scholarly journals See-Saw Relationship and its Reversal after Immunotherapy in a Case of Graves’ Disease with Coexisting Myasthenia Gravis

2019 ◽  
Vol 10 (01) ◽  
pp. 136-138 ◽  
Author(s):  
Sathish Kumar Mallikarjuna ◽  
S. Sakthi Velayutham ◽  
P. R. Sowmini ◽  
Malcolm K. Jeyaraj ◽  
S. Arunan
Keyword(s):  
Clinical Practice ◽  
Myasthenia Gravis ◽  
Beta Blockers ◽  
Reciprocal Relationship ◽  
The Other ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Immunomodulatory Effects ◽  
The Relationship ◽  
Unique Association

ABSTRACTThe unique association of myasthenia gravis (MG) with Graves' disease in clinical practice emphasizes that one autoimmune disease can coexist with another or many. The relationship between these two entities has remained controversial till date. Some authors have reported a see-saw relationship between these two entities, MG waning with hyperthyroidism and waxing with treatment of hyperthyroidism. Treatment of both these disorders concurrently may be challenging at times as treatment for one entity may worsen the other. The use of beta-blockers and steroids for Graves' disease may worsen myasthenic weakness. Antithyroid drugs can worsen myasthenia probably by immunomodulatory effects. We report a case of Graves' disease coexisting with MG in a reciprocal relationship which was subsequently reversed after immunotherapy.

scholarly journals Co-existent ocular myasthenia gravis and Graves’ disease in a 5 year old

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Olivia Watson ◽  
Michelle Jack ◽  
Helen Young
Keyword(s):  
Myasthenia Gravis ◽  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Clinical Presentation ◽  
Graves Disease ◽  
Autoimmune Thyroid ◽  
Ocular Myasthenia ◽  
Ocular Myasthenia Gravis ◽  
The Relationship ◽  
Symptom Recurrence

Myasthenia gravis and Graves’ disease are known to co-exist in adults, yet there have only been a small number of paediatric cases reported. We report a 5 year old female who was diagnosed with ocular myasthenia gravis after presenting with unilateral ptosis and subsequently found also to have Graves’ disease. She was treated successfully with pyridostigmine, corticosteroids and carbimazole without symptom recurrence or progression to generalised myasthenia gravis. The aetiology of the coexistence is not fully understood, nor is the relationship between the two disorders’ presentation and treatment. We discuss the variation in clinical presentation of myasthenia gravis between populations and when associated with autoimmune thyroid disease, potential HLA-related genetic susceptibility and the varying approaches to treatment of the co-existent disorders.

A Prospective Study of the Relationship between Relapse of Hyperthyroid Graves’ Disease after Antithyroid Drugs and HLA Haplotype*

1983 ◽  
Vol 57 (4) ◽  
pp. 719-722 ◽  
Author(s):  
HUBERT ALLANNIC ◽  
RENÈE FAUCHET ◽  
YANNICK LORCY ◽  
MONIQUE GUEGUEN ◽  
ANNE-MARIE LE GUERRIER ◽  
...  
Keyword(s):  
Prospective Study ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
A Prospective Study ◽  
The Relationship

Impact of 30- Versus 60-Second Time Intervals Between Automated Office Blood Pressure Measurements on Measured Blood Pressure

Hypertension ◽  
2021 ◽  
Vol 78 (5) ◽  
pp. 1502-1510
Author(s):  
Stephen P. Juraschek ◽  
Anthony M. Ishak ◽  
Kenneth J. Mukamal ◽  
Julia M. Wood ◽  
Timothy S. Anderson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Practice ◽  
Linear Regression ◽  
Ambulatory Blood Pressure ◽  
The Other ◽  
Pressure Measurements ◽  
Time Intervals ◽  
Interaction Term ◽  
Automated Office Blood Pressure ◽  
The Relationship

Guidelines recommend 1 to 2 minutes between repeated, automated office-based blood pressure (AOBP) measures, which is a barrier to broader adoption. Patients from a single hypertension center underwent a 3-day evaluation that included a 24-hour ambulatory blood pressure (BP) monitor (ABPM) and one of two nonrandomized, unattended AOBP protocols. Half of the patients underwent 3 AOBP measurements separated by 30 seconds, and the other half underwent 3 BP measurements separated by 60 seconds. All measurements were compared with the average awake-time BP from ABPM and the first AOBP measurement. We used linear regression to assess whether the 30-second protocol was associated with individual or average AOBP measurements or awake-time ABPM and used an interaction term to determine whether interval modified the relationship between AOBP measurements (individual and mean) with awake-time ABPM. Among 102 patients (mean age, 59.2±16.2 years; 64% women; 24% Black), the average awake-time BP was 132.5±15.6/77.7±12.2 mm Hg among those who underwent the 60-second protocol and 128.6±13.6/76.5±12.5 mm Hg for the 30-second protocol. Mean systolic/diastolic BP was lower with the second and third AOBP measurement by −0.5/−1.7 mm Hg and −1.0/−2.3 mm Hg for the 60-second protocol versus −0.8/−2.0 mm Hg and −0.7/−2.7 mm Hg for the 30-second protocol; protocol did not significantly modify these differences. Differences between AOBP measurements (first, second, or third) and awake-time ABPM were nearly identical across protocols. In conclusion, a 30-second interval between AOBP measurements was as accurate and reliable as a 60-second interval. These findings support shorter time intervals between BP measurements, which would make AOBP more feasible in clinical practice.

scholarly journals Recurrent Thyrotoxicosis due to Both Graves’ Disease and Hashimoto’s Thyroiditis in the Same Three Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Ashley Schaffer ◽  
Vidya Puthenpura ◽  
Ian Marshall
Keyword(s):  
Case Report ◽  
Autoimmune Disease ◽  
Thyroid Gland ◽  
Hashimoto’S Thyroiditis ◽  
Monozygotic Twins ◽  
The Other ◽  
Initial Presentation ◽  
Hashimoto's Thyroiditis ◽  
Graves Disease ◽  
The Relationship

Hashimoto’s thyroiditis (HT) and Graves’ disease (GD) are the 2 most common autoimmune disease processes affecting the thyroid gland. The relationship between the two is complex and not clearly understood. It has been theorized that HT and GD are 2 separate disease processes due to unique genetic differences demonstrated by genome studies. On the other hand, based on occurrence of both HT and GD in monozygotic twins and within the same family, they have been regarded to represent 2 ends of the same spectrum. This case report describes 3 patients who presented with thyrotoxicosis due to both GD and HT. The initial presentation was thyrotoxicosis due to GD treated with antithyroid medication followed by temporary resolution. They all subsequently experienced recurrence of thyrotoxicosis in the form of Hashitoxicosis due to HT, and then eventually all developed thyrotoxicosis due to GD, requiring radioablation therapy.

scholarly journals Value of Apoptotic, Antiapoptotic, and Cell Proliferation Markers in the Treatment of Graves’ Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Jessica Castro de Vasconcelos ◽  
Icléia Siqueira Barreto ◽  
Patrícia Sabino Matos ◽  
Frederico Fernandes Ribeiro Maia ◽  
Marcos Antônio Tambascia ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Beta Blockers ◽  
Expression Level ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyroid Cells ◽  
Antiapoptotic Effect ◽  
Hyperthyroid State ◽  
Diagnostic Time ◽  
Lower Expression

To better understand the genesis of autoimmunity in Graves’ disease (GD), it is essential to study the mechanism of apoptosis and cell proliferation in thyroid cells and intrathyroidal lymphocytic infiltrate of GD patients. Methods. A cross sectional, observational study performed by evaluating histopathological samples of thyroidectomy products from GD patients using immunohistochemistry. New histological sections were prepared for immunohistochemical analysis with markers of cell proliferation, antiproliferation, apoptosis, and antiapoptosis. Results. Patients with GD who underwent radioiodine therapy (RIT) had a lower lymphocytic expression level of p27Kip1, and those who took beta-blockers had higher expression levels of BID (BH3-interacting domain) and a lower Ki-67 expression level in thyrocytes than those who did not. The association of a shorter diagnostic time with a lower expression level of MCL-1 in thyroid cells suggests that the hyperthyroid state was related to a lower antiapoptotic effect on thyrocytes. In comparison to patients with GD not using antithyroid drugs (ATD), we found a lower expression level of BID in lymphocytes for those who used ATD. Conclusion. In GD, the hyperthyroid state was associated with a lower antiapoptotic effect on thyroid cells. RIT, beta-blockers, and thionamide act by stimulating apoptosis of thyrocytes by intrathyroidal lymphocytes.

Thyroid hypoechogenic pattern at ultrasonography as a tool for predicting recurrence of hyperthyroidism after medical treatment in patients with Graves' disease

1992 ◽  
Vol 126 (2) ◽  
pp. 128-131 ◽  
Author(s):  
Paolo Vitti ◽  
Teresa Rago ◽  
Francesco Mancusi ◽  
Stefania Pallini ◽  
Massimo Tonacchera ◽  
...  
Keyword(s):  
Antithyroid Drugs ◽  
Graves Disease ◽  
Study Group ◽  
Thyrotropin Receptor ◽  
Thyroid Ultrasonography ◽  
Normal Thyroid ◽  
End Of Treatment ◽  
The Relationship ◽  
Prediction Of Relapse

An abnormal thyroid echographic pattern characterized by a diffuse low echogenicity has been described in Hashimoto's thyroiditis and Graves' disease. The aim of the present work was to study the relationship between thyroid hypoechogenicity and the outcome of treatment for hyperthyroidism with antithyroid drugs in patients with Graves' disease. The study group included 105 patients who underwent a course of methimazole treatment. Thyroid ultrasonography was carried out at diagnosis, and autoantibodies to thyrotropin receptor (TR-ab) were measured at the end of treatment. During the follow-up after methimazole treatment, 87/105 (83%) patients had relapse of hyperthyroidism and 18/105 (17%) were in remission. Recurrence of hyperthyroidism occurred in 71/76 (93%) patients with thyroid hypoechogenicity and in 16/29 (55%) of those with normal thyroid echogenicity (ϰ2= 19.0; p<0.0001). Positive TR-ab values at the end of methimazole treatment were found in 59/76 (78%) patients with thyroid hypoechogenicity and in 12/29 (41%) patients with normal thyroid echogenicity (ϰ2 = 10.9; p< 0.0001). Sixty-five/87 (74%) patients with relapse of hyperthyroidism and 6/18(3 3%) of those who remained euthyroid were TR-ab-positive at the end of methimazole treatment (ϰ2 = 9.8; p< 0.002). The finding of thyroid hypoechogenicity at diagnosis had higher specificity (0.81) and sensitivity (0.72) with respect to TR-ab positivity at the end of methimazole treatment (0.74 and 0.66 respectively) for the prediction of relapse of hyperthyroidism. Therefore, the evaluation of thyroid echographic pattern can be considered a useful prognostic tool in patients with Graves' disease.

scholarly journals The review of the relationship between UCP2 and obesity: Focusing on inflammatory-obesity

2021 ◽  
Vol 5 (1) ◽  
pp. 001-013
Author(s):  
Moradi Sara ◽  
Khaje-Bishak Yaser ◽  
Alipour Maedeh ◽  
Alivand Mohamadreza ◽  
Alipour Beitullah
Keyword(s):  
Oxidative Stress ◽  
Adipose Tissue ◽  
Weight Management ◽  
Inflammatory Process ◽  
Reciprocal Relationship ◽  
The Other ◽  
Ros Production ◽  
Inflammatory Status ◽  
The Relationship ◽  
And Oxidative Stress

Obesity is rising worldwide, and the inflammatory disease increased in parallel. Many studies demonstrate excess fat mass is an indicator of obesity. As much as lipid increased in the cell, ROS production increased. On the other hand, ROS could enhance lipid storage and increased adiposity. So obesity and inflammation have a reciprocal relationship. Uncoupling protein2 (UCP2) could control the metabolism of energy, adipose tissue, and weight management. Also, UCP2 decreased ROS, oxidative stress, and inflammation. Therefore, as metabolism-related to oxidative stress and inflammatory status, and by considering the modulatory contribution of UCP2 in inflammation; it seems UCP2 could link obesity and inflammation. This study aims to review the studies about the association between UCP2 and obesity focusing on the inflammatory process linked to ROS. In conclusion, as the results contradict the association between UCP2 as the center of metabolism and obesity, obesity-related hormones, and oxidative stress, further studies in human trials are recommended.

Psychoanalysis, Science and Clinical Practice

1992 ◽  
Vol 26 (1) ◽  
pp. 98-106 ◽  
Author(s):  
Robert King
Keyword(s):  
Clinical Practice ◽  
The Other ◽  
Central Question ◽  
The Relationship ◽  
Epistemological Basis

The question of the relationship between psychoanalysis and science, and the place of psychoanalysis in clinical practice is reviewed. A commonly held view that the central question is whether or not psychoanalysis is scientific is challenged. It is argued instead that psychoanalysis, science and clinical practice are epistemologically independent fields and attempts to subsume one within the other are unproductive. Psychoanalysis may have as much to say concerning the epistemological basis of science as science has to say concerning the epistemological basis of psychoanalysis. Only a proper appreciation of this enables the question of the relationship between psychoanalysis and clinical practice to be adequately examined.

Multiple Intracranial Arterial Stenoses around the Circle of Willis in Association with Graves' Disease: Report of Two Cases

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1210-1215 ◽  
Author(s):  
Kazuhiro Nakamura ◽  
Kiyoyuki Yanaka ◽  
Satoshi Ihara ◽  
Tadao Nose
Keyword(s):  
Clinical Presentation ◽  
Daily Life ◽  
Circle Of Willis ◽  
The Other ◽  
Graves Disease ◽  
Collateral Vessels ◽  
Arterial Stenoses ◽  
Revascularization Procedures ◽  
The Relationship ◽  
Angiographic Findings

Abstract OBJECTIVE AND IMPORTANCE The association of Graves' disease with multiple intracranial arterial stenoses is rare. CLINICAL PRESENTATION We report on two Japanese women who experienced the concurrence of Graves' disease and cerebral ischemia attributable to multiple intracranial arterial stenoses around the circle of Willis. Clinically, these patients demonstrated hyperthyroidism, goiter, ophthalmopathy, and ensuing ischemic strokes. Cerebral angiography demonstrated multiple intracranial arterial stenoses around the circle of Willis in both cases. These cases did not meet the full diagnostic criteria for moyamoya disease, in that there were no abnormal, net-like, collateral vessels, but the other clinical and angiographic findings were consistent with this condition. INTERVENTION After normalization of their hormonal conditions, the patients underwent cerebral revascularization procedures. Both patients achieved excellent recoveries and returned to normal daily life after treatment. CONCLUSION Multiple intracranial arterial stenoses and Graves' disease may occur simultaneously. Such cases may offer new insights into the pathogenesis of these two conditions. It is important to study more patients with this dual condition, to obtain more evidence of the relationship between genetic and immunogenic backgrounds.

scholarly journals Serum Thyroglobulin—Its Measurement and Clinical Use

1989 ◽  
Vol 26 (5) ◽  
pp. 401-406 ◽  
Author(s):  
R Wilson ◽  
J H McKillop ◽  
C Jenkins ◽  
G H Beastall ◽  
J A Thomson
Keyword(s):  
Prognostic Value ◽  
The Other ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Clinical Use ◽  
Serum Thyroglobulin ◽  
Antithyroglobulin Antibodies

Radioimmunoassays (RIA) have been shown to be unreliable in measuring serum thyroglobulin levels in patients with antithyroglobulin antibodies. The aim of this study was twofold. Firstly to compare the abilities of two immunoradiometric assays (IRMA), one commercially available, the other an ‘in house’ assay, with a conventional RIA. In addition the prognostic value of serum thyroglobulin levels in patients likely to relapse following a course of antithyroid drugs for Graves' disease was examined. The results obtained showed both of the IRMA methods to be unaffected by the presence of antithyroglobulin antibodies. Serum thyroglobulin levels were found to be poor predictors of relapse or remission following a 12 month course of antithyroid drugs.

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