scholarly journals Surgical treatment of Graves’ disease: Subtotal thyroidectomy might still be the preferred option

Medicina ◽  
2007 ◽  
Vol 44 (1) ◽  
pp. 22 ◽  
Author(s):  
Urmas Lepner ◽  
Indrek Seire ◽  
Veronika Palmiste ◽  
Ülle Kirsimägi
Keyword(s):  
Thyroid Function ◽  
Significant Proportion ◽  
Subtotal Thyroidectomy ◽  
Graves Disease ◽  
Thyroid Remnant ◽  
Large Goiter ◽  
Significant Difference ◽  
The Relationship ◽  
Recurrent Hyperthyroidism

Objective. The aim of this prospective study was to report our results after thyroidectomy for Graves’ disease. In addition, the relationship between the thyroid remnant and postoperative thyroid function was studied. Material and methods. Forty-nine consecutive patients were operated on for Graves’ disease. The indications for surgery were persistent or recurrent hyperthyroidism after medical treatment in 34 patients (69.4%), mechanical symptoms due to a large goiter in 7 (14.3%), increased ophthalmopathy in 7 (14.3%), and allergy to antithyroid medications in 1 patient (2.0%). Total thyroidectomy (TT) was performed in 28 and subtotal thyroidectomy (STT) in 21 patients. Followup lasted 24 to 70 months. Results. There was no statistically significant difference in the rate of postoperative complications comparing TT and STT. The patients who underwent TT had no recurrence during a mean follow-up of 47 months. After STT, with the mean weight of the thyroid remnant 3.0±1.0 g, there was no relapse of Graves’ disease during a mean follow-up of 52 months. After STT, postoperative hypothyroidism developed in 14 patients (66.7%); 7 patients (33.3%) remained euthyroid during follow-up. Comparison of the euthyroid patients and the hypothyroid patients revealed no difference in the weight of the remnant (3.3 g vs. 2.8 g), but a statistically significant difference occurred in the weight of the resected gland (61.0 g vs. 94.4 g, P=0.026) and in the proportion of the remnant (5.6% vs. 3.3%, P=0.030). Conclusions. Both TT and STT are safe procedures regarding postoperative complication rate. STT with the thyroid remnant of about 3 g allows to permanently cure hyperthyroidism ensuring the euthyroid state in a significant proportion of patients. Postoperative thyroid function after STT is best predicted by the proportion of the remnant.

A study of thyroid function after subtotal thyroidectomy for Graves' disease: particularly on TRH tests, T3 suppression tests and antithyroid antibodies in euthyroid patients

1983 ◽  
Vol 103 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Osamu Fukino ◽  
Hajime Tamai ◽  
Shinichi Fujii ◽  
Noriyuki Ohsako ◽  
Sunao Matsubayashi ◽  
...  
Keyword(s):  
Elevated Serum ◽  
Subtotal Thyroidectomy ◽  
Graves Disease ◽  
Trh Test ◽  
Antithyroid Antibodies ◽  
Abnormal Response ◽  
Suppression Test ◽  
Recurrent Hyperthyroidism ◽  
Serum Tsh

Abstract. Of 305 patients who underwent subtotal thyroidectomy for Graves' disease between 1969 and 1975, recurrent hyperthyroidism was found in 31 (10.2%) and hypothyroidism in 18 (5.9%). The remaining 256 patients were clinically euthyroid, but an elevated serum TSH level was found in 104 (34.1%) and an elevated serum T3 level in 19 (6.28%). In 57 of 133 clinically and biochemically euthyroid patients, a TRH test, T3 suppression test and measurement of antithyroid antibodies were performed. Twenty-nine of the 57 patients (50.9%) showed an abnormal response to TRH. Eight of these (14.0%) showed an impaired or absent response. The T3 suppression test showed that 15 of the 57 patients (26.3%) were non-suppressible. Positive antithyroid antibodies, especially antimicrosomal antibodies, were more frequent in non-suppressible and TRH-non-responsive patients than in suppressible and TRH-responsive patients. It is suggested that after operation for Graves' disease: 1) only half of the clinically euthyroid patients were biochemically euthyroid, 2) of the clinically and biochemically euthyroid patients, there were many with abnormalities in TRH responsiveness and T3 suppressibility, and 3) thyroid functional status is unstable and long careful follow-up is important after operation for Graves' disease.

Evaluation of thyroid function after bilateral subtotal thyroidectomy for Graves' disease: a long term follow up of 100 patients

1994 ◽  
Vol 35 (2) ◽  
pp. 177 ◽  
Author(s):  
Sung Hoon Noh ◽  
Euy Young Soh ◽  
Cheong Soo Park ◽  
Kyung Sik Lee ◽  
Kap Bum Huh
Keyword(s):  
Thyroid Function ◽  
Subtotal Thyroidectomy ◽  
Graves Disease ◽  
Long Term Follow Up

Relationship between Thyroglobulin and Tumor Detectabilily with Thallium-201 in Differentiated Thyroid Cancer

2000 ◽  
Vol 39 (01) ◽  
pp. 10-15 ◽  
Author(s):  
S. P. Müller ◽  
Ch. Reiners ◽  
A. Bockisch ◽  
Katja Brandt-Mainz
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Roc Analysis ◽  
Tsh Suppression ◽  
Significant Difference ◽  
Test Specificity ◽  
The Relationship ◽  
Tumor Scintigraphy ◽  
Tsh Stimulation

Summary Aim: Tumor scintigraphy with 201-TICI is an established diagnostic method in the follow-up of differentiated thyroid cancer. We investigated the relationship between thyroglobulin (Tg) level and tumor detectability. Subject and methods: We analyzed the scans of 122 patients (66 patients with proven tumor). The patient population was divided into groups with Tg above (N = 33) and below (N = 33) 5 ng/ml under TSH suppression or above (N = 33) and below (N = 33) 50 ng/ml under TSH stimulation. Tumor detectability was compared by ROC-analysis (True-Positive-Fraction test, specificity 90%). Results: There was no significant difference (sensitivity 75% versus 64%; p = 0.55) for patients above and below 5 ng/ml under TSH suppression and a just significant difference (sensitivity 80% versus 58%; p = 0.04) for patients above and below 50 ng/ml under TSH stimulation. In 18 patients from our sample with tumor, Tg under TSH suppression was negative, but 201-TICI-scan was able to detect tumor in 12 patients. Conclusion: Our results demonstrate only a moderate dependence of tumor detectability on Tg level, probably without significant clinical relevance. Even in patients with slight Tg elevation 201-TICI scintigraphy is justified.

The Relationship between Serum Ferritin Levels and 5-Year All-Cause Mortality in Hemodialysis Patients

2021 ◽  
pp. 1-7
Author(s):  
Emre Erdem ◽  
Ahmet Karatas ◽  
Tevfik Ecder
Keyword(s):  
Serum Ferritin ◽  
Hemodialysis Patients ◽  
Rank Test ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Group 3 ◽  
Group 2 ◽  
The Relationship ◽  
Group 1

<b><i>Introduction:</i></b> The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. <b><i>Methods:</i></b> A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin &#x3c;800 ng/mL, group 2: serum ferritin 800–1,500 ng/mL, and group 3: serum ferritin &#x3e;1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. <b><i>Results:</i></b> Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, <i>p</i> = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; <i>p</i> = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; <i>p</i> = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; <i>p</i> = 0.063). <b><i>Conclusion:</i></b> Time-averaged serum ferritin levels &#x3e;1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

scholarly journals Correlation of Triiodothyronine Level with In-Hospital Cardiac Function and Long-Term Prognosis in Patients with Acute Myocardial Infarction

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Jianqing She ◽  
Jiahao Feng ◽  
Yangyang Deng ◽  
Lizhe Sun ◽  
Yue Wu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Survival Analysis ◽  
Cardiac Function ◽  
Thyroid Function ◽  
Major Adverse Cardiovascular Events ◽  
Free Triiodothyronine ◽  
Kaplan Meier ◽  
Significant Difference

Objective. The pathophysiologic mechanism of how thyroid function is related to the development and prognosis of acute myocardial infarction (AMI) remains under explored, and there has been a lack of clinical investigations. In this study, we investigate the relationship between triiodothyronine (T3) level and cardiac ejection fraction (EF) as well as probrain natriuretic peptide (NT-proBNP) on admission and subsequent prognosis in AMI patients. Methods. We measured admission thyroid function, NT-proBNP, and EF by echocardiography in 345 patients diagnosed with AMI. Simple and multiregression analyses were performed to investigate the correlation between T3 level and EF as well as NT-proBNP. Major adverse cardiovascular events (MACE), including new-onset myocardial infarction, acute heart failure, and cardiac death, were documented during the follow-up. 248 participants were separated into three groups based on T3 and free triiodothyronine (FT3) levels for survival analysis during a 2-year follow-up. Results. 345 patients diagnosed with AMI were included in the initial observational analysis. 248 AMI patients were included in the follow-up survival analysis. The T3 levels were found to be significantly positively correlated with EF (R square=0.042, P<0.001) and negatively correlated with admission NT-proBNP levels (R square=0.059, P<0.001), which is the same with the correlation between FT3 and EF (R square=0.053, P<0.001) and admission NT-proBNP levels (R square=0.108, P<0.001). Kaplan-Meier survival analysis revealed no significant difference with regard to different T3 or FT3 levels at the end of follow-up. Conclusions. T3 and FT3 levels are moderately positively correlated with cardiac function on admission in AMI patients but did not predict a long-time survival rate. Further studies are needed to explain whether longer-term follow-up would further identify the prognosis effect of T3 on MACE and all-cause mortality.

Abstract WMP18: Assessment of Perfusion Pattern Can be Useful for Predicting the Progression of Lacunar Infartion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Dong Hoon Shin
Keyword(s):  
Multivariate Regression Analysis ◽  
Parent Artery ◽  
Ischemic Lesion ◽  
Predicting Factors ◽  
Significant Difference ◽  
Branch Atheromatous Disease ◽  
The Relationship ◽  
Time To Drain ◽  
Subcortical Infarct

Background and Purpose: The pathomechanism of a single subcortical infarct (SSI) may be better determined by assessing the perfusion status between parent artery and ischemic lesion. We aimed to compare the classifications into branch atheromatous disease (BAD) versus non-BAD based on DWI or CTP and to test whether a CTP-based classification improves the predicting power for progression in SSI (PSSI) compared to that by DWI. Methods: We enrolled 93 consecutive patients with SSI examined by whole-supratentorial brain CTP and follow-up DWI. Time-to-drain (TTD) maps were calculated from 1-mm dynamic CTP data. BAD was assumed when either the ischemic lesion extended to the basal surface of the parent artery on axial DWI or the hypoperfused area (TTD≥5 sec) was <5mm apart from the CSF-perforators interface on both coronal and sagittal CTP. We tested the relationship between DWI and CTP for determining BAD, and compared demographics, imaging, and the frequency of PSSI between the BAD and non-BAD based on CTP. Multivariate regression analysis was performed to determine predicting factors for PSSI. Results: On DWI, 57 of 93 patients (61.3%) were classified as BAD; on CTP 28 patients (30.1%), showing significant difference ( P <0.0001). PSSI was significantly different between BAD versus non-BAD by CTP (35.7% versus 12.3%, P =0.020), but not different by DWI (22.8% versus 13.9%, P =0.289). BAD-type perfusion was the only independent predictor for PSSI (OR, 5.242; 95% CI, 1.372-20.021; P =0.015). Conclusion: The classifications of SSI with and without BAD by CTP and DWI are significantly different. CTP may help to predict PSSI.

Prognosis

2020 ◽  
pp. 241-247
Keyword(s):  
Coronary Artery Disease ◽  
Poor Prognosis ◽  
B Cell Lymphoma ◽  
Graves Disease ◽  
Papillary Thyroid ◽  
Myxedema Coma ◽  
Follow Up Care ◽  
Artery Disease ◽  
The Relationship

With early diagnosis, timely institution of L-T4 replacement therapy, regular patient follow-up care, and attention to other attendant complications, the prognosis in Hashimoto's thyroiditis (HT) is excellent with patients leading a normal life. Untreated myxedema coma has a poor prognosis and a high mortality rate, particularly in old age. Transient periods of thyrotoxicosis sometimes occur, and rarely full hyperthyroid Graves' disease with active ophthalmopathy. There is an increased prevalence of coronary artery disease in patients with untreated or undertreated HT. The relationship between papillary thyroid carcinoma (PTC) and HT has been controversial. Primary thyroid B-cell lymphoma affects less than one in a thousand persons, and it is more likely to affect those with long-standing autoimmune thyroiditis. Complications of over-replacement with L-T4 should be avoided. This chapter explores the prognosis of Hashimoto's disease.

The Relationship Between N-Terminal Pro-Brain Natriuretic Peptide Level and Myocardial Performance Index and Their Prognostic Importances in Patients With Acute Myocardial Infarction in Short Term Follow-up

2020 ◽  
Vol 1 (1) ◽  
pp. 12-17
Author(s):  
Mehmet Küçükosmanoğlu ◽  
Cihan Örem
Keyword(s):  
Heart Failure ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ejection Time ◽  
Ventricular Ejection Fraction ◽  
Significant Difference ◽  
The Mean ◽  
The Relationship

Introduction: MPI is an echocardiographic parameter that exibit the left ventricular functions globally. NT-proBNP  is an important both diagnostic and prognostic factor in heart failure. In this study, we aimed to investigate the prognostic significance of serum NT-proBNP levels and MPI in patients with STEMI. Method: Totally 104 patients with a diagnosis of STEMI were included in the study. Patients followed for 30-days and questioned for presence of symptoms of heart failure (HF) and cardiac death. Patients were invited for outpatient control after 30-days and were divided into two groups: (HF (+) group) and (HF (-) group). Results: Totally 104 patients with STEMI were hospitalized in the coronary intensive care unit. Of those patients, 17 were female (16%), 87 were male (84%), and the mean age of the patients was 58.9±10.8 years. During the 30-day follow-up, 28 (27%) of 104 patients developed HF. The mean age, hypertension ratio and anterior STEMI rate were significantly higher in the HF (+) group compared to the HF (-) group. Ejection time (ET) and left ventricular ejection fraction (LVEF) were significantly lower and MPI was significantly higher in the HF (+) group. When the values on day first and  sixth were compared, NT-ProBNP levels were decreased in both groups. There was no significant difference between the two groups in terms of the change in MPI values on the first and sixth days. Multiple regression analysis showed that the presence of anterior MI, first day NT-proBNP level and LVEF were independently associated with development of HF and death. Conclusion: In our study, NT-proBNP levels were found to be positively associated with MPI in patients with acute STEMI. It was concluded that the level of NT-proBNP detected especially on the 1st day was more valuable than MPI in determining HF development and prognosis after STEMI.  

Different aetiologies in post-partum thyroiditis?

1983 ◽  
Vol 104 (2) ◽  
pp. 195-200 ◽  
Author(s):  
Per Anders Dahlberg ◽  
Rolf Jansson
Keyword(s):  
Thyroid Function ◽  
Autoimmune Thyroiditis ◽  
Thyroid Dysfunction ◽  
Post Partum ◽  
Lymphocytic Infiltration ◽  
Graves Disease ◽  
Thyroid Autoantibodies ◽  
Radioiodine Uptake ◽  
Thyroid Cytology

Abstract. During a 4 year period 19 women with post-partum onset of thyroid dysfunction have been seen in our clinic. Five women had high radioiodine uptake thyrotoxicosis (Graves' disease). Twelve women had hypothyroid symptoms starting within 3–6 months of delivery. All of these women had thyroid microsomal and/or cytoplasmic autoantibodies and thyroid lymphocytic infiltration suggesting aggravation of pre-existing subclinical autoimmune thyroiditis (Hashimoto's disease). At follow-up thyroid function gradually improved in all but signs of persistent thyroid hypofunction remained in seven. Thus women developing symptomatic postpartum hypothyroidism should be followed regularly and when thyroxine treatment is commenced in the post-partum period, it has to be continued indefinitely in many cases. Two women presented with transient low radioiodine uptake thyrotoxicosis and a small painless goitre. Thyroid cytology revealed thyroiditis but they had no thyroid autoantibodies. When followed after a succeeding delivery none of these women developed post-partum thyroid dysfunction in contrast to women in the autoimmune group. Probably the aetiology of thyroid dysfunction in these 2 women was different.

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