Surgery for Grave’s Disease

Nodular Goitre ◽

Continue Medical ◽

Definitive Therapy ◽

Iodine 123 ◽

Thyroid Receptor ◽

Antibody Levels ◽

Toxic Nodular Goitre ◽

Radioactive Iodine Ablation

Graves’ disease (GD) is the commonest cause of hyperthyroidism followed by toxic nodular goitre. Patients presenting as goitre with clinical features of hyperthyroidism are to be carefully evaluated with biochemically with thyroid stimulating hormone (TSH), free thyroxine (fT4) and radionuclide scan (Technitium-99/Iodine-123). Those with GD also have raised thyroid receptor stimulating antibody levels. Patients are simultaneously evaluated for eye disease and managed accordingly. Initial treatment is rendering patient euthyroid using anti thyroid drugs (ATD) and if remission does not occur either continue medical therapy or proceed for definitive therapy by radioactive iodine ablation (RAI) or surgery. In last decades there is ample literature preferring surgery as preferred definitive therapy. Surgery in thyroid disease has become safer with development of many intra-operative adjuncts but it should be performed by high volume thyroid surgeon. The procedure of choice is near total or total thyroidectomy as it avoids recurrences. Patients who are not eligible or willing for surgery can be managed with RAI.

Somatic mutations of the thyroid-stimulating hormone receptor gene in feline hyperthyroidism: parallels with human hyperthyroidism

Journal of Endocrinology ◽

10.1677/joe.1.06277 ◽

2005 ◽

Vol 186 (3) ◽

pp. 523-537 ◽

Cited By ~ 17

Author(s):

S G Watson ◽

A D Radford ◽

A Kipar ◽

P Ibarrola ◽

L Blackwood

Keyword(s):

Hormone Receptor ◽

Genetic Basis ◽

Somatic Mutations ◽

Receptor Gene ◽

Nodular Goitre ◽

Tshr Gene ◽

Toxic Nodular Goitre ◽

Exon 10 ◽

Hyperthyroidism is the most common endocrinopathy in cats, and is both clinically and histopathologically very similar to human toxic nodular goitre (TNG). Molecular studies on human TNG have revealed the presence of mis-sense mutations in the thyroid-stimulating hormone receptor (TSHR) gene, most frequently in exon 10. Our hypothesis was that similar mutations exist in hyperthyroid cats. Genomic DNA was extracted from 134 hyperplastic/ adenomatous nodules (from 50 hyperthyroid cats), and analysed for the presence of mutations in exon 10 of the TSHR gene. 11 different mutations were detected, one silent and 10 mis-sense, of which nine were somatic mutations. 28 of the 50 cats (67/134 nodules) had at least one mis-sense mutation. The mis-sense mutations were Met-452→Thr in 17 cats (35 nodules), Ser-504→Arg (two different mutational forms) in two cats (two nodules), Val-508→Arg in one cat (three nodules), Arg-530→Gln in one cat (two nodules), Val-557→Leu in 13 cats (36 nodules), Thr-631→Ala or Thr-631→Phe (each mutation seen in one nodule of one cat), Asp-632→Tyr in six cats (10 nodules) and Asp-632→His in one cat (one nodule). Five of these mutations have been associated previously with human hyperthyroidism. Of the 41 cats for which more than one nodule was available, 14 had nodules with different mutations. The identification of a potential genetic basis for feline hyperthyroidism is novel, increases our understanding of the pathogenesis of this significant feline disease, and confirms its similarity to TNG.

The influence of single dose recombinant human thyroid-stimulating hormone on the efficacy of radioiodine therapy in patients with non toxic nodular goitre with low RAIU

Endocrine Abstracts ◽

10.1530/endoabs.32.p981 ◽

2013 ◽

Author(s):

Saeid Abdelrazek ◽

Janusz Mysliwiec ◽

Piotr Szumowski ◽

Malgorzata Mojsak ◽

katarzyna Siewko ◽

...

Keyword(s):

Single Dose ◽

Radioiodine Therapy ◽

Human Thyroid ◽

Nodular Goitre ◽

Toxic Nodular Goitre ◽

The efficacy of radioiodine therapy in patients with non-toxic nodular goitre with large cold nodule

Endocrine Abstracts ◽

10.1530/endoabs.37.ep931 ◽

2015 ◽

Author(s):

Saeid Abdelrazek ◽

Piotr Szumowski ◽

Katrzyna Siewko ◽

Janusz Mysliwiec ◽

Malgorzata Szelachowska ◽

...

Keyword(s):

Radioiodine Therapy ◽

Nodular Goitre ◽

Toxic Nodular Goitre ◽

Cold Nodule

Serum thyroid-stimulating hormone receptor antibody levels and thyroid dysfunction after hysterosalpingography: a case-control study

Gynecological Endocrinology ◽

10.1080/09513590.2021.1963430 ◽

2021 ◽

pp. 1-4

Author(s):

Shuhei So ◽

Koshi Hashimoto ◽

Masatomo Mori ◽

Shigeki Endo ◽

Wakasa Yamaguchi ◽

...

Keyword(s):

Hormone Receptor ◽

Thyroid Dysfunction ◽

Case Control Study ◽

Case Control ◽

Receptor Antibody ◽

Antibody Levels ◽

Control Study ◽

Enzyme-linked immunosorbent assay of autoantibodies reacting with thyroid plasma membrane antigens in sera of patients with autoimmune thyroid diseases

Acta Endocrinologica ◽

10.1530/acta.0.1130255 ◽

1986 ◽

Vol 113 (2) ◽

pp. 255-260 ◽

Cited By ~ 7

Author(s):

Andrzej Gardas ◽

Kathleen L. Rives

Keyword(s):

Plasma Membrane ◽

Immunosorbent Assay ◽

Lupus Erythematosus ◽

Antithyroid Drug ◽

Cross Reactivity ◽

Enzyme Linked Immunosorbent Assay ◽

Autoimmune Thyroid Diseases ◽

Nodular Goitre ◽

Membrane Antigens ◽

Toxic Nodular Goitre

Abstract. A sensitive and specific enzyme-linked immunosorbent assay (ELISA) for the detection of autoantibodies reacting with thyroid plasma membrane antigens has been established. Autoantibodies reacting with thyroid plasma membrane antigens were detected by the ELISA in 95% of untreated hyperthyroid Graves', 68% of antithyroid drug-treated Graves' up to four months of the therapy, in 62% of Hashimoto's thyroiditis and in 8.9% of toxic nodular goitre. The ELISA was negative in 100% healthy blood donors, 100% non-toxic nodular goitre, in 12 patients with rheumatoid arthritis, 18 patients with scleroderma and 94% of patients with systemic lupus erythematosus. The mean value of autoantibodies titre was higher in untreated hyperthyroid Graves' (1:84 000) and lowest in positive patients with autoimmune disease of non-thyroid origin (1:4000). The cross-reactivity of antimicrosomal antigen antibodies was below 10%; there was no influence of antithyroglobulin antibodies on the ELISA; and most of the autoantibodies react with plasma membrane antigens different from the TSH binding sites.

Development of hypothyroidism during long-term follow-up of patients with toxic nodular goitre after radioiodine therapy

Clinical Endocrinology ◽

10.1111/j.1365-2265.2011.04204.x ◽

2012 ◽

Vol 76 (2) ◽

pp. 297-303 ◽

Cited By ~ 8

Author(s):

Deniz Kahraman ◽

Christian Keller ◽

Christina Schneider ◽

Wolfgang Eschner ◽

Ferdinand Sudbrock ◽

...

Keyword(s):

Radioiodine Therapy ◽

Nodular Goitre ◽

Long Term Follow Up ◽

Toxic Nodular Goitre

Early Cardiac Changes in Radioiodine Treated Young Athyrotic Patients Receiving Thyroid Stimulating Hormone (TSH) Suppressive Levothyroxine (LT4) Replacement

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v18i1.34925 ◽

2017 ◽

Vol 18 (1) ◽

pp. 9-15

Author(s):

Fatima Begum ◽

Chaudhury Meshkat Ahmed ◽

Enamul Kabir ◽

Nurun Nahar ◽

Sadia Sultana ◽

...

Keyword(s):

Healthy Volunteers ◽

Tissue Doppler ◽

Differentiated Thyroid Carcinoma ◽

Doppler Imaging ◽

Tei Index ◽

Ablation Therapy ◽

Short Period ◽

Radioactive Iodine Ablation ◽

Objective: The objective of this study was to evaluate early changes of heart due to thyroid stimulating hormone (TSH) suppressive levothyroxine (LT4) replacement in young athyrotic patients with differentiated thyroid carcinoma (DTC). Materials andMethods: Thirty young athyrotic patients with DTC, age ranged 20-39 years after radioactive iodine ablation therapy (RAIT), were selected prospectively. These patients had been receiving 200µg/day LT4 replacement therapy starting from the third day of RAIT. Age, sex, body mass index (BMI), body surface area (BSA) and life style matched 23 healthy volunteers were recruited in the study. Clinical, thyroid hormones levels and Doppler Echocardiographic and Tissue Doppler Imaging (TDI) data were taken at baseline at two months of initiation of LT4 replacement in patients with DTC and in healthy volunteers. Echocardiographic data of patients with DTC were repeated at second visit after 6-12 months of RAIT and both data compared with control.Results: Diastolic parameters evaluated by Doppler Echocardiography and TDI were significantly different in patients with DTC compared to control. Early diastolic tissue velocity (Em) in patients with DTC showed higher value at second visit compared to control (Em, control subjects, 19±6 cm /sec, patients at second visit, 23 ± 4 cm /sec, p<0.03). Late diastolic flow (Am) of patients was higher at two visits (Am, at first visit, 15±5 cm/sec; at second visit, 19 ± 6 cm/sec) (p<0.004) compared to control (Am, 9 ± 1.6 cm/sec). Modified Tei index was significantly increased (mean 0.48 ± 0.06) in second visit in patients with DTC compared to control (mean 0.33 ± 0.04) and at first visit (mean 0.31 ± 0.05, p<0.001) respectively.Conclusion: It is concluded that supraphysiologic dose of LT4 has side effects on heart even within short period of replacement. TDI is an important tool to evaluate the early changes in myocardium.Bangladesh J. Nuclear Med. 18(1): 9-15, January 2015

Outcomes analysis of radioactive iodine and total thyroidectomy for pediatric Graves’ disease

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2015-0333 ◽

2016 ◽

Vol 29 (3) ◽

Cited By ~ 10

Author(s):

Reuven Zev Cohen ◽

Eric I. Felner ◽

Kurt F. Heiss ◽

J. Bradley Wyly ◽

Andrew B. Muir

Keyword(s):

Children And Adolescents ◽

Total Thyroidectomy ◽

Relapse Rate ◽

Radioactive Iodine ◽

High Volume ◽

Graves Disease ◽

Complication Rates ◽

Case Volume ◽

Definitive Therapy

AbstractThe majority of pediatric patients with Graves’ disease will ultimately require definitive therapy in the form of radioactive iodine (RAI) ablation or thyroidectomy. There are few studies that directly compare the efficacy and complication rates between RAI and thyroidectomy. We compared the relapse rate as well as the acute and long-term complications of RAI and total thyroidectomy among children and adolescents with Graves’ disease treated at our center.Medical records from 81 children and adolescents with a diagnosis of Graves’ disease who received definitive therapy over a 12-year period were reviewed.Fifty one patients received RAI and 30 patients underwent thyroidectomy. The relapse rate was not significantly different between RAI and thyroidectomy (12.1% vs. 0.0%, p=0.28). There were no acute or long-term complications in the RAI group, but there were eight cases of hypoparathyroidism (two transient and six permanent) in the thyroidectomy group. None of the patients developed a recurrent laryngeal nerve injury.RAI is a safe and effective option for treatment of children and adolescents with Graves’ disease. In light of the rate of permanent hypoparathyroidism seen at our center with thyroidectomy and previously published long-term safety of RAI, we recommend RAI as the first line treatment for children and adolescents with Graves’ disease. For those centers performing thyroidectomies, we recommend that each center select 1–2 high-volume pediatric surgeons to perform all thyroid procedures, allowing individuals to increases case volume and potentially decrease long-term complications of thyroidectomy.