scholarly journals A Patient With Graves’ Disease And Thyroid-Associated Orbitopathy Undergoing Radioactive Iodine in Dr. Soetomo General Academic Hospital, Surabaya

2021 ◽  
Vol 4 (1) ◽  
pp. 48
Author(s):  
Rizki Adrian Hakim ◽  
Stepanus Massora ◽  
Delfitri Lutfi ◽  
Hermina Novida
Keyword(s):  
Multinodular Goiter ◽  
Radioactive Iodine ◽  
Graves Disease ◽  
Academic Hospital ◽  
Toxic Adenoma ◽  
Relative Contraindication ◽  
Graves Ophthalmopathy ◽  
Common Etiology ◽  
Toxic Multinodular Goiter

Graves’ Disease (GD) is the most common etiology of thyrotoxicosis, followed by toxic multinodular goiter and toxic adenoma. GD can be managed with anti-thyroid drugs (ATDs), surgery, or radioactive iodine (RAI). Thyroid-associated orbitopathy (TAO) or Graves’ Ophthalmopathy (GO) affects 25%-50% patients with GD, and its presence usually dissuade clinicians to use RAI in treating hyperthyroidism. The presence of GO is a relative contraindication use of RAI in patients with GD, as RAI can worsen existing GO. Corticosteroid prophylaxis can be given to such patients to reduce likelihood of worsening of GO. However, patient with moderate to severe active GO is currently advised against undergoing RAI. Established guidelines recommend the use of corticosteroid prophylaxis in these patients. We reported a patients with GD and orbitopathy who was treated with RAI and was given steroid prophylaxis to prevent worsening of GO.

scholarly journals SAT-415 Clinical Performance of Thyroid-Stimulating Immunoglobulin for Graves′ Disease Diagnosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Suemi Marui ◽  
Aline Lenczuk ◽  
Nelisa Helena Rocha ◽  
Tomoco Watanabe ◽  
Luciana Pinto Brito
Keyword(s):  
Multinodular Goiter ◽  
Clinical Performance ◽  
Graves Disease ◽  
Toxic Adenoma ◽  
Serum Samples ◽  
Toxic Multinodular Goiter ◽  
Analytical Range ◽  
Roche Diagnostics ◽  
Receptor Antibodies ◽  
Tsh Receptor Antibodies

Abstract INTRODUCTION The diagnosis of Graves′disease (GD) is likely when patient presents hyperthyroidism, symmetrical goiter and orbitopathy and further evaluation is unnecessary. Nevertheless patient with nodular thyroid or in the absence of clinical orbitopathy, measurement of TSH receptor antibodies (TRAb) is recommended to distinguish GD from toxic multinodular goiter, toxic adenoma and other etiologies. Radioiodine uptake (RAIU) also helps to diagnosis when TRAb is unavailable. Third generation TRAb assays measure all types of TSH receptor antibodies: stimulating, blocking and neutral with an excellent sensitivity and specificity for GD diagnosis. Recently, an automated bioassay for the thyroid stimulating immunoglobulin (TSI) was introduced to improve GD diagnosis. OBJECTIVE To analyze clinical performance of TSI and compare with TRAb assay for GD diagnosis. MATERIAL AND METHODS Serum samples of 117 patients with thyrotoxicosis due to GD, toxic multinodular goiter and toxic adenoma were runned simultaneously in two analytical system commercially available. TRAb was analyzed by Elecsys Anti-TSHR assay (Roche Diagnostics, Germany) in a Cobase411 analyzer (Roche Diagnostics, Germany) and results, according to the manufacturer interval reference, were negative if < 1.75 IU/L (analytical range: 0.3 to 40 IU/L). TSI was measured by Immulite TSI assay (Siemens Healthcare, UK) in Immulite XPi 2000 and results, according to the manufacturer interval reference, were negative if < 0.55 IU/L (analytical range: 0.1 to 40 IU/L). Clinical diagnoses of thyrotoxicosis were determined according to ATA guideline (2016). Statistical analyses were performed using SPSS and MedCalc softwares. Comparison were evaluated by regression equations and were considered significant when p values were < .05. RESULTS From 2017 to 2019 a total of 312 serum samples from 117 patients (96 females) were evaluated with mean age 49.5 ±15.8 years-old (18 to 90 yrs). We excluded 26 results above the analytical measurement range of both assays. A high degree correlation was observed with a slope of 0.647 and an intercept -.094 IU/L. Spearman correlation coefficient was 0.858 (p < 0.0001, 95% CI 0.825 to 0.886). TSI assay had higher sensibility and negative predictive value compared to TRAb (95.6% vs 88.5% and 83.6% vs 54.8%, respectively) but lower specificity and positive predictive value (90.3% vs 100% and 97.5% vs 100%, respectively). The results of TSI assay showed good agreement with those of the TRAb assay (k=0.74). A total of 31 samples were discordant, favoring to TSI assay in all but one case of GD according to clinical diagnosis (TRAb positive and TSI negative). CONCLUSION TSI assay showed an excellent performance for GD diagnosis with a better sensibility than TRAb assay.

scholarly journals Thyroid Cancer in Patients with Hyperthyroidism

2015 ◽  
Vol 7 (2) ◽  
pp. 29-32 ◽  
Author(s):  
Baki Tastan ◽  
Alper Dogu ◽  
Yusuf Sevim
Keyword(s):  
Differential Diagnosis ◽  
Thyroid Cancer ◽  
Multinodular Goiter ◽  
Malignant Tumors ◽  
Graves Disease ◽  
Thyroid Malignancy ◽  
Toxic Adenoma ◽  
Endocrine Organs ◽  
Toxic Multinodular Goiter ◽  
Hyperthyroid Patients

ABSTRACT Background and objective Malignant tumors of the thyroid gland are the most common of the endocrine malignancies. Although, patients with thyroid cancer have high 5 years survival rate, thyroid cancer is the most seen cause of mortality among cancers of the endocrine organs. The incidence of thyroid cancer in hyperthyroid patients varies from 0.1 to 21% in the literature. We aimed in this study to analyze the frequency of coexisting thyroid cancer and hyperthyroidism in our experience. Results Total 230 patients, who were operated for hyperthyroidism without the suspicion of thyroid malignancy between January 2005 and September 2010 were included in our study. Toxic multinodular goiter, toxic adenoma and Graves’ disease were diagnosed preoperatively in 187, 16 and 27 patients respectively. Histopathological thyroid malignancy was detected in 13 patients (5.7%). Conclusion Thyroid cancer with variable incidence up to 21% should be remembered in differential diagnosis of hyperthyroid patients. How to cite this article Tastan B, Dogu A, Sevim Y. Thyroid Cancer in Patients with Hyperthyroidism. World J Endoc Surg 2015;7(2):29-32.

Frequency of Pathological Types of Hyperthyroidism in Thyroid Scan Patients

2020 ◽  
Vol 16 ◽  
Author(s):  
Ali Pooria ◽  
Afsoun Pourya ◽  
Alireza Gheini
Keyword(s):  
Multinodular Goiter ◽  
Clinical Information ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Toxic Adenoma ◽  
Aged Patients ◽  
Cross Sectional ◽  
Radioiodine Uptake ◽  
Systemic Disorder ◽  
Toxic Multinodular Goiter

Background: Hyperthyroidism is a common systemic disorder where Graves’ disease is known as the leading cause of the disease. Thyroid stimulating hormone, T4 and T3 antibody assay are usually performed for the diagnosis of the pathology. However, with uncertainty in the results and in order to estimate the magnitude and the exact cause of the disease, radioactive iodine uptake (RAIU) test is recommended. The aim of this study is to evaluate underlying pathology in the patients presenting hyperthyroidism using RAIU test results. Methods: This is a cross-sectional retrospective study conducted on the patients with hyperthyroidism referred to Shahid Madani Hospital in Khorramabad. Data regarding the biochemical analysis and RAIU test was collected from the records and a questionnaire based on demographic and clinical information was completed for each patient. Results: Of 137 patients presenting hyperthyroidism, 62.04% were presented with Graves’ disease, 24.08% with toxic multinodular goiter and 13.86% with toxic adenoma. 24-hour RAIU test showed that the percent of radioiodine uptake was most in toxic adenoma 67.7%, Graves’ disease 53.5% and multinodular goiter 39%, respectively. From the age-based analysis, we found that Graves’ was most common in 20-30 years old individuals 34%, multinodular goiter in 50+ aged individuals 36.3% and toxic adenoma was most prevalent in 30-40 and 50+ aged patients, 26.3% each. In our population of interest, 81.8% toxic multinodular goiter patients were females. Conclusions: Our study presents the outcome of RAIU tests in hyperthyroidism based on the underlying pathologies. We also conclude, in light of other findings, Graves’ disease is the most common cause of hyperthyroidism in our population.

The risk factors for malignancy in surgically treated patients for Graves' disease, toxic multinodular goiter, and toxic adenoma

Surgery ◽  
2008 ◽  
Vol 144 (6) ◽  
pp. 1028-1037 ◽  
Author(s):  
Yasemin Giles (Senyurek) ◽  
Tunca Fatih ◽  
Boztepe Harika ◽  
Kapran Yersu ◽  
Terzioglu Tarik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multinodular Goiter ◽  
Graves Disease ◽  
Toxic Adenoma ◽  
Toxic Multinodular Goiter

scholarly journals Toxic Multinodular Goiter with Low Radioactive Iodine Uptake

2011 ◽  
Vol 50 (16) ◽  
pp. 1709-1714 ◽  
Author(s):  
Toshio Kahara ◽  
Akiko Shimizu ◽  
Akio Uchiyama ◽  
Shintaro Terahata ◽  
Junichi Tajiri ◽  
...  
Keyword(s):  
Multinodular Goiter ◽  
Radioactive Iodine ◽  
Iodine Uptake ◽  
Toxic Multinodular Goiter ◽  
Radioactive Iodine Uptake

scholarly journals Open angle glaucoma, glaucoma suspect and ocular hypertension in thyroid related immune orbitopathy and other thyroid diseases

2016 ◽  
Vol 8 (1) ◽  
pp. 50
Author(s):  
Saleha Sultana ◽  
Syed Abdul Wadud ◽  
Shabeena Huda ◽  
Sharfuddin Ahmed
Keyword(s):  
Ocular Hypertension ◽  
Multinodular Goiter ◽  
Open Angle Glaucoma ◽  
Thyroid Diseases ◽  
Graves Disease ◽  
Open Angle ◽  
Glaucoma Suspect ◽  
Toxic Multinodular Goiter ◽  
Group A ◽  
Group B

<p><strong>Background:</strong> The eye changes associated with thyroid disease are referred to as Thyroid related Orbitopathy. A well described association exist between open angle glaucoma and thyroid related orbitopathy, the possible relationship between open angle glaucoma and either hypothyroidism or hyperthyroidism without orbitopathy is variable.</p><p><strong>Objective:</strong> To observe the relation of open angle glaucoma (OAG), glaucoma suspect (GS) and ocular hypertension(OHT) between Thyroid related immune orbitopathy (TRIO) and other thyroid diseases (toxic multinodular goiter and hypothyroidism).</p><p><strong>Method:</strong> With purposive type of sampling technique 40 patients of Graves' disease disease in Group-A and 40 patients of other thyroid diseases in Group-B which was subdivided into 20 patients of toxic multinodular goiter in Group-B 1, 20 patients of hypothyroidism in Group-B2 were selected in Bangabandhu Sheikh Mujib Medical University (BSMMU) for this cross sectional study. The diagnosis of Graves' disease, toxic multinodular goiter and hypothyroidism were carried out by history, clinical examination and clinical test in endocrinology department. All the patients underwent complete ocular examinations, measuring of intraocular pressure (IOP), fundus examination, visual field analysis, gonioscopy and exophthalmometry.</p><p><strong>Result:</strong> The OAG, GS and OHT was 7.5% (3 cases), 5.0% (2 cases) and 17.5% (7 cases) respectively in Group-A. In contrast OAG, GS was 5% (lease), 5% (1 case) respectively in Group-Bl, only 5% (1 case) OAG in Group-B2. There was no incidence of OHT in Group-B (B1+B2). Although the occurrence of OAG and GS were higher in Group-A than Group-B, this difference was not statistically significant (p&gt;0.05). However OHT was more common in Group-A than Group-B and is statistically significant (p&lt;0.05). Among the 12 patients with OAG, GS and OHT in Group-A, 11 had ≥22mm exophthalmos. In Group-A, ≥22mm exophthalmos in 60% cases, in contrast none of Group-B have ≥22mm.</p><p><strong>Conclusion:</strong> The occurrence of OHT was higher in thyroid related immune orbitopathy than other thyroid diseases.</p>

scholarly journals Factors Affecting and Outcome of Radioactive Iodine Therapy in Hyperthyroidism: A study at Institute of Nuclear Medicine & Allied Sciences (INMAS), Sylhet

2018 ◽  
Vol 19 (1) ◽  
pp. 19-23
Author(s):  
Kamrun Nahar ◽  
Papia Akhter
Keyword(s):  
Radioactive Iodine ◽  
Antithyroid Drug ◽  
Nodular Goiter ◽  
Fixed Dose ◽  
Graves Disease ◽  
Radioactive Iodine Therapy ◽  
Cure Rate ◽  
Toxic Adenoma ◽  
Significant Difference ◽  
One Year

Objective: Radioactive iodine therapy (RIT) is the most commonly used modality to treat hyperthyroidism and is indeed in most cases, the treatment of choice. The aim of this study was to assess the clinical outcome one year after radioactive Iodine-131 (RAI -131) therapy and to identify the factors associated with response of the therapy.Patients and Methods: A total 107 hyperthyroid patients were included in this study. All patients were pre-treated with anti-thyroid drugs (ATD). A fixed dose of 8 mCi of radioiodine was given to the patients with Graves’ disease, 12 mCi to patients with single toxic adenoma and 15 mCi to patients with toxic multi-nodular goiter . The patients were done serum FT4 initially and followed up with serum T3, T4, and TSH at three months , six months and one year of RAI therapy . The clinically and biochemically euthyroid and hypothyroid patients were considered as cure of the disease.Results : The cure rate was about 94.7% seen in female patients and 93.8% in male ( P=0.92), 93.6% in younger age group (below 40 years) and 95.0% of the older patients ( P=1.51), 95.5% of the patients who were taking ATD for more than one year and 92.7% of the patients who were taking ATD for less than one year before therapy( P=1.95), 95.4 % of the patients who had initial FT4 level less than 35 pmol/L and 92.7 % of the patients who had high initial FT4 ( P=1.54). Cure rate of Graves’ disease was 45/53 (92.5%), multi-nodular goiter 41/43 (95.3% ) and for single toxic adenoma was 11/11 (100% ) (P= 0.65). The incidence of radioiodine induced hypothyroidism was 6.5 % at three months, 13.1 % at six months and 15.0 % at one year. Overall incidence of cure rate of RAI therapy after one year was 101 (94.4 %).Conclusion: No statistically significant difference was found in the cure rate when sex, age, duration of pretreatment with antithyroid drug, initial FT4 level and cause of hyperthyroidism were considered.   From this study it can be concluded that cure rate of RAI therapy is quite good and the pretreatment factors have little influence on the final outcome.Bangladesh J. Nuclear Med. 19(1): 19-23, January 2016

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