Improving Diagnostic Coincidence Rate of Graves’ Disease by Ultrasound Examination with Clinical Symptoms

Abstract Background and Study Aims Thyroid-associated orbitopathy, the most common extrathyroidal manifestation of Graves’ disease, is an autoimmune inflammation of orbital soft tissue. We report the study assessing the effect of immunosuppressive treatment with methylprednisolone on selected antioxidant parameters in patients with Graves’ disease with active thyroid-associated orbitopathy. Patients and Methods Activity and serum levels of selected antioxidant parameters as well as lipid peroxidation products were determined in a group of 56 patients with active thyroid-associated orbitopathy at three time-points: at baseline, after the discontinuation of intravenous methylprednisolone treatment and at 3 months after the discontinuation of additional oral methylprednisolone treatment. A control group consisted of 20 healthy age- and sex-matched volunteers. Results We found an increased activity of superoxide dismutase and glutathione peroxidase and increased serum levels of uric acid, malondialdehyde and conjugated dienes, as well as a reduced activity of paraoxonase-1 and reduced serum vitamin C level in the study group at baseline. Systemic intravenous and oral methylprednisolone therapy led to normalization of activity and concentration of the most studied parameters. Conclusion Results of our study confirmed that oxidative stress is one of the factors involved in the pathogenesis of thyroid-associated orbitopathy and the methyloprednisolone treatment is effective in reducing both clinical symptoms and oxidative stress in patients with this disease.

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A case of intussuscepted and incarcerated Meckel’s diverticulum in to the coecum

Acta chirurgica iugoslavica ◽

10.2298/aci1104107d ◽

2011 ◽

Vol 58 (4) ◽

pp. 107-109

Author(s):

Srdjan Dikic ◽

Svetlana Dragojevic ◽

Darko Zdravkovic ◽

Miroslav Djordjevic ◽

Vladimir Kovcin ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Ultrasound Examination ◽

Clinical Symptoms ◽

Common Cause ◽

Prior Surgery ◽

History Of ◽

Physical Examinations ◽

Possible Cause

BACKGROUND: Intussusception with the Meckel?s diverticulum is rare cause of small bowel obstruction in the adults. The Meckel diverticulum is the most common cause of intestinal obstruction in children. METHODS (CASE REPORT): We present a case of 18-year-old boy with developing signs of small bowel obstruction The onset of disease was the day before the first examination. There was no history of prior surgery. According to the clinical symptoms, physical examinations as well as radiographic and ultrasound examination, surgical treatment was indicated. Surgical approach was inferior medial laparotomy. Intussusceptions of the Meckel?s diverticulum and into the coecum with incarceration were found. De-sincarceration and simple diverticulectomy was done. CONCLUSION: The Meckels?s diverticulum should be consider as a possible cause of the small bowel obstruction in previously healthy patient.

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Thr92Ala Polymorphism of Human Type 2 Deiodinase Gene (hD2) Affects the Development of Graves' Disease, Treatment Efficiency, and Rate of Remission

Clinical and Developmental Immunology ◽

10.1155/2012/340542 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Babenko Alina ◽

Popkova Daria ◽

Freylihman Olga ◽

Solncev Vladislav ◽

Kostareva Anna ◽

...

Keyword(s):

Single Nucleotide Polymorphisms ◽

Genetic Factors ◽

Clinical Symptoms ◽

Graves Disease ◽

Disease Development ◽

Nucleotide Polymorphisms ◽

Treatment Efficiency ◽

Disease Treatment ◽

Single Nucleotide

Clinical symptoms vary in thyrotoxicosis, and severity of these depends on many factors. Over the last years, impact of genetic factors upon the development and clinical significance of thyrotoxic symptoms became evident. It is known that a production of T3 in various tissues is limited by deiodinase 2 (D2). Recent studies revealed that certain single nucleotide polymorphisms (including threonine (Thr) to alanine (Ala) replacement in D2 gene codon 92, D2 Thr92Ala) affect T3 levels in tissues and in serum. Individuals with Ala92Ala genotype have lower D2 activity in tissues, compared with that in individuals with other genotypes. In our study, we have assessed an association of D2 Thr92Ala polymorphism with (1) frequency of disease development, (2) severity of clinical symptoms of thyrotoxicosis, and (3) rate of remissions, in Graves' disease patients.

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Hyperthyroidism and Graves' disease: Is an ultrasound examination needed?

Indian Journal of Endocrinology and Metabolism ◽

10.4103/2230-8210.192899 ◽

2016 ◽

Vol 20 (6) ◽

pp. 866 ◽

Cited By ~ 2

Author(s):

Lakshminarayanan Varadhan ◽

GeorgeIype Varughese ◽

Sailesh Sankaranarayanan

Keyword(s):

Ultrasound Examination ◽

Graves Disease

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Anti-TSH receptor antibodies as predictors of the severity and outcome of endocrine ophthalmopathy in the patients presenting with Graves' disease

Problems of Endocrinology ◽

10.14341/probl201157223-26 ◽

2011 ◽

Vol 57 (2) ◽

pp. 23-26 ◽

Cited By ~ 2

Author(s):

N Iu Sviridenko ◽

V G Likhvantseva ◽

I M Belovalova ◽

M S Sheremeta ◽

K I Tabeeva

Keyword(s):

Thyroid Gland ◽

Clinical Symptoms ◽

Active Phase ◽

Tsh Receptor ◽

Graves Disease ◽

Depth Analysis ◽

Endocrine Ophthalmopathy ◽

Inactive Phase ◽

Receptor Antibodies ◽

Tsh Receptor Antibodies

A total of 139 patients (278 eyes) presenting with Graves' disease (GD) and endocrine ophthalmopathy (EOP) were examined. The age of 35 men and 104 women ranged from 17 to 71 years. All of them were tested for the functional activity of the thyroid gland and underwent standard ophthalmologic examination; anti-TSH receptor antibodies were measured. Both the activity and severity of EOP were verified as recommended by the European Group on Graves' Orbitopathy (EUGOGO) It was shown that the frequency of detection of anti-TSH receptor antibodies and their titers in patients with GD and EOP depended on the activity of the intraorbital process and the severity of EOP manifestations. The functional state of the thyroid gland also influenced the level of anti-TSH receptor antibodies level during the active phase unlike that in the inactive phase. The in-depth analysis of the relationship between the level of anti-TSH receptor antibodies and clinical characteristics of either EOP (activity, severity, manifestation of selected clinical symptoms) or GD (thyrotoxicosis, euthyroidism, hypothyroidism) demonstrated the possibility to use these characteristics as the factors predicting the severity and outcome of EOP. Also, they may be helpful for the choice of a therapeutic strategy for the treatment of such patients.

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Radioiodine therapy for Graves' disease as a risk factor of endocrine ophthalmopathy

Problems of Endocrinology ◽

10.14341/probl200955151-55 ◽

2009 ◽

Vol 55 (1) ◽

pp. 51-55

Author(s):

M S Sheremeta ◽

I M Belovalova ◽

N Yu Sviridenko

Keyword(s):

Elevated Level ◽

Radioactive Iodine ◽

Radioiodine Therapy ◽

Clinical Symptoms ◽

Thyroid Stimulating Hormone ◽

External Irradiation ◽

Graves Disease ◽

Endocrine Ophthalmopathy ◽

Eye Symptoms ◽

The Relationship

In 1973 and 1976 R. Wasnich and R. Jackson described 2 cases of endocrine ophthalmopathy (EO) that occurred after external irradiation of the anterior surface of the neck due to a tumor (Hodgkin's lymphoma). Further observations showed that treatment of Graves' disease with radioactive iodine (131I) can worsen the course of EO. So, L. De Groot et al., Observing 264 patients after exposure to 131I for Graves' disease, found progression of EO in 4% of patients after the 1st course of therapy and in 12% after subsequent sessions. L. Bartalena et al. observed the appearance or significant progression of EO in 15% of 150 patients treated with 131I. At the same time, against the background of glucocorticoid therapy, only 10% of patients worsened the course of EO. Other studies have shown that the progression of EO after treatment with 131I without glucocorticoid administration was observed in 18-30% of cases. Along with this, it is believed that 131I does not affect the incidence of clinical symptoms in the orbit, and hypothyroidism that occurs after it does not lead to the progression of eye symptoms. The relationship between treatment and the onset or progression of EO is not clear. Nevertheless, there is evidence of an adverse effect of an elevated level of antibodies to the thyroid stimulating hormone receptor (TSH) in the blood serum after 1131I training for EO. This review is devoted to a review of the problem presented.

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Hyperthyroidism in Children

10.5772/intechopen.97444 ◽

2021 ◽

Author(s):

Artur Bossowski ◽

Karolina Stożek

Keyword(s):

Surgical Treatment ◽

Thyroid Hormones ◽

Clinical Symptoms ◽

Pediatric Population ◽

Tsh Receptor ◽

Graves Disease ◽

Common Cause ◽

Receptor Antibodies ◽

Tsh Receptor Antibodies ◽

Immunological Dysfunction

Hyperthyroidism is the state of excessive synthesis and release of the thyroid hormones by thyrocytes. Graves’ disease is the most common cause of hyperthyroidism in children. The condition may occur at any age but the prevalence increases with age. According to the classical paradigm, coexistence of genetic susceptibility, environment triggers and immunological dysfunction are responsible for its development. Diagnosis of Graves’ disease is based on presence of characteristic clinical symptoms, TSH receptor antibodies and excess of thyroid hormones. The management in pediatric population involves mainly pharmacotherapy (thyrostatics, β-adrenolitics), in resistant cases radical radioiodine I131 therapy or surgical treatment is necessary.

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Poly (ADP-ribose) polymerase-1 (PARP-1) in Chinese patients with Graves’ disease and Graves’ ophthalmopathy

Canadian Journal of Physiology and Pharmacology ◽

10.1139/cjpp-2016-0332 ◽

2018 ◽

Vol 96 (6) ◽

pp. 556-561

Author(s):

Tong Wu ◽

Dong-run Tang ◽

Liang Zhao ◽

Feng-yuan Sun

Keyword(s):

Clinical Symptoms ◽

Sandwich Elisa ◽

Chinese Patients ◽

Graves Disease ◽

Plasma Dna ◽

Serum Samples ◽

Graves Ophthalmopathy ◽

Study Results ◽

Department Of Ophthalmology ◽

Parp 1

We aimed to evaluate the genetic variation of poly (ADP-ribose) polymerase-1 (PARP-1) as risk factor in development of Graves’ disease (GD) and Graves’ ophthalmopathy (GO) among Chinese individuals. Patients with confirmed diagnosis of GD or healthy individuals with no clinical symptoms of hyperthyroiditis were enrolled at the Department of Ophthalmology, Tianjin First Center Hospital, China. Genetic polymorphism was studied in plasma DNA samples of subjects by polymerase chain reaction of restriction fragment length polymorphism to confirm our hypothesis. Cytokine levels were measured routinely on serum samples of subjects by sandwich ELISA technique. Patients with GG genotype (odds ratio (OR) 95% CI = 2.25 (1.35–3.73), p = 0.002) and carriers of G allele (OR = 2.03 (1.23–3.36), p = 0.006) were at high risk of developing ophthalmopathy. Polymorphism of del/ins of nuclear factor-κB1 gene (NFkB1) gene (OR = 7.1 (2.88–17.52), p < 0.0001) and PARP-1 C410T polymorphism was found to be associated with GO (p < 0.05). Cytokine level was significantly higher in patients with GD (p < 0.05), but no significant change in cytokines level among GO patients from baseline (p > 0.05). Our study results recommended that polymorphism of PARP-1 gene is more likely responsible for development of GD in Chinese individuals. We also observed that the polymorphism of gene-related del/ins to NFkB1 in development of GO.

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Experimental clinical study on the using of adhesive in the obliteration of varicose veins in humans

Ambulatory surgery hospital-replacing technologies ◽

10.21518/1995-1477-2020-3-4-113-123 ◽

2021 ◽

pp. 113-123

Author(s):

A. B. Sannikov ◽

E. V. Shaydakov ◽

V. M. Emelyanenko ◽

T. G. Tolstikova

Keyword(s):

Connective Tissue ◽

Allergic Reaction ◽

Ultrasound Examination ◽

Clinical Symptoms ◽

Varicose Veins ◽

Histological Study ◽

Experimental Studies ◽

Butyl Ether ◽

Aseptic Inflammation ◽

Adhesive Compound

Introduction. In order to perform endovasal vein lining, the American Rodney D.Raabe developed a system for varicose veins obliteration, consisting of a glue gun and two catheters, called “VenaSeal”. As an occlusant for varicose veins in this system, “Medtronic” company today proposes to use an adhesive compound synthesized on the basis of butyl ether of α-cyanacrylic acid.Materials and methods. Endovasal catheter obliteration of tributaries and main trunks of the great saphenous vein on the tibia was performed in 15 patients with varicose disease (C2 to CEAR) in order to substantiate the possibility of using the adhesive compound Sulfacrylate. Severity of pain, presence or absence of phlebitis and thrombophlebitis, hyper pigmentation, neurological disorders, allergic reaction were clinically evaluated.Results and discussion. All patients after the introduction of the glue Sulfakrilat had a clinic of moderate phlebitis, without the formation of blood clots in the lumen of the vein. No local or general allergic reaction was observed. From day 7 occluded venous segments were palpated in the form of moderate density bands, without infiltration to surrounding tissues. In the absence of blood flow ultrasound examination showed gradual biodegradation of the adhesive strip inside the vein with the development of complete obliteration of the lumen starting from the 4th month. Starting with the 7th day gradually stopped aseptic inflammation in the wall of the vein was observed on histological examination. Monocytic infiltration of the venous wall with the formation of multinucleated cells of foreign bodies was present until the time of complete biodegradation of the glue. The process of diffuse growth of connective tissue with the presence of fibroblasts from the subendothelium and in the middle shell was most actively observed in histological material from 90 to 120 days after occlusion. Within 180 days, the lumen of the veins occluded by “Sulfacrylate” was completely obliterated by mature connective tissue, in the absence of glue particles, which indicated its complete biodegradation.Conclusion. The experimental studies conducted with the assessment of clinical symptoms, ultrasound examination and histological study of morphogenesis in the lumen of blood vessels in different periods up to 6 months allow us to conclude the potential use of the adhesive compound “Sulfacrylate” (produced in Russia) for endovasal obliteration of varicose veins in humans.

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Comparison of Clinical Symptoms of Assumed vs. Actual Uterine Fibroids – Symptoms Described by Patients and Ultrasound Findings

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-0991-0105 ◽

2019 ◽

Vol 80 (03) ◽

pp. 316-323

Author(s):

Nina Isabelle Knudsen ◽

Klaus-D. Wernecke ◽

Heribert Kentenich ◽

Matthias David

Keyword(s):

Ultrasound Examination ◽

Clinical Symptoms ◽

Uterine Fibroids ◽

Abdominal Ultrasound ◽

Physical Symptoms ◽

Bleeding Disorders ◽

Inclusion Criteria ◽

Significant Difference ◽

Ultrasound Findings ◽

Ultrasound Investigation

Abstract Purpose How many women assume that they have fibroids but are found not to have fibroids on ultrasound examination? How severe are the physical symptoms reported by these women compared to the symptoms reported by women with actual uterine fibroids? Are the symptoms more severe if the patient believes that she has at least one relatively large (dominant) fibroid or more than 3 fibroids? Material and Methods A total of 1548 patients completed an anonymous questionnaire in which they were asked about the number of their fibroids, dysmenorrhea and premenstrual symptoms, dyspareunia and bleeding disorders (using a numerical analog scale between 0 – 10). The questionnaire was administered in a hospital-based fibroid clinic. The information provided by the patients was then compared with transvaginal or abdominal ultrasound findings. The symptoms reported by women with and without fibroid(s) were compared. Results 1045 out of 1548 patients fulfilled the studyʼs inclusion criteria. Contrary to the information they provided, no fibroid(s) were detected in 6% (62 of 1045 patients) of patients on ultrasound examination. Of these women, 87% had dysmenorrhea, 79% had premenstrual pain and 57% reported dyspareunia. The severity of the symptoms was found not to be associated with the assumed size or number of fibroid(s). There was no significant difference in the pain reported by women without and by women with fibroids. Reporting a feeling of strong pressure on the bladder (OR: 1.18) or abdomen (OR: 1.12) or constipation (OR: 1.16) increased the likelihood of detecting a fibroid on ultrasound investigation. Conclusions The presence of manifest symptoms (dysmenorrhea, dyspareunia, premenstrual pain, bleeding disorders) does not allow conclusions to be made about the number or size of fibroids or about which therapy is indicated. Even an erroneous assumption about the presence of fibroids may result in patients experiencing symptoms.

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