scholarly journals Graves’ Disease

2021 ◽  
Author(s):  
Sanjay Saran
Keyword(s):  
Older Patients ◽  
Autoimmune Disorder ◽  
Organ System ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Younger Patients ◽  
Skin Symptoms ◽  
Diffuse Goiter ◽  
Pretibial Myxedema ◽  
Symptoms And Signs

Graves’ disease (GD) is an autoimmune disorder characterized by presence of TSH receptor autoantibody. It is most common cause of hyperthyroidism worldwide. Though GD can occur any age but peak incidence is seen during adulthood in between 20 to 50 years of age. GD is more commonly seen in female. GD is primarily disease of thyroid gland but affects multi organ system i.e. heart, liver, muscle, eye and skin. Symptoms and signs are result from hyperthyroidism or a consequence of underlying autoimmunity. Weight loss, fatigue, heat intolerance, tremor, and palpitations are the most common symptoms. Diffuse goiter presents in most of younger patients with thyrotoxicosis but less common in older patients. Graves’ ophthalmopathy and pretibial myxedema are extrathyroidal manifestations of GD which results from action of TSHR autoantibodies on TSHR present onfibroblast, adipocyte and T cells in extrathyroidal tissue. Treatment of GD remains in between antithyroid drugs, radioiodine or surgery. In this review we discuss the diagnosis and management of GD.

Presentation of stroke in the older person

2020 ◽  
pp. 25-32
Author(s):  
Jagdish Sharma
Keyword(s):  
Older People ◽  
Ischaemic Stroke ◽  
Older Patients ◽  
Clinical Presentation ◽  
Cerebral Haemorrhage ◽  
Older Person ◽  
Younger Patients ◽  
Age Related ◽  
Atypical Presentations ◽  
Symptoms And Signs

‘Presentation of stroke in the older person’ outlines the varied patterns of clinical presentation of stroke in the older person, looking at common and the less common syndromes. Symptoms and signs in older people can be very subtle, often difficult to diagnose, and challenge even the most astute of clinicians. Most stroke presentations in older patients are similar to those in younger patients with respect to Oxford Community Stroke Project classification. However, atypical presentations can lead to diagnostic challenges in older patients due to the interaction between age-related cerebral and circulatory changes and comorbidities. The presentation of ischaemic stroke with its different vascular patterns, is discussed. Cerebral haemorrhage is explored in the context of its presentation patterns.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

2017 ◽  
Vol 177 (2) ◽  
pp. R59-R67 ◽  
Author(s):  
Juliane Léger ◽  
Jean-Claude Carel
Keyword(s):  
Medical Treatment ◽  
Autoimmune Disorder ◽  
High Volume ◽  
Medical Intervention ◽  
Prolonged Treatment ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Extensive Experience ◽  
Major Disadvantage ◽  
Pituitary Thyroid Axis

Graves’ disease is an autoimmune disorder. It is the leading cause of hyperthyroidism, but is rare in children. Patients are initially managed with antithyroid drugs (ATDs), such as methimazole/carbimazole. A major disadvantage of treatment with ATD is the high risk of relapse, exceeding 70% of children treated for duration of 2 years, and the potential major side effects of the drug reported in exceptional cases. The major advantage of ATD treatment is that normal homeostasis of the hypothalamus–pituitary–thyroid axis may be restored, with periods of drug treatment followed by freedom from medical intervention achieved in approximately 40–50% of cases after prolonged treatment with ATD, for several years, in recent studies. Alternative ablative treatments such as radioactive iodine and, less frequently and mostly in cases of very high volume goiters or in children under the age of 5 years, thyroidectomy, performed by pediatric surgeons with extensive experience should be proposed in cases of non-compliance, intolerance to medical treatment or relapse after prolonged medical treatment. Ablative treatments are effective against hyperthyroidism, but they require the subsequent administration of levothyroxine throughout the patient’s life. This review considers data relating to the prognosis for Graves’ disease remission in children and explores the limitations of study designs and results; and the emerging proposal for management through the prolonged use of ATD drugs.

scholarly journals Management of Graves' hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy

2009 ◽  
Vol 160 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Peter Laurberg ◽  
Claire Bournaud ◽  
Jesper Karmisholt ◽  
Jacques Orgiazzi
Keyword(s):  
Drug Therapy ◽  
Thyroid Function ◽  
Antithyroid Drug ◽  
Autoimmune Disorder ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Limited Effect ◽  
Antithyroid Drug Therapy ◽  
Maternal Thyroid ◽  
In Pregnancy

Graves' disease is a common autoimmune disorder in women in fertile ages. The hyperthyroidism is causedby generation of TSH-receptor activating antibodies. In pregnancy both the antibodies and the antithyroid medication given to the mother pass the placenta and affect the foetal thyroid gland. Thyroid function should be controlled not only in the mother with Graves' hyperthyroidism but also in her foetus.The review includes two cases illustrating some of the problems in managing Graves' disease in pregnancy.Major threats to optimal foetal thyroid function are inadequate or over aggressive antithyroid drug therapy of the mother. It should be taken into account that antithyroid drugs tend to block the foetal thyroid function more effectively than the maternal thyroid function, and that levothyroxin (l-T4) given to the mother will have only a limited effect in the foetus.Surgical thyroidectomy of patients with Graves' hyperthyroidism does not lead to immediate remission of the autoimmune abnormality, and the combination thyroidectomy+withdrawal of antithyroid medication+l-T4 replacement of the mother involves a high risk of foetal hyperthyroidism.ConclusionAntithyroid drug therapy of pregnant women with Graves' hyperthyroidism should be balanced to control both maternal and foetal thyroid function. Surgical thyroidectomy of a pregnant woman with active disease may lead to isolated foetal hyperthyroidism.

scholarly journals Propylthiouracil-induced agranulocytosis as a rare complication of antithyroid drugs in a patient with Graves’ disease

2019 ◽  
Vol 65 (6) ◽  
pp. 755-760 ◽  
Author(s):  
Patrícia Novais Rabelo ◽  
Paula Novais Rabelo ◽  
Allyne Fernanda de Paula ◽  
Samuel Amanso da Conceição ◽  
Daniela Pultrini Pereira de Oliveira Viggiano ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Beta Blockers ◽  
Rare Complication ◽  
Young Male ◽  
Autoimmune Disorder ◽  
Lithium Carbonate ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Lugol Solution ◽  
Therapeutic Alternatives

SUMMARY INTRODUCTION: Graves’ disease (GD) is an autoimmune disorder characterized by hyperthyroidism. Antithyroid drugs (ATDs) are available as therapy. Agranulocytosis is a rare but potentially fatal complication of this therapy. In this study, we report agranulocytosis induced by propylthiouracil (PTU) in a patient with GD and the difficulties of clinical management. CASE: RNBA, male, 30 years old, with GD, treated with propylthiouracil (PTU). He progressed with pharyngotonsillitis. Then, PTU was suspended and antibiotic, filgrastim, propranolol, and prednisone were initiated. Due to the decompensation of hyperthyroidism, lithium carbonate, dexamethasone, and Lugol's solution were introduced. Total thyroidectomy (TT) was performed with satisfactory postoperative progression. DISCUSSION: We describe here the case of a young male patient with GD. For the treatment of hyperthyroidism, thioamides are effective options. Agranulocytosis induced by ATDs is a rare complication defined as the occurrence of a granulocyte count <500/mm3 after the use of ATDs. PTU was suspended, and filgrastim and antibiotics were prescribed. Radioiodine (RAI) or surgery are therapeutic alternatives. Due to problems with ATD use, a total thyroidectomy was proposed. The preoperative preparation was performed with beta-blocker, glucocorticoid, lithium carbonate, and Lugol solution. Cholestyramine is also an option for controlling hyperthyroidism. TT was performed without postoperative complications. CONCLUSION: Thionamide-induced agranulocytosis is a rare complication. With a contraindication to ATDs, RAI and surgery are definitive therapeutic options in GD. Beta-blockers, glucocorticoids, lithium carbonate, iodine, and cholestyramine may be an adjunctive therapy for hyperthyroidism.

scholarly journals Acute Drug-Induced Cholestatic Syndrome in Basedow Graves’ Disease

2020 ◽  
Vol 5 (2) ◽  
pp. 81-85 ◽  
Author(s):  
Robert Aurelian Tiucă ◽  
Alina Mioara Boeriu ◽  
Rareș Adrian Georgescu ◽  
Ionela Maria Pașcanu
Keyword(s):  
Liver Damage ◽  
Therapeutic Option ◽  
Autoimmune Disorder ◽  
Thyroid Stimulating Hormone ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Drug Induced ◽  
Immune Mediated ◽  
Viral Hepatitis A ◽  
Cholestatic Syndrome

AbstractIntroduction: Graves’ disease (GD), an autoimmune disorder caused by high levels of auto-antibodies against the thyroid-stimulating hormone receptor, is considered the most common cause of thyrotoxicosis, characterized by features such as goiter, ophthalmopathy and dermopathy. In our country, the administration of antithyroid drugs (ATD) is the first line of treatment in this disease. Side effects are rare but some of them, such as agranulocytosis or liver damage, may become serious.Case presentation: We report the case of a 20-year-old female patient who was diagnosed with GD after being previously diagnosed with viral hepatitis A. Treatment was initiated with methimazole 30 mg/day, and three weeks later she developed intense hepatic cytolysis and cholestatic syndrome, therefore the ATD was stopped. A suspicion of autoimmune liver disease was raised, and a liver biopsy was performed in order to establish the diagnosis. The next therapeutic option for hyperthyroidism was radioactive iodine (RAI). Three months following RAI, the patient presented severe hypothyroidism, thereupon treatment with levothyroxine was initiated.Conclusions: Although severe acute liver injury is rare, mild liver dysfunction is quite common in patients with GD. The overproduction of thyroid hormones, or the treatment with ATD through immune mediated processes or drug reactions, represent possible mechanisms responsible for liver damage.

Guideline for radioiodine therapy for benign thyroid diseases (version 3)

2004 ◽  
Vol 43 (06) ◽  
pp. 217-220 ◽  
Author(s):  
J. Dressler ◽  
F. Grünwald ◽  
B. Leisner ◽  
E. Moser ◽  
Chr. Reiners ◽  
...  
Keyword(s):  
Radioiodine Therapy ◽  
Thyroid Volume ◽  
Thyroid Diseases ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Co Morbidity ◽  
History Of ◽  
Individual Decisions ◽  
Prophylactic Use ◽  
Benign Thyroid

SummaryThe version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves’ disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves’ disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient’s preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients’ preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3rd version.

Impact of the serum thyroglobulin concentration on the diagnostics of benign and malignant thyroid diseases

2000 ◽  
Vol 39 (05) ◽  
pp. 133-138 ◽  
Author(s):  
W. Dembowski ◽  
H.-J. Schroth ◽  
K. Klinger ◽  
Th. Rink
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Thyroid Volume ◽  
Nodular Goiter ◽  
Thyroid Diseases ◽  
Hashimoto's Thyroiditis ◽  
Graves Disease ◽  
Normal Range ◽  
Serum Thyroglobulin ◽  
Diffuse Goiter ◽  
Hyperthyroid Patients

Summary Aim of this study is to evaluate new and controversially discussed indications for determining the thyroglobulin (Tg) level in different thyroid diseases to support routine diagnostics. Methods: The following groups were included: 250 healthy subjects without goiter, 50 persons with diffuse goiter, 161 patients with multinodular goiter devoid of functional disorder (108 of them underwent surgery, in 17 cases carcinomas were detected), 60 hyperthyroid patients with autonomously functioning nodular goiter, 150 patients with Hashimoto’s thyroiditis and 30 hyperthyroid patients with Graves’ disease. Results: The upper limit of the normal range of the Tg level was calculated as 30 ng Tg/ml. The evaluation of the collective with diffuse goiter showed that the figure of the Tg level can be expected in a similar magnitude as the thyroid volume in milliliters. Nodular tissue led to far higher Tg values then presumed when considering the respective thyroid volume, with a rather high variance. A formula for a rough prediction of the Tg levels in nodular goiters is described. In ten out of 17 cases with thyroid carcinoma, the Tg was lower than estimated with thyroid and nodular volumes, but two patients showed a Tg exceeding 1000 ng/ml. The collective with functional autonomy had a significantly higher average Tg level than a matched euthyroid group being under suppressive levothyroxine substitution. However, due to the high variance of the Tg values, the autonomy could not consistently be predicted with the Tg level in individual cases. The patients with Hashimoto’s thyroiditis showed slightly decreased Tg levels. In Graves’ disease, a significantly higher average Tg level was observed compared with a matched group with diffuse goiter, but 47% of all Tg values were still in the normal range (< 30 ng/ml). Conclusion: Elevated Tg levels indicate a high probability of thyroid diseases, such as malignancy, autonomy or Graves’ disease. However, as low Tg concentrations cannot exclude the respective disorder, a routine Tg determination seems not to be justified in benign thyroid diseases.

Pretibial myxedema in Graves' disease: about two cases

2019 ◽  
Author(s):  
Yousra Aouinati ◽  
Aziz Siham El ◽  
Amal Mjaber ◽  
Asmaa Chadli
Keyword(s):  
Graves Disease ◽  
Pretibial Myxedema
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