scholarly journals Results obtained after the surgical treatment of Graves’ disease depending on the levels of anti-thyroid antibodies

2021 ◽  
Author(s):  
S. L. Shliakhtych ◽  
V. R. Antoniv
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Surgical Technique ◽  
Hormone Receptors ◽  
Thyroid Stimulating Hormone ◽  
Endocrine Surgery ◽  
Graves Disease ◽  
Autoimmune Thyroid ◽  
Early Postoperative Complications ◽  
Surgery Duration

Graves' disease (GD) is a hereditary autoimmune disease which is characterized by persistent abnormal hypersecretion of thyroid hormones and thyrotoxicosis syndrome development. GD affects from 0.5 % to 2.0 % of population in different regions. 46 % of these patients develop ophthalmopathy. GD is a common cause of disabilities in patients under 60 years of age. In recent years, the incidence of GD in Ukraine has increased by 9.9 % — from 106.2 to 117.9 per 100,000 individuals. This can be connected with the improved diagnostic possibilities and active disease detection as well as with the increased number of autoimmune thyroid disorders. The recent studies focus on prevention of specific complications and recurrences of GD after surgery. Objective — to compare the levels of antibodies to the thyroid‑stimulating hormone receptors (TSHR‑Ab) during different postoperative periods as well as the incidence of early and late complications depending on the surgical technique used for the treatment of GD. Materials and methods. The results of surgical treatment of 130 patients, with GD were compared. 29 male patients and 101 female patients aged from 19 to 76 (average — 44.1 ± 3.2 years), receiving their treatment for GD in Kyiv Center of Endocrine Surgery during 2010—2018, were randomly selected and divided into two groups. At the time of operation the duration of disease was from 1 to 30 years (average — 4.6 ± 1.2 years). Group  1 included 65 patients that underwent total thyreoidectomy (TT) and group 2 included 65 patients that underwent subtotal thyreoidectomy (ST). The following parameters were compared: surgery duration, the incidence of early postoperative complications, including bleedings and damage to the recurrent laryngeal nerves, and late outcomes of surgical treatment (persistent hypoparathyreoidism disorder and disorder recurrences) depending on the method of surgery (ST or TT). Furthermore, the patterns of the TSHR‑Ab level reduction were studied for different postoperative periods. Results. The comparison of surgical outcomes following TТ and ST didn’t reveal any statistically significant differences in such evaluation criteria as the average surgery duration, the average volume of intraoperative blood loss and the average duration of the postoperative inpatient treatment. The comparative assessment of the thyroid stump volume and the average amount of drained discharge showed statistically significant differences for TТ. It allows considering TТ as a surgery which causes less complications than ST. The studied parameters of early postoperative complications had no significant differences for ST and TТ. The long‑term (5 years) postoperative level of TSHR‑Ab was statistically significantly lower in patients after TT and made up 1.15 ± 0.13 IU/L (thus corresponding to the normal level). Conclusions. Total thyroidectomy is an optimal surgical technique and is more appropriate compared with subtotal thyroid gland resection. It should be noted that TT provides lower risk of complications due to significantly lower level of TSHR‑Ab in late postoperative period.  

scholarly journals Possible interplay between estrogen and the BAFF may modify thyroid activity in Graves’ disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chao-Wen Cheng ◽  
Wen-Fang Fang ◽  
Kam-Tsun Tang ◽  
Jiunn-Diann Lin
Keyword(s):  
Mononuclear Cells ◽  
Thyroid Stimulating Hormone ◽  
Clinical Samples ◽  
Control Group ◽  
Graves Disease ◽  
Peripheral Blood Mononuclear ◽  
Autoimmune Thyroid ◽  
Protein Levels ◽  
Antibody Levels ◽  
And Control

AbstractA link between sex hormones and B-cell activating factor (BAFF), a crucial immunoregulator of autoimmune thyroid disease (AITD), may exist. The study aimed to elucidate the role of estrogen (E2) in regulating BAFF in Graves' disease (GD). In clinical samples, serum BAFF levels were higher in women than in men in both the GD and control groups. serum BAFF levels were associated with thyroid-stimulating hormone receptor antibody levels and thyroid function only in women and not in men. BAFF transcripts in peripheral blood mononuclear cells were higher in women with GD than those in the control group. Among GD patients with the AA genotype of rs2893321, women had higher BAFF transcripts and protein levels than men. In the progression of a spontaneous autoimmune thyroiditis (SAT) murine model, NOD.H-2h4, serum free thyroxine and BAFF levels were higher in female than in male mice. Moreover, exogenous E2 treatment increased serum BAFF levels in male SAT mice. Meanwhile, female SAT mice exhibited higher thyroid BAFF transcripts levels than either the E2-treated or untreated male SAT mouse groups. Our results showed that E2 might be implicated in modulating BAFF expression, and support a possible mechanism for the higher incidence of AITD in women.

Determination of serum neopterin levels in patients with autoimmune thyroid diseases

2012 ◽  
Vol 153 (29) ◽  
pp. 1127-1131 ◽  
Author(s):  
Csaba Balázs ◽  
Boglárka Türke ◽  
Árpád Vámos
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Thyroid Stimulating Hormone ◽  
Hashimoto's Thyroiditis ◽  
Graves Disease ◽  
Important Indicator ◽  
Autoimmune Thyroid ◽  
Serum Neopterin ◽  
Antibody Levels ◽  
Stimulating Hormone

An elevated serum level of neopterin indicates the activation of the cellular immune system. Aim: The objective was to find a correlation in autoimmune thyroid patients between neopterin levels and the clinical stage of the disease and to examine whether neopterin can predict the relapse of the disease. Methods: Serum neopterin, thyroid stimulating hormone, free thyroxine, free triiodothyronine, anti-thyroglobulin and anti-thyroid peroxidase antibody levels were determined in 137 patients with Graves’ disease (in different stages), 25 with Hashimoto’s thyroiditis and 14 with toxic adenoma. Results: The neopterin levels were significantly higher in patients with Graves’ disease (hyper-, eu-, hypothyroidism and relapsed hyperthyroidism) and Hashimoto’s thyroiditis. Positive correlation was found between neopterin and anti-thyroglobulin and anti-tyhroid peroxidase antibody levels, but no correlation was detected between neopterin levels and thyroid hormones, thyroid stimulating hormone values and antibodies against thyroid stimulating hormone receptors. Conclusions: Higher level of serum neopterin reflects an underlying autoimmune process, and does not correlate with changes in thyroid hormone levels. Determination of neopterin level can be an important indicator in the exacerbation of autoimmune processes. Orv. Hetil., 2012, 153, 1127–1131.

scholarly journals Hashimoto’s Thyroiditis and Graves’ Disease in One Patient: The Extremes of Thyroid Dysfunction Associated with Interferon Treatment

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
R. H. Bishay ◽  
R. C. Y. Chen
Keyword(s):  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Pegylated Interferon ◽  
Thyroid Stimulating Hormone ◽  
Tracer Uptake ◽  
Graves Disease ◽  
Interferon Treatment ◽  
Autoimmune Thyroid ◽  
Technetium Scan ◽  
Chronic Hcv

Autoimmune thyroid disease associated with interferon therapy can manifest as destructive thyroiditis, Graves’ Hyperthyroidism, and autoimmune (often subclinical) hypothyroidism, the latter persisting in many patients. There are scare reports of a single patient developing extremes of autoimmune thyroid disease activated by the immunomodulatory effects of interferon. A 60-year-old man received 48 weeks of pegylated interferon and ribavirin therapy for chronic HCV. Six months into treatment, he reported fatigue, weight gain, and slowed cognition. Serum thyroid stimulating hormone (TSH) was 58.8 mIU/L [0.27–4.2], fT4 11.1 pmol/L [12–25], and fT3 4.2 pmol/L [2.5–6.0] with elevated anti-TPO (983 IU/mL [<35]) and anti-TG (733 U/mL [<80]) antibodies. He commenced thyroxine with initial clinical and biochemical resolution but developed symptoms of hyperthyroidism with weight loss and tremor 14 months later. Serum TSH was <0.02 mIU/L, fT4 54.3 pmol/L, and fT3 20.2 pmol/L, with an elevated TSH receptor (TRAb, 4.0 U/L [<1.0]), anti-TPO (1,163 IU/mL) and anti-TG (114 U/mL) antibodies. Technetium scan confirmed Graves’ Disease with bilateral diffuse increased tracer uptake (5.9% [0.5–3.5%]). The patient commenced carbimazole therapy for 6 months. Treatment was ceased following spontaneous clinical and biochemical remission (TSH 3.84 mIU/L, fT4 17pmol/L, fT3 4.5 pmol/L, and TRAb <1 U/L). This raises the need to monitor thyroid function closely in patients both during and following completion of interferon treatment.

scholarly journals The development of Graves' disease after long-term hypothyroidism due to Hashimoto's disease

2020 ◽  
Vol 66 (5) ◽  
pp. 24-30
Author(s):  
E. A. Panfilova ◽  
L. P. Kruk ◽  
M. P. Isaeva ◽  
P. O. Osmanova ◽  
F. A. Bostanova ◽  
...  
Keyword(s):  
Hormone Receptor ◽  
Clinical Case ◽  
Thyroid Volume ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Autoimmune Thyroid Diseases ◽  
Autoimmune Thyroid ◽  
Blocking Antibodies ◽  
Stimulating Hormone

The main autoimmune thyroid diseases are Hashimoto's thyroiditis (HT) and Graves' disease (GD). Despite the significant differences in a pathogenesis and a clinical picture between HT and GD, the literature describes the cases of the conversion of one autoimmune disease to another, which, according to one version, is associated with a change in the balance between the levels of a stimulating and blocking antibodies to the thyroid-stimulating hormone receptor. At the same time, there are more frequent observations of the transition of GD to HT, and much less often describe, on the contrary, the development of GD against the background of HT. The article presents a clinical case of the conversion of HT to GD. A detailed algorithm of the conservative management according to the «block-replace» scheme is described, indicating the results of laboratory and instrumental examination. At the time of describing the clinical case, the result of the treatment can be considered successful. The predictors such as a low level of the thyroid-stimulating hormone receptor and thyroid volume before discontinuation of the thyrostatic therapy suggest a low risk of the recrudescence of GD.According to the authors, the phenomenon of the conversion of one autoimmune thyroid disease to another, in addition to the scientific interest, is important for the practitioners, since a timely change in the diagnostic paradigm can significantly change the treatment strategy and the favorably affect the prognosis of disease, preventing the development of complications.

scholarly journals Ahmed valve implantation: intraoperative and early postoperative complications

2014 ◽  
Vol 7 (4) ◽  
pp. 10-12 ◽  
Author(s):  
Vadim Petrovich Nikolaenko ◽  
Larisa Mikhaylovna Kontantinova ◽  
Ol'ga Gennad'yevna Pavlova
Keyword(s):  
Postoperative Complications ◽  
Surgical Technique ◽  
Scar Tissue ◽  
Corneal Perforation ◽  
Anterior Chamber Angle ◽  
Early Postoperative Complications ◽  
Ahmed Valve ◽  
Preparatory Stage ◽  
Valve Implantation ◽  
Choroidal Effusion

Purpose. To analyze the causes of intraoperative and early postoperative complications and to develop a plan to improve the surgical technique. Methods. An Ahmed valve implantation by a standard method with obligatory posterior sclerectomy was performed in 238 patients aged from 18 to 88 years. Results. There were 7 cases of corneal perforation during the preparatory stage in excessively deep bridle suture; 3 cases of conjunctival and scleral perforation; 4 cases of inadvertent orifice enlargement in needle perforation of limbal scar tissue with consequent excessive filtration; in 37 patients, there was a hemorrhage from new vessels situated in the anterior chamber angle and the iris; 59 cases of serous cilio-choroidal effusion; 12 cases of hemorrhagic detachment. Conclusions. It is mandatory to follow the main principles of surgical technique and to take into consideration associated diseases.

scholarly journals COMPARATIVE CHARACTERISTICS OF DIFFERENT METHODS OF TREATMENT OF CHRONIC COMPLICATED HEMORRHOIDS

2021 ◽  
pp. 36-42
Author(s):  
A. V. Makukha ◽  
M. A. Kashtalyan ◽  
V. Yu. Shapovalov ◽  
R. V. Enin
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Postoperative Bleeding ◽  
Stage Ii ◽  
Group Iii ◽  
Early Postoperative Complications ◽  
Group I ◽  
External Component ◽  
Group Ii ◽  
Methods Of Treatment

Abstract. Introduction. In recent years, a method of surgical treatment of hemorrhoids by the method of ligation of hemorrhoidal arteries under Doppler control (THD technique), as well as with additional rectoanal reconstruction (HAL-RAR) has been developed and widely used. The aim of the study. The aim of our study was to compare methods of treatment of chronic complicated hemorrhoids stage II-III: classical Milligan-Morgan surgery, staple mucopexy according to Longo, as well as a combined technique: Doppler desarterization by HAL-RAR with additional removal of the external anodermal component. Materials and methods. In the clinic of coloproctology of Military medical: Clinical Center of the Southern Region of Odessa performed an analysis of three groups of patients for the period from 2011 to 2021, who underwent hemorrhoidectomy for complicated forms of hemorrhoids (bleeding, nodular prolapse, mucosal prolapse, anal fissure). All patients suffered from chronic complications of stage II or III hemorrhoids, with one or more of the above complications. Selected cases are divided into three groups: Group I (control) operations on Milligan-Morgan — 240 patients, including -64 women and 176 men; Distribution by age from 18 to 75 years; Group II staple hemorrhoidopexy for Longo — 276 patients, including 89 women and 115 men. Distribution by age from 18 to 72 years; Combined interventions using the wireless Doppler surgical complex Wi-3 HAL-RAR and additional removal of excess anoderm (from January 2019 to May 2021) operated on 53 patients, including 31 (58%) men and 22 (42%) women . Distribution by age from 28 to 62 years. Results and discussion. According to our data: bed day ranged from 1 to 8 days, mostly it was lower in group III — 1.3 (± 0.4) bed per day compared to 3.1 (± 0.8) in group II and 4.8 (± 1,7) in group III resorptive fever was not observed; the highest pain syndrome for VASH (average 7 points) in the group of patients of group I — compared with patients from group II (average 4 points) and patients of group III (average 2 points); the highest number of early postoperative complications was found in the group of patients operated on Milligan- Morgan: 1) acute urinary retention was observed in 43 cases (18%) of group I, compared with 38 cases (14%) of group II. The lowest number of cases of urinary retention was observed in group III — 2 cases (4%) (p <0.05). 2) postoperative bleeding from the wound was significantly more common in group I — 9 cases (3.75%), compared with group II — 6 cases (2.5%). No postoperative bleeding was observed in group III. 3) resorptive fever was most common in group I — 43 cases (18%) compared with group II - 33 cases (12%). Resorptive fever did not occur in group III (p<0.05). In all patients using the combined intervention HAL-RAR + excision of the external component of the anoderm, the pain was acquired by taking nonspecific anti-inflammatory drugs without the use of narcotic analgesics. No complications were observed. All patients noted no reduction in quality of life in the postoperative period. Conclusions. 1. Surgical treatment of hemorrhoids by the combined method of HAL-RAR + excision of the external component is a simple and effective method that in the postoperative period reduces the patient’s stay in the hospital, relatively lower in pain and the frequency of early postoperative complications. 2. HAL-RAR technology with excision of the outer component of the anoderm can be the operation of choice in the surgical treatment of chronic complicated hemorrhoids stage II-III.

Evaluation of the Surgical Treatment for Congenital Blepharoptosis Using Mustarde’s Modified Method

2016 ◽  
Vol 88 (3) ◽  
Author(s):  
Aleksandra Iljin ◽  
Andrzej Zieliński ◽  
Edward Lewandowicz ◽  
Bogusław Antoszewski ◽  
Tomasz Zieliński
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Surgical Technique ◽  
Surgical Correction ◽  
Small Range ◽  
Modified Method ◽  
Aesthetic Results ◽  
Low Rate

AbstractThe aim of the study was evaluation of the results of surgical treatment of congenital blepharoptosis (CBP) using Mustarde’s modified method.Material and methods. Between 2005-2014 forty eight children with CBP underwent surgical correction of CBP by Mustarde’s modified method. Basing on the results of ophthalmic and orthoptic examination, and standard measurements, we estimated postoperative difference in the position and symmetry of the upper eyelids, and postoperative complications in our patients.Results. Very good results were obtained in all cases with mild, in 89.5% with moderate, and in 85.7% with severe unilateral CBP after correction by Mustarde’s modified method. Lagophthalmos was seen in 6.25%, and undercorrection in 12.5% of cases.Conclusions. 1. Mustarde’s modified method allows for obtaining very good functional and aesthetic results in CBP patients. 2. Mustarde’s modified method is a valuable supplemental surgical technique in CBP, and contributes to a low rate and small range of lagophthalmos.

scholarly journals Coexistence of Autoimmune Hyper- and Hypothyroidism in a Kindred with Reduced Sensitivity to Thyroid Hormone

2020 ◽  
Vol 9 (5) ◽  
pp. 263-268
Author(s):  
Yasmine Abdellaoui ◽  
Dimitra Magkou ◽  
Sofia Bakopoulou ◽  
Ramona Zaharia ◽  
Marie-Laure Raffin-Sanson ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormone Receptor ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Free Triiodothyronine ◽  
Autoimmune Thyroid Diseases ◽  
Autoimmune Thyroid ◽  
Autoimmune Hypothyroidism ◽  
First Time ◽  
Receptor Antibodies

Introduction: Resistance to thyroid hormone beta (RTHβ) is a rare disease with an autosomal dominant transmission. Diagnosis may be challenging especially in patients with hyper- or hypothyroidism. Case Presentation: A 31-year-old male patient with suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine and free triiodothyronine, along with high thyroid receptor antibodies was diagnosed with Graves’ disease. Benzylthiouracil was started. One month later, reduced sensitivity to thyroid hormones was suspected because of persistently high thyroid hormone levels contrasting with high TSH level. Molecular analysis highlighted a 10c.1357C>T p.P453S mutation in the thyroid hormone receptor beta gene (THRB). RTHβ was diagnosed. Several relatives also had RTHβ (the mother, the young son, and 2 out of 3 siblings). Autoimmune hypothyroidism was present in the mother, whereas 2 out of 3 siblings had asymptomatic autoimmunity. Discussion/Conclusion: Both Graves’ disease and autoimmune hypothyroidism were described in patients with RTHβ. We show here for the first time that autoimmune hypo- and hyperthyroidism may coexist in kindred with RTHβ. Seven previously published cases of Graves’ disease and RTHβ were retrieved and analyzed. Treatments and thyroid hormone level targets are discussed as well as the possible link between RTHβ and autoimmune thyroid diseases.

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