyroid hormones as Euthyroid sick syndrome were observed in 23.8%. The most common type of dysfunction was an isolated increase in free T3 (isolated T3 toxicosis) – in 43.3% of cases. In 2 cases out of 18 (0.6%), a complete picture of AIT was presented, and in the remaining 16 (5.1%), signs of AIT were observed only on ultrasound of the thyroid gland, and were not confirmed by the concentrations of anti-TPO Ab, anti-TG Ab. In 47 (14.7%) children, laboratory data on thyroid hormone levels showed elevated values of TSH, free T3, free T4. Keywords: children, diabetes mellitus, thyroid status, autoimmune thyroiditis

scholarly journals A Brief Exposure to Moderate Passive Smoke Increases Metabolism and Thyroid Hormone Secretion

2007 ◽  
Vol 92 (1) ◽  
pp. 208-211 ◽  
Author(s):  
Giorgos S. Metsios ◽  
Andreas D. Flouris ◽  
Athanasios Z. Jamurtas ◽  
Andres E. Carrillo ◽  
Demetrios Kouretas ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Passive Smoking ◽  
Repeated Measures ◽  
Hormone Secretion ◽  
Free T4 ◽  
Hormone Levels ◽  
Urine Cotinine ◽  
The Mean ◽  
Thyroid Hormone Levels ◽  
Serum And Urine

Abstract Context: Active smoking influences normal metabolic status and thyroid function. Objective: The objective was to assess experimentally the effects of 1 h of moderate passive smoking in a controlled simulated bar/restaurant environment on the metabolism and thyroid hormone levels in healthy nonsmokers. Participants: Eighteen (nine females, nine males) healthy individuals (mean ± sd: age, 25.3 ± 3.1 yr; height, 174.0 ± 10.1 cm; weight, 65.2 ± 13.7 kg) participated in the study. Design: In repeated-measures randomized blocks, participants visited the laboratory on 2 consecutive days. In the experimental condition, they were exposed to 1 h of moderate passive smoking at a carbon monoxide concentration of 23 ± 1 ppm in an environmental chamber, whereas in the control condition participants remained in the same chamber for 1 h breathing normal atmospheric air. Main Outcome Measures: In both conditions, cotinine serum and urine levels, resting energy expenditure (REE), as well as concentration of T3, free T4, and TSH were assessed before participants entered the chamber and immediately after their exit. Heart rate and blood pressure were tested in 10-min intervals during all REE assessments. Results: The mean ± sd difference of serum and urine cotinine levels (−0.27 ± 3.94 vs. 14.01 ± 6.54 and 0.05 ± 2.07 vs. 7.23 ± 3.75, respectively), REE (6.73 ± 98.06 vs. 80.58 ± 120.91) as well as T3 and free T4 (0.05 ± 0.11 vs. 0.13 ± 0.12 and 0.02 ± 0.15 vs. 0.22 ± 0.20) were increased in the experimental compared with the control condition at baseline and follow-up (P < 0.05). No statistically significant variation was observed in the mean difference of the remaining parameters (P > 0.05). Serum and urine cotinine values were linearly associated with REE (P < 0.05). Conclusion: One hour of passive smoking at bar/restaurant levels is accompanied by significant increases in metabolism and thyroid hormone levels.

Graves' disease: An analysis of thyroid hormone levels and hyperthyroid signs and symptoms

1989 ◽  
Vol 87 (5) ◽  
pp. 558-561 ◽  
Author(s):  
Paula T. Trzepacz ◽  
Irwin Klein ◽  
Michelle Roberts ◽  
Joel Greenhouse ◽  
Gerald S. Levey
Keyword(s):  
Thyroid Hormone ◽  
Signs And Symptoms ◽  
Graves Disease ◽  
Hormone Levels ◽  
Thyroid Hormone Levels

Catatony in Graves' disease

1998 ◽  
Vol 13 (8) ◽  
pp. 419-420 ◽  
Author(s):  
J Rudolf ◽  
M Grond ◽  
M Neveling ◽  
W-D Heiss
Keyword(s):  
Thyroid Hormone ◽  
Psychiatric Symptoms ◽  
Normal Serum ◽  
Prior History ◽  
Graves Disease ◽  
Drug Induced ◽  
Hormone Levels ◽  
Neuroleptic Syndrome ◽  
Serum Thyroid Hormone ◽  
Thyroid Hormone Levels

SummaryWe report a 27-year-old female patient with prior history of Graves' disease and relapsing episodes of tachycardia, hyperpyrexia, muscular rigidity and coma. With the subsequent manifestation of an acute schizophreniform psychotic disorder unresponsive to neuroleptics, the primary syndrome was re-classified as febrile catatony. Hyperthyroidism was ruled out with normal serum thyroid hormone levels, as were toxic effects of thyrostatic treatment, drug-induced hypothyroidism and a malignant neuroleptic syndrome. All psychiatric symptoms subsided completely following subtotal thyroidectomy. Febrile catatatony has to be added to the spectrum of psychotic phenomena that may be caused by Graves' disease, irrespective of serum thyroid hormone levels.

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