scholarly journals Free thyroid hormons ration in patients with amiodaron-induced thyrotoxicosis type 1 and type 2

2018 ◽  
Vol 5 (3) ◽  
pp. 28-35
Author(s):  
E. O. Ulupova ◽  
G. A. Bogdanova ◽  
T. L. Karonova ◽  
E. N. Grineva
Keyword(s):  
Doppler Sonography ◽  
Graves Disease ◽  
Additional Test ◽  
Diagnostic Challenge ◽  
Color Flow ◽  
Serum T4 ◽  
Color Flow Doppler Sonography ◽  
Effect Of Treatment

Differentiation between amiodarone-induced thyrotoxicosis type 1 (AmIT1) and type 2 (AmIT2) is a diagnostic challenge. The current diagnostic tests are often unable to differentiate these two types of thyrotoxic syndrome. Several studies had shown that the serum T4 level and T3/T4 ratio are significantly different in patients with destructive thyroiditis, and those with Graves` disease. These studies showed that the serum T4 concentration is significantly higher, and the T3/T4 ratio is significantly lower in patients with destructive forms of thyroiditis compared to their values  in Graves’ disease. Since AmIT1 is known to develop in patients with latent Graves` disease, and AmIT2 is a destructive thyroiditis, the purpose of our study was to evaluate the serum FТ4 level and FT4/FT3 ratio in AmIT1 and AmIT2 as an additional diagnostic test for differentiating these types of thyrotoxicosis. 45 patients with thyrotoxicosis (33 with AmIT1 and 12 AmIT2) were included in the study. The diagnosis of thyrotoxicosis type (AmIT1 or AmIT2) was established on the basis of clinical data, color flow Doppler sonography (CFDS), the presence of TSH receptor autoantibody in patients with AmIT1, as well as the effect of treatment. There was no difference in FT3 levels in patients with AmIT1 and AmIT2, while the FT4 values were significantly higher in patients with AmIT2 (36,2±19,1 mmol/L) than in those with AmIT1 (17,8±3,7 mmol/L, p= 0,002). Also, a difference in the FT4/FT3 ratio was found between AmIT1 (2,7±0,8) and AmIT2 (6,1±5,7, p=0,048). Moreover, 75% of patients with AmIT1 had FT4/FT3ratio < 3,10, while 75% of patients with AmIT2 had FT4/FT3 ratio > 3,65. The FT4/FT3 ratio can be used as an additional test in the differential diagnosis AmIT1 and AmIT2.

Color-flow Doppler sonography in the differential diagnosis and management of amiodarone-induced thyrotoxicosis

2007 ◽  
Vol 48 (6) ◽  
pp. 628-634 ◽  
Author(s):  
M. Loy ◽  
E. Perra ◽  
A. Melis ◽  
M. E. Cianchetti ◽  
M. Piga ◽  
...  
Keyword(s):  
Blood Flow ◽  
Differential Diagnosis ◽  
Clinical Outcome ◽  
Doppler Sonography ◽  
Color Flow ◽  
Therapeutic Choice ◽  
Color Flow Doppler Sonography ◽  
Increased Blood Flow

Background: Amiodarone-induced thyrotoxicosis (AIT) may be caused by excessive thyroidal hormone synthesis and release (type 1) or by a destructive process (type 2). This differentiation is considered essential for therapeutic choice. Purpose: To evaluate the utility of color-flow Doppler sonography (CFDS) in the differential diagnosis and management of AIT. Material and Methods: The clinical and laboratory data, thyroid sonography (grayscale sonography [GSS], CFDS), thyroid radioiodine uptake (RAIU) and thyroid scintigraphy, treatment, and clinical outcome were retrospectively reviewed in 21 AIT patients. The CFDS pattern of thyroid nodules was separately described from that of the perinodular parenchyma, and AIT was classified as type 1 (increased blood flow) or type 2 (low/no blood flow). Type 1 AIT patients were treated with methimazole (alone or associated with potassium perchlorate), while type 2 patients were treated with prednisone or amiodarone withdrawal alone. Results: Eleven patients with increased blood flow were considered as type 1, and 10 with low/no blood flow as type 2. Ten of the 11 patients in the first group showed a hypervascular nodular pattern, while one showed a hypervascular parenchymal pattern. Clinical diagnoses were toxic nodular goiter and Graves' disease, respectively. Of the 10 patients with low/no blood flow, six had normal thyroid volume, three small diffuse goiter, and one small multinodular goiter. The clinical outcome showed that 20 of the 21 patients were treatment responsive. Conclusion: CFDS is a useful tool in the differential diagnosis of AIT. This differentiation appeared to be of clinical relevance as regards therapeutic choice. Separate evaluation of parenchymal blood flow from that of nodules may prove beneficial in the diagnosis of underlying thyroid diseases in patients with type 1 AIT.

scholarly journals Color-flow Doppler sonography in Graves disease: "thyroid inferno"

1988 ◽  
Vol 150 (4) ◽  
pp. 781-784 ◽  
Author(s):  
PW Ralls ◽  
DS Mayekawa ◽  
KP Lee ◽  
PM Colletti ◽  
DR Radin ◽  
...  
Keyword(s):  
Doppler Sonography ◽  
Graves Disease ◽  
Color Flow ◽  
Color Flow Doppler Sonography

Endocrine autoimmunity

2011 ◽  
pp. 34-44 ◽  
Author(s):  
Matthew J. Simmonds ◽  
Stephen C. L. Gough
Keyword(s):  
Immune Response ◽  
Type 1 Diabetes ◽  
Immune System ◽  
Endocrine System ◽  
Graves Disease ◽  
Self Tolerance ◽  
Autoimmune Attack ◽  
Endocrine Organs

Dysfunction within the endocrine system can lead to a variety of diseases with autoimmune attack against individual components being some of the most common. Endocrine autoimmunity encompasses a spectrum of disorders including, e.g., common disorders such as type 1 diabetes, Graves’ disease, Hashimoto’s thyroiditis, and rarer disorders including Addison’s disease and the autoimmune polyendocrine syndromes type 1 (APS 1) and type 2 (APS 2) (see Table 1.6.1). Autoimmune attack within each of these diseases although aimed at different endocrine organs is caused by a breakdown in the immune system’s ability to distinguish between self and nonself antigens, leading to an immune response targeted at self tissues. Investigating the mechanisms behind this breakdown is vital to understand what has gone wrong and to determine the pathways against which therapeutics can be targeted. Before discussing how self-tolerance fails, we first have to understand how the immune system achieves self-tolerance.

Color Flow Doppler Sonography in the Diagnosis of Vesicoureteric Reflux

1994 ◽  
Vol 26 (1) ◽  
pp. 93-97 ◽  
Author(s):  
Mustafa Salih ◽  
Sümer Baltaci ◽  
Sahir Kiliç ◽  
Kadri Anafarta ◽  
Yaşar Bedük
Keyword(s):  
Doppler Sonography ◽  
Vesicoureteric Reflux ◽  
Color Flow ◽  
Color Flow Doppler Sonography
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