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Baek HS, Kim J, Jeong C, Lee J, Ha J, Jo K, Kim MH, Sohn TS, Lee IS, Lee JM, Lim DJ. Deep Learning Analysis with Gray Scale and Doppler Ultrasonography Images to Differentiate Graves' Disease. J Clin Endocrinol Metab 2024:dgae254. [PMID: 38609169 DOI: 10.1210/clinem/dgae254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/20/2024] [Accepted: 04/10/2024] [Indexed: 04/14/2024]
Abstract
CONTEXT Thyrotoxicosis requires accurate and expeditious differentiation between Graves' disease (GD) and thyroiditis to ensure effective treatment decisions. OBJECTIVE This study aimed to develop a machine learning algorithm using ultrasonography and Doppler images to differentiate thyrotoxicosis subtypes, with a focus on GD. METHODS This study included patients who initially presented with thyrotoxicosis and underwent thyroid ultrasonography at a single tertiary hospital. A total of 7,719 ultrasonography images from 351 patients with GD and 2,980 images from 136 patients with thyroiditis were used. Data augmentation techniques were applied to enhance the algorithm's performance. Two deep learning models, Xception and EfficientNetB0_2, were employed. Performance metrics such as accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score were calculated for both models. Image pre-processing, neural network model generation, and neural network training results verification were performed using DEEP:PHI® platform. RESULTS The Xception model achieved 84.94% accuracy, 89.26% sensitivity, 73.17% specificity, 90.06% PPV, 71.43% NPV, and an F1 score of 89.66 for the diagnosis of GD. The EfficientNetB0_2 model exhibited 85.31% accuracy, 90.28% sensitivity, 71.78% specificity, 89.71% PPV, 73.05% NPV, and an F1 score of 89.99. CONCLUSION Machine learning models based on ultrasound and Doppler images showed promising results with high accuracy and sensitivity in differentiating GD from thyroiditis.
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Affiliation(s)
- Han-Sang Baek
- 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jinyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chaiho Jeong
- 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwanhoon Jo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Seo Sohn
- 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ihn Suk Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Jong Min Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Aleksashina A, Rachina S, Kiyakbaev G, Hewathanthirige G, Cherdantseva Y. A Case of Acute Neurologic Deficit and Hypoglycemia in the Setting of Thyroid Storm and Diabetic Ketoacidosis: A New Clinical Scenario. Korean J Fam Med 2024; 45:51-55. [PMID: 38272451 PMCID: PMC10822729 DOI: 10.4082/kjfm.23.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 01/27/2024] Open
Abstract
The simultaneous development of diabetic ketoacidosis (DKA) and thyroid storm (TS) is a rare but potentially lifethreatening condition that requires immediate and targeted treatment. However, their combined diagnosis poses a serious challenge because of the similarities between their clinical manifestations. To date, only a few dozen cases have been described; most of which have been linked to the progression of thyrotoxicosis or uncontrolled hyperglycemia as contributing factors. We present the case of a 37-year-old woman with type 1 diabetes mellitus and Graves' disease who presented with both TS and DKA. She was initially admitted to the emergency department as a suspected case of stroke. Severe hypoglycemia significantly lowered her alertness to TS and probably provoked a sharp hyperthyroid decompensation, thereby leading to subsequent DKA development.
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Affiliation(s)
- Alena Aleksashina
- City Clinical Hospital Named after S.S. Yudin, Moscow, Russian Federation
| | - Svetlana Rachina
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Gayrat Kiyakbaev
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | - Yulia Cherdantseva
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Li P, Wang W, Yan M, Zhang X, Pan J, Gong L. Different doses of methimazole treatment of children and adolescents with graves' disease: a clinical study based on 161 cases of outpatients. BMC Endocr Disord 2023; 23:233. [PMID: 37872592 PMCID: PMC10591405 DOI: 10.1186/s12902-023-01484-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the association between the initial dose of MMI and the clinical course, as well as adverse effects on young people with GD. METHODS One hundred and sixty-one children and adolescents with newly diagnosed GD were enrolled for this study and categorized into four groups based on initial serum-free T3 and T4 levels and daily MMI doses: Group A (mild, 0.3-0.5 mg/kg/day, n = 78), Group B (moderate, 0.6-0.8 mg/kg/day, n = 37), Group C (severe, 0.6-0.8 mg/kg/day, n = 24), and Group D (severe, 0.8-1.0 mg/kg/day, n = 22). The thyroid function, blood cell analysis and liver function were examined before treatment and at 4, 8 and 12 weeks after treatment. Outcome of long-term follow-up were also observed. RESULTS After 12 weeks of treatment, 91.0% of the patients in group A and 90.9% of the patients in group D recovered to normalization of FT3, which was slightly higher than the other two groups; 70.8% of the patients in group C recovered to normalization of FT4, which was slightly lower than that in the other three groups. The incidence of minor adverse effects was 12.8% in group A, 13.5% in group B, 16.7% in group C and 40.9% in group D (P < 0.01). Remission was achieved in 38 patients (23.6%). CONCLUSIONS Lower doses of MMI (0.3-0.5 mg/kg/day) are suitable for mild GD, and higher doses of MMI (0.6-0.8 mg/kg/day) are advisable for moderate or severe GD. Much higher doses of MMI (0.8-1.0 mg/kg/day) are harmful for initial use in children and adolescents with GD patients.
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Affiliation(s)
- Peng Li
- Department of Laboratory Medicine, Shanxi Children's Hospital, Shanxi Maternal and Child Health Hospital, Taiyuan, China
| | - Wei Wang
- Department of Laboratory Medicine, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Meiqin Yan
- Department of Laboratory Medicine, Shanxi Children's Hospital, Shanxi Maternal and Child Health Hospital, Taiyuan, China
| | - Xianhui Zhang
- Department of Laboratory Medicine, Shanxi Children's Hospital, Shanxi Maternal and Child Health Hospital, Taiyuan, China
| | - Jie Pan
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, 94305, USA
| | - Lina Gong
- Department of Medical Risk Management, The Third Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
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Jansen HI, Gohy HG, Boelen A, Bisschop PH, Hillebrand JJ, Heijboer AC. Stability of TSH receptor antibody concentrations and comparability of its immunoassays. Clin Chim Acta 2023; 548:117505. [PMID: 37543354 DOI: 10.1016/j.cca.2023.117505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND AND AIMS Graves' Disease (GD) is an autoimmune form of hyperthyroidism where autoantibodies are directed against the TSH-receptor (TSH-receptor antibodies; TRAb). GD is suspected if TRAb concentrations are above a pre-specified cut-off value. TRAb concentrations are measured using immunoassays. This study aimed to compare the performance of the recently implemented Alinity immunoassay to the KRYPTOR and Cobas TRAb immunoassays. MATERIALS AND METHODS Left-over serum samples in which TRAb concentrations were measured (KRYPTOR) were used. First, TRAb stability at -20 °C for four to six years and up to five freeze-thaw cycles were assessed. Second, TRAb measurements (n = 436) were repeated using the Alinity and Cobas immunoassay and results (scored as positive/negative based on cut-off value) were compared. RESULTS TRAb results were stable over five years and up to five freeze-thaw cycles. When comparing immunoassays, 86.2% of the results were similar. Total discrepancy differed between the immunoassays (5.4% Cobas vs Alinity, 8.8% Alinity vs KRYPTOR, 13.3 % Cobas vs KRYPTOR). The KRYPTOR immunoassay showed more negative TRAb results than Cobas and Alinity. CONCLUSION The Alinity immunoassay showed comparable TRAb results, even though slightly more positive results compared to the KRYPTORand slightly more negative results compared to the Cobas immunoassay were seen.
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Affiliation(s)
- Heleen I Jansen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Laboratory Medicine, Endocrine Laboratory, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Laboratory Medicine, Endocrine Laboratory, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Gastroenterology, Endocrinology & Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Héloïse G Gohy
- Amsterdam UMC Location University of Amsterdam, Department of Laboratory Medicine, Endocrine Laboratory, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Anita Boelen
- Amsterdam UMC Location University of Amsterdam, Department of Laboratory Medicine, Endocrine Laboratory, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Gastroenterology, Endocrinology & Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Peter H Bisschop
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jacquelien J Hillebrand
- Amsterdam UMC Location University of Amsterdam, Department of Laboratory Medicine, Endocrine Laboratory, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Gastroenterology, Endocrinology & Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Annemieke C Heijboer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Laboratory Medicine, Endocrine Laboratory, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Laboratory Medicine, Endocrine Laboratory, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Gastroenterology, Endocrinology & Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Purnamasari D, Wildan A, Kurniawan J, Mulansari NA, Karim B, Danil Yulian E. Therapeutic Plasma Exchange as a Bridging Therapy for the Definitive Treatment of a Patient with Graves' Disease and Methimazole-Induced Liver Injury. Int J Endocrinol Metab 2023; 21:e136608. [PMID: 38028251 PMCID: PMC10676661 DOI: 10.5812/ijem-136608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Graves' disease (GD) is an autoimmune condition affecting the thyroid gland. The aim of treating GD is to control the symptoms of hyperthyroidism and achieve long-term remission. Antithyroid drugs (ATDs) are the medications of choice among newly-diagnosed GD patients as they are easy to be delivered and cause remission in more than 50% of patients. However, ATDs increase the risk of hepatotoxicity, especially among patients with liver abnormalities. Patients who cannot tolerate ATDs should receive definitive therapy such as radioactive iodine (RAI) or surgery. In order to minimize the risk of thyroid storm during these procedures, patients should be in euthyroid condition and receive bridging therapy. Therapeutic plasma exchange (TPE), which aims to remove thyroid hormones from plasma, is one of the modalities that can be considered as a bridging therapy during the perioperative period among GD patients who cannot tolerate ATD. Case Presentation A 35-year-old man with general weakness and thyrotoxicosis symptoms was admitted to the emergency room. Lid retraction, diffuse Goiter, and tremors were evident. Laboratory findings revealed TSH = 0.005 µIU/mL, FT4 = 7.77 ng/dL, TRAb = 9.90 IU/L, ALT = 123 U/L, total bilirubin = 23.94 µmol/L, and direct bilirubin = 10.26 µmol/L. Ultrasonographic examination showed the enlargement of the thyroid gland, and abdomen ultrasonographic evaluation showed mild hepatomegaly with mild fatty infiltration. The patient was diagnosed with GD, suspected thyroid storm, elevated liver transaminases, and fatty liver disease. The patient then received methimazole, propranolol, and glycyrrhizin. During observation, the patient developed drug-induced liver injury (DILI) evidenced by an increase in liver enzymes (ALT up to 1023 U/L) and the elevation of total bilirubin to 258.21 µmol/L, so methimazole was stopped. After discontinuing methimazole, liver injury improved. However, thyrotoxicosis symptoms returned, so the patient underwent a total thyroidectomy. In order to achieve a euthyroid status before surgery, five sessions of therapeutic plasma exchange were performed, which improved the signs and symptoms of hyperthyroidism and retained the thyroxine hormone within the normal range. Thyroidectomy was then performed successfully without serious complications (e.g., thyroid storm, etc.). Conclusions Therapeutic plasma exchange is a safe and effective bridging therapy for GD patients who require thyroidectomy but cannot tolerate ATDs.
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Affiliation(s)
- Dyah Purnamasari
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Ardy Wildan
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Juferdy Kurniawan
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Nadia Ayu Mulansari
- Division of Hematology Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Birry Karim
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Erwin Danil Yulian
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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Comarella AP, Vilagellin D, Bufalo NE, Euflauzino JF, de Souza Teixeira E, Miklos ABPP, Dos Santos RB, Romaldini JH, Ward LS. The polymorphic inheritance of DIO2 rs225014 may predict body weight variation after Graves' disease treatment. Arch Endocrinol Metab 2021; 64:787-795. [PMID: 33049131 PMCID: PMC10528618 DOI: 10.20945/2359-3997000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed to investigate the role of DIO2 polymorphisms rs225014 and rs12885300 in Graves' disease patients, mainly for controlling body weight following treatment. METHODS We genotyped 280 GD patients by the time of diagnosis and 297 healthy control individuals using a TaqMan SNP Genotyping technique. We followed up 141 patients for 18.94 ± 6.59 months after treatment. RESULTS There was no relationship between the investigated polymorphisms with susceptibility to GD and gain or loss of weight after GD treatment. However, the polymorphic inheritance (CC+CT genotype) of DIO2 rs225014 was associated with a lower body weight variation after GD treatment (4.26 ± 6.25 kg) when compared to wild type TT genotype (6.34 ± 7.26 kg; p = 0.0456 adjusted for the follow-up time). This data was confirmed by a multivariate analysis (p = 0.0138) along with a longer follow-up period (p = 0.0228), older age (p = 0.0306), treatment with radioiodine (p-value = 0.0080) and polymorphic inheritance of DIO2 rs12885300 (p = 0.0306). CONCLUSION We suggest that DIO2 rs225014 genotyping may have an auxiliary role in predicting the post-treatment weight behavior of GD patients.
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Affiliation(s)
- Ana Paula Comarella
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil,
| | - Danilo Vilagellin
- Endocrinologia e Metabolismo, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil
| | - Natassia Elena Bufalo
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Jessica Ferreira Euflauzino
- Endocrinologia e Metabolismo, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil
| | - Elisangela de Souza Teixeira
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | | | - Roberto Bernardo Dos Santos
- Endocrinologia e Metabolismo, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil
| | - João H Romaldini
- Endocrinologia e Metabolismo, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil
| | - Laura S Ward
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
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Gill JH, Nam TK, Jung HK, Jang KM, Choi HH, Park YS, Kwon JT. Acute cerebral infarction combined with a thyroid storm in a patient with both Moyamoya syndrome and Graves' disease. J Cerebrovasc Endovasc Neurosurg 2021; 24:160-165. [PMID: 34696552 PMCID: PMC9260458 DOI: 10.7461/jcen.2021.e2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Moyamoya syndrome (MMS) associated with hyperthyroidism, such as Graves' disease, is a rare condition that causes ischemic stroke with thyrotoxicity. A 43-year-old woman with symptoms of right hemiparesis was admitted. Brain magnetic resonance imaging revealed a small cerebral infarction in the left frontal lobe. Cerebral angiography revealed multi-vessel intracranial occlusive disease. Several days later, neurologic deterioration and aggravation of cerebral infarction developed due to a thyroid storm. A thyroid function test revealed the following: thyroid-stimulating hormone (TSH) <0.01 μunits/mL (reference range, 0.55-4.78 μunits/mL); triiodo-thyronine >8.0 ng/mL (reference range, 0.77-1.81 ng/mL); free thyroxine (T4) of 9.47 pmol/L (reference range, 11.4-22.6 pmol/L); and TSH receptor antibody of 37.10 U/L (reference range, 0-10 U/L). For thyroid storm management, we initiated treatment with methimazole, Gemstein's solution, and hydrocortisone. Finally, the thyroid disease was controlled, and neurologic deficits improved. We describe a case of acute cerebral infarction combined with a thyroid storm in a patient with Moyamoya syndrome and Graves' disease. Hyperthyroidism such as Graves' disease should be considered in the differential diagnosis for patho-etiologic mechanisms associated with MMS. A cerebrovascular disease with a thyroid storm can lead to severe mortality and morbidity. Prompt diagnosis and strict treatment are important.
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Affiliation(s)
- Jong Han Gill
- Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Taek Kyun Nam
- Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Hoon Kyo Jung
- Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Kyung Min Jang
- Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Hyun Ho Choi
- Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Yong Sook Park
- Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jeong Taik Kwon
- Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
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Küchlin S, Gruber M, Reich M, Joachimsen L, Metzger M, Beck J, Grauvogel J, Lagrèze WA. [Orbital decompression in Graves' orbitopathy-Experiences and results]. Ophthalmologe 2021; 118:345-55. [PMID: 32681301 DOI: 10.1007/s00347-020-01181-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hintergrund Die endokrine Orbitopathie ist die häufigste extrathyreoidale Manifestation des Morbus Basedow und tritt bei schätzungsweise 25–50 % der betroffenen Patienten auf. Krankheitsbedingt kommt es zu einer entzündlichen Schwellung der Orbitaweichteile. Die Behandlung erfolgt meist konservativ. Bei schweren Fällen mit beeinträchtigendem Exophthalmus oder akuter, steroidrefraktärer Visusbedrohung kann eine chirurgische Orbitadekompression die Beschwerden der Patienten lindern oder das Sehvermögen erhalten. Ein wesentlicher Aspekt der Versorgungsqualität besteht in der Vermeidung postoperativer Doppelbilder. Ziel der Arbeit Erfahrungs- und Ergebnisbericht von 100 chirurgischen Orbitadekompressionen bei 62 Patienten an einem interdisziplinären Orbitazentrum. Patienten mit Kompression der Orbitaspitze wurden mittels pterionaler Dekompression behandelt. Patienten ohne Hinweise auf Orbitaspitzenbeteiligung wurden mittels tiefer lateraler Wandresektion oder pterionaler Dekompression behandelt. Methodik Retrospektive Datenanalyse. Ergebnisse Die mittlere Exophthalmusreduktion betrug 2,9 mm. Augen mit visusbedrohendem Schweregrad gewannen im Mittel 2,2 Zeilen an Sehschärfe, der Visus bei rehabilitativer Indikation blieb stabil. Die Komplikationsrate betrug 4 %. Neue Doppelbilder wurden nach 2 Eingriffen beobachtet. Bei einem Patienten kam es zu einer Visusminderung von 0,8 auf 0,1. In 9 Fällen führte die Operation zu einem vollständigen Rückgang zuvor beklagter Doppelbilder. Diskussion Visusgewinn, Exophthalmusreduktion und Komplikationsrate sind in diesem Kollektiv vergleichbar mit zuvor publizierten Arbeiten. Diese Studie bestätigt die Rolle der Orbitadekompression bei visusbedrohender und schwer beeinträchtigender endokriner Orbitopathie.
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Bufalo NE, Dos Santos RB, Rocha AG, Teodoro L, Romaldini JH, Ward LS. Polymorphisms of the genes CTLA4, PTPN22, CD40, and PPARG and their roles in Graves' disease: susceptibility and clinical features. Endocrine 2021; 71:104-112. [PMID: 32419081 DOI: 10.1007/s12020-020-02337-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE CTLA4, PTPN22, and CD40 are immune-regulatory genes strongly associated with GD, as well as PPARG, but their clinical significance in different populations is still uncertain. METHODS We genotyped 282 Brazilian GD patients (234 women and 48 men, 39.80 ± 11.69 years old), including 144 patients with GO, and 308 healthy control individuals (246 women and 62 men, 36.86 ± 12.95 years old). RESULTS A multivariate analysis demonstrated that the inheritance of the GG genotype rs3087243 of CTLA4 (OR = 2.593; 95% CI = 1.630-4.123; p < 0.0001) and the CC genotype of rs3789607 of PTPN22 (OR = 2.668; 95% CI = 1.399-5.086; p = 0.0029) consisted in factors independent of the susceptibility to GD. The inheritance of polymorphic genotypes of rs5742909 of CTLA4 was associated with older age at the time of diagnosis (42.90 ± 10.83 versus 38.84 ± 11.81 years old; p = 0.0105), with higher TRAb levels (148.17 ± 188.90 U/L versus 112.14 ± 208.54 U/L; p = 0.0229) and the need for higher therapeutic doses of radioiodine (64.23 ± 17.16 versus 50.22 ± 16.86; p = 0.0237). The inheritance of the CC genotype of rs1883832 CD40 gene was more frequent among women (69.65%) than men (52.00%; p = 0.0186). The polymorphic genotype of PPARG gene (rs1801282) was associated with TPOAb positivity (p = 0.0391), and the GG genotype of rs2476601 of PTPN22 gene was associated with positivity for both TgAb (p = 0.0360) and TPOAb (p < 0.0001). Both polymorphic genotypes rs2476601 and rs3789607 of the PTPN22 gene were more frequent among nonsmoking patients (p = 0.0102 and p = 0.0124, respectively). CONCLUSIONS Our data confirm the important role of CTLA4 polymorphisms in GD susceptibility; demonstrate the role of PTPN22 polymorphisms in patients' clinical features; and suggest these genes may influence the severity of the disease.
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Affiliation(s)
- Natássia Elena Bufalo
- Laboratory of Cancer Molecular Genetics, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
| | - Roberto Bernardo Dos Santos
- Division of Endocrinology, Pontifical Catholic University of Campinas (PUCCAMP), Campinas, São Paulo, Brazil
| | - Angélica Gomes Rocha
- Laboratory of Cancer Molecular Genetics, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Larissa Teodoro
- Laboratory of Cancer Molecular Genetics, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - João Hamilton Romaldini
- Division of Endocrinology, Pontifical Catholic University of Campinas (PUCCAMP), Campinas, São Paulo, Brazil
- Endocrinology Service, São Paulo State Public Servant's Hospital, Institute of Medical Assistance of the State Public Servant (HSPE-IAMSPE), São Paulo, SP, Brazil
| | - Laura Sterian Ward
- Laboratory of Cancer Molecular Genetics, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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10
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Gu Y, Liang X, Liu M, Wu D, Li W, Cao B, Li Y, Su C, Chen J, Gong C. Clinical features and predictors of remission in children under the age of 7 years with Graves' disease. Pediatr Investig 2020; 4:198-203. [PMID: 33150314 PMCID: PMC7520111 DOI: 10.1002/ped4.12219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/11/2020] [Indexed: 11/09/2022] Open
Abstract
Importance Graves' disease (GD) is rare in children under the age of 7 years. Children with this disease exhibit greater thyrotoxicity at diagnosis and require a longer course of medical therapy, compared with pubertal and postpubertal children and adults. Objective To investigate the clinical features and identify predictors of remission in children under the age of 7 years with GD. Methods This retrospective study included 77 children who were diagnosed with GD under the age of 7 years and were treated in the Department of Endocrinology, Beijing Children's Hospital from 2010 to 2018. Clinical manifestations, laboratory data, and follow-up records were collected for all patients. Children who achieved remission of treatment with methimazole were compared with those who had persistent disease to identify which variables were associated with remission; multiple logistic regression and Cox regression analyses were used to evaluate interactions among predictive variables. Results Sixty-three boys and 14 girls were included; the median age at diagnosis was 4.2 years (interquartile range: 3.2-5.3 years). Forty-six (56.7%) patients had no family history of thyroid disease, 17 patients had family history of thyroid disease and 14 patients with unknown family history. Of the 77 patients, 18 (23.4%) patients achieved remission of treatment with methimazole and 59 patients did not; moreover, 51 (66.2%) had Graves' ophthalmopathy. Univariate analyses revealed no significant differences between the remission group and non-remission group in terms of age at diagnosis, sex, initial goiter size, or initial thyroid hormone concentration. However, there were a trend of correlation between the initial level of thyroid peroxidase antibody (TPOAb) and remission status (univariate analysis OR 1.002, P = 0.038; multivariate analysis OR 1.004, P = 0.019). Similar results were observed in univariate analysis of the initial thyrotropin receptor antibody (TRAb) level, but this association was not significant in multivariate analysis. Cox regression analyses revealed that children with high TRAb level required longer duration of remission, compared with low TRAb level (OR 0.950, 95% CI 0.904-0.997, P = 0.037). Interpretation Initial TRAb level was an independent predictor of remission outcome in young children under the age of 7 years with GD. Initial TRAb level may predict the likelihood of remission in patients with young-age-of-onset GD.
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Affiliation(s)
- Yi Gu
- Department of Endocrinology, Genetics and Metabolism Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Xuejun Liang
- Department of Endocrinology, Genetics and Metabolism Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Ming Liu
- Department of Endocrinology, Genetics and Metabolism Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Di Wu
- Department of Endocrinology, Genetics and Metabolism Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Wenjing Li
- Department of Endocrinology, Genetics and Metabolism Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Bingyan Cao
- Department of Endocrinology, Genetics and Metabolism Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Yuchuan Li
- Department of Endocrinology, Genetics and Metabolism Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Chang Su
- Department of Endocrinology, Genetics and Metabolism Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Jiajia Chen
- Department of Endocrinology, Genetics and Metabolism Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Chunxiu Gong
- Department of Endocrinology, Genetics and Metabolism Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
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Abdi H, Zakavi SR, Azizi F. A Clinical Debate: What Is the Therapeutic Choice for Recurrent Graves' Hyperthyroidism? Int J Endocrinol Metab 2020; 18:e108876. [PMID: 33613682 PMCID: PMC7887460 DOI: 10.5812/ijem.108876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Hengameh Abdi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Rasoul Zakavi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Akkuş G, Sökmen Y, Yılmaz M, Bekler Ö, Akkuş O. Comparison of 24-Hour Electrocardiogram Parameters in Patients with Graves' Disease Before and After Anti-Thyroid Therapy. Endocr Metab Immune Disord Drug Targets 2020; 21:183-191. [PMID: 32727336 DOI: 10.2174/1871530320666200729145100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/31/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND We aimed prospectively to investigate the laboratory and electrocardiographic parameters (heart rate, QRS, QT, QTc, Tpe, Tpe/QTc, and arrhythmia prevalence) in patients with Graves' disease before and after antithyroid therapy. METHODS Seventy-one patients (48 female, and 23 male), of age between 18-50 years (mean±SD: 36.48±12.20) with GD were included in the study. Patients were treated with antithyroid therapy (thioamides and/or surgical therapy) to maintain euthyroid status. Patients were examined in terms of electrocardiographic parameters before and after the treatment. RESULTS Mean TSH, free thyroxin (fT4), and tri-iodothyrionine (fT3) levels of all patients were 0.005±0.21, 3.27± 1.81, 11.42±7.44, respectively. While 9 patients (group 2) underwent surgical therapy, had suspicious malignant nodule or large goiter, and unresponsiveness to medical treatment; the other patients (n=62, group 1) were treated with medical therapy. Patients with surgical therapy had more increased serum fT4 (p=0.045), anti-thyroglobulin value (p=0.018) and more severe graves orbitopathy (n=0.051) before treatment when compared to a medical therapy group. Baseline Tpe duration and baseline Tpe/QTc ratio and frequency of supraventricular ectopic beats were found to be significantly higher in group 2 when compared to group 1 (p=0.00, p=0.005). Otherwise, the baseline mean heart rate, QRS duration, QTc values of both groups were similar. Although the patients came at their euthyroid status, group 2 patients still suffered from more sustained supraventricular ectopics beats than group 1. CONCLUSION Distinct from the medical treatment group, surgical treatment group with euthyroidism for at least 3 months still suffered from an arrhythmia (Tpe, Tpe/QTc, supraventricular and ventricular ectopic beats).
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Affiliation(s)
- Gamze Akkuş
- Department of Endocrinology, Cukurova University, Adana, Turkey
| | - Yeliz Sökmen
- Department of Cardiology, Antakya State Hospital, Hatay, Turkey
| | - Mehmet Yılmaz
- Department of Ophthalmology, Antakya State Hospital, Hatay, Turkey
| | - Özkan Bekler
- Department of Cardiology, Mustafa Kemal University, Hatay, Turkey
| | - Oğuz Akkuş
- Department of Cardiology, Mustafa Kemal University, Hatay, Turkey
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Calapkulu M, Sencar ME, Yıldız A, Unsal IO, Cakal E. A Rare Clinical Manifestation of Graves' Disease: Evans Syndrome and a Review of the Literature. Acta Endocrinol (Buchar) 2020; 16:518-521. [PMID: 34084247 DOI: 10.4183/aeb.2020.518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Evans syndrome is a rare combination of autoimmune hemolytic anemia and immune thrombocytopenia. Evans syndrome in cases of Graves' disease is extremely rare. The coexistence of these autoimmune diseases suggests that they may share a common pathogenic pathway. The case here presented is of a 36-year old female patient who was admitted for anemia and thrombocytopenia and was diagnosed with Evans syndrome associated with Graves' disease, and was then treated with methimazole and methylprednisolone (MPSL). During follow-up, MPSL was discontinued gradually over the course of two months. Interestingly, while Evans syndrome is characterized by frequent relapses, this patient has been in remission of Evans syndrome for approximately 1 year without MPSL therapy. The remission of Evans syndrome associated with Graves' disease in the absence of immunosuppressive therapy suggests that these 2 diseases have a common pathogenetic mechanism.
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Affiliation(s)
- M Calapkulu
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital - Endocrinology and Metabolism - Ankara, Turkey.,University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital - Endocrinology and Metabolism - Ankara, Turkey
| | - M E Sencar
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital - Endocrinology and Metabolism - Ankara, Turkey
| | | | - I O Unsal
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital - Endocrinology and Metabolism - Ankara, Turkey
| | - E Cakal
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital - Endocrinology and Metabolism - Ankara, Turkey
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Azizi F, Amouzegar A, Tohidi M, Hedayati M, Cheraghi L, Mehrabi Y. Systemic Thyroid Hormone Status in Treated Graves' Disease. Int J Endocrinol Metab 2019; 17:e95385. [PMID: 31998382 PMCID: PMC6942169 DOI: 10.5812/ijem.95385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/07/2019] [Accepted: 09/29/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We aimed to compare the markers of thyroid hormone status in treated euthyroid Graves' patients and levothyroxine (LT4)-treated hypothyroid Graves' patients. METHODS We collected the data of 277 patients, including 140 radioiodine-treated hypothyroid Graves' patients on LT4 treatment (group 1), 83 euthyroid Graves' patients on methimazole (MMI) therapy (group 2), and 54 euthyroid Graves' patients off MMI or radioiodine therapy for > 2 years (group 3). After the exclusion of diabetic patients, 130, 73, and 52 patients remained for analysis in groups 1, 2, and 3, respectively. Pearson and Spearman correlation coefficients were employed to assess the relationships between T3:T4 ratio and variables in each group along with univariate and multivariate linear regression models. RESULTS The mean age and female/male ratio were similar in the three groups. Serum fT4 was significantly higher and T3, TSH, TPOAb, and TRAb were significantly lower in group 1 than in group 2 and combined groups 2 and 3, which translated to 27% lower serum T3:T4 ratio in group 1. Higher BMI, serum cholesterol, and LDL cholesterol and lower HDL cholesterol were observed in group 1 than in combined groups 2 and 3. In multivariate regression analysis, the T3:T4 ratio was significantly higher in combined groups 2 and 3 than in group 1 in the presence of BMI and serum fasting blood glucose, triglycerides, and TSH. CONCLUSIONS Hypothyroid Graves' patients using LT4 exhibited lower T3:T4 ratio despite lower TSH levels and their BMI and lipid parameters differed from those of euthyroid Graves' patients.
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Affiliation(s)
- Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Cheraghi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology and Biostatistics, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lešin M, Rogošić V, Vanjaka Rogošić L, Barišić I, Pelčić G. Flow Changes in Orbital Vessels Detected with Color Doppler Ultrasound in Patients with Early Dysthyroid Optic Neuropathy. Acta Clin Croat 2018; 57:301-306. [PMID: 30431723 PMCID: PMC6532009 DOI: 10.20471/acc.2018.57.02.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 09/06/2017] [Indexed: 11/30/2022] Open
Abstract
Thyroid-associated orbitopathy (TAO) is a common manifestation of Graves' disease. The aim of the study was to assess the six percent of patients with TAO that develop dysthyroid optic neuropathy (DON), which is the most serious complication of TAO. As DON can cause perma-nent damage, it is essential to detect DON early when visual loss is still reversible. Color Doppler ultrasound is a noninvasive diagnostic method, which may be useful in early detection of DON. Thirty-six patients with confirmed Graves' disease and active TAO were included, 21 (58%) of them with early DON (eDON) and 15 (42%) free from any signs of eDON. All study patients underwent Doppler ultrasound examination to determine the blood flow rates in the internal carotid artery, ophthalmic artery, and central retinal artery. Study results showed color Doppler ultrasound examination to have a potential to detect orbital blood flow changes in patients with eDON. Early detection of DON may result in earlier treatment and prevention of permanent optic nerve damage.
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16
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Young Oh S, Hyun Kim B, Young Kim D, Min Lee K, Jin Lee M, Su Kim S, Ho Kim J, Kyung Jeon Y, Soo Kim S, Ki Kim Y, Joo Kim I. Chylothorax Associated with Substernal Goiter in Graves' Disease Treated with Radioactive Iodine. Int J Endocrinol Metab 2017; 15:e41787. [PMID: 28835765 PMCID: PMC5555731 DOI: 10.5812/ijem.41787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/08/2016] [Accepted: 01/02/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION We present a rare case of chylothorax associated with an intrathoracic goiter in Graves' disease that was treated with radioactive iodine. CASE REPORT A 23-year-old woman with Graves' disease was referred to our clinic with a pleural effusion, dyspnea, characteristic bilateral proptosis, and a diffuse goiter. The pleural fluid biochemistry was consistent with chylothorax. However, the chylothorax did not decrease with conservative therapy. Therefore, RAI was administered. Subsequently, the chylothorax and goiter improved more quickly than expected. CONCLUSIONS This case illustrates that chylothorax associated with a substernal goiter in Graves' disease can be treated successfully with radioactive iodine instead of surgery.
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Affiliation(s)
- Seo Young Oh
- M.D., Department of Internal Medicine, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 602-739, South Korea
| | - Bo Hyun Kim
- M.D., Ph.D., Department of Internal Medicine, Medical Research Institute, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 602-739, South Korea
- Corresponding author: Bo Hyun Kim, M.D., Ph.D., Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, 305 Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: +82-512407678, Fax: +82-512543217, E-mail:
| | - Do Young Kim
- Department of Internal Medicine, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 602-739, South Korea
| | - Kyu Min Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 602-739, South Korea
| | - Min Jin Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 602-739, South Korea
| | - Sung Su Kim
- Department of Internal Medicine, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 602-739, South Korea
| | - Jong Ho Kim
- Department of Internal Medicine, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 602-739, South Korea
| | - Yun Kyung Jeon
- Department of Internal Medicine, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 602-739, South Korea
| | - Sang Soo Kim
- Department of Internal Medicine, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 602-739, South Korea
| | - Yong Ki Kim
- Internal Medicine Clinic, Chungmu-dong 1-ga, Seo-gu, Busan 602-011, Korea
| | - In Joo Kim
- M.D., Department of Internal Medicine, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 602-739, South Korea
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Ugwu ET, Maluze J, Onyebueke GC. Graves' Thyrotoxicosis Presenting as Schizophreniform Psychosis: A Case Report and Literature Review. Int J Endocrinol Metab 2017; 15:e41977. [PMID: 28835762 PMCID: PMC5554607 DOI: 10.5812/ijem.41977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 11/16/2022] Open
Abstract
Psychosis, as the first presentation of thyrotoxicosis, is extremely rare. Consequently, it is often misdiagnosed as a primary psychiatric disorder, especially in developing countries with poor healthcare facilities. Owing to the high level of illiteracy and lack of knowledge, it is fairly common to ascribe many illnesses to spiritual attacks in Nigeria and other African countries, especially when the disease is rarely seen or is associated with psychiatric manifestations. Herein, we present the case of a teenage female Nigerian and review the literature on this subject.
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Affiliation(s)
- Ejiofor T. Ugwu
- Department of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
- Corresponding author: Ejiofor T. Ugwu, Department of Internal Medicine, College of Medicine, Enugu State University of Science and Technology, PMB 01660, Enugu, Nigeria, E-mail:
| | - John Maluze
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Godwin C. Onyebueke
- Department of Psychiatry, Enugu State University of Science and Technology, Enugu, Nigeria
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Chen B, Yang X, Sun S, Guo W, Li X, Zhang L, Guo Z, Han J, Li N. Propylthiouracil-Induced Vasculitis With Alveolar Hemorrhage Confirmed by Clinical, Laboratory, Computed Tomography, and Bronchoscopy Findings: A Case Report and Literature Review. Iran Red Crescent Med J 2016; 18:e23320. [PMID: 27257510 PMCID: PMC4888935 DOI: 10.5812/ircmj.23320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 04/05/2015] [Accepted: 05/23/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Propylthiouracil (PTU) is commonly used to treat hyperthyroidism and can induce antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Although this is a rare side effect, ANCA-associated vasculitis can progress to severe disease if its diagnosis and treatment are delayed, leading to a poor prognosis. CASE PRESENTATION A 43-year-old woman with Graves' disease developed pulmonary vasculitis and diffuse alveolar hemorrhage (DAH) associated with ANCA against myeloperoxidase and proteinase-3 that was confirmed by computed tomography (CT) and bronchoscopy and treated with PTU. The symptoms and signs of alveolar hemorrhage were rapidly resolved after PTU withdrawal and treatment with corticosteroids. After 6 months of follow-up, the patient maintained complete ANCA-negative clinical remission status, as confirmed by normal CT and bronchoscopy findings. To our knowledge, this is the first documented case of bronchoscopic comparison of PTU-induced DAH before and after steroid treatment. CONCLUSIONS Patients treated with PTU should be closely monitored and followed up, even if the drug has been used for several years. When patients develop progressive dyspnea with alveolar opacities on chest imaging that cannot be explained otherwise, alveolar hemorrhage should be an important differential diagnosis while investigating the case. Early diagnosis and prompt discontinuation of the PTU treatment are essential for improving patient outcomes.
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Affiliation(s)
- Bo Chen
- Department of Radiologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoqing Yang
- Department of Internal Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shihai Sun
- Department of Surgery, Taian Second Chinese Medicine Hospital, Taian, Shandong, China
| | - Weina Guo
- Department of Rheumatologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaosheng Li
- Department of Radiologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Radiologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongliang Guo
- Department of Internal Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jie Han
- Department of Rheumatologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Corresponding Authors: Jie Han, Department of Rheumatologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, No.150 Ji Mo Road, Shanghai 200120, China. Tel: +86-2161569573, Fax: +86-2161569538, E-mail: ; Ning Li, Department of Rheumatologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. Tel: +86-2161569573, Fax: +86-2161569538, E-mail:
| | - Ning Li
- Department of Rheumatologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Corresponding Authors: Jie Han, Department of Rheumatologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, No.150 Ji Mo Road, Shanghai 200120, China. Tel: +86-2161569573, Fax: +86-2161569538, E-mail: ; Ning Li, Department of Rheumatologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. Tel: +86-2161569573, Fax: +86-2161569538, E-mail:
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Al Qahtani ES, Rootman J, Kersey J, Godoy F, Lyons CJ. Clinical Pearls and Management Recommendations for Strabismus due to Thyroid Orbitopathy. Middle East Afr J Ophthalmol 2015; 22:307-11. [PMID: 26180468 PMCID: PMC4502173 DOI: 10.4103/0974-9233.159731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thyroid orbitopathy causes a unique form of strabismus with adult-onset diplopia. Prisms can be a temporizing measure, but many patients require strabismus surgery, which can be challenging. In this article, we highlight clinical guidelines for addressing strabismus due to thyroid orbitopathy and review our surgical experience.
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Affiliation(s)
- Elham S Al Qahtani
- Department of Ophthalmology and Visual Sciences, University of British Columbia and Department of Ophthalmology, BC Children's Hospital, Vancouver, BC, Canada
| | - Jack Rootman
- Department of Ophthalmology and Visual Sciences, University of British Columbia and Department of Ophthalmology, BC Children's Hospital, Vancouver, BC, Canada
| | - James Kersey
- Department of Ophthalmology and Visual Sciences, University of British Columbia and Department of Ophthalmology, BC Children's Hospital, Vancouver, BC, Canada
| | - Flavia Godoy
- Department of Ophthalmology and Visual Sciences, University of British Columbia and Department of Ophthalmology, BC Children's Hospital, Vancouver, BC, Canada
| | - Christopher J Lyons
- Department of Ophthalmology and Visual Sciences, University of British Columbia and Department of Ophthalmology, BC Children's Hospital, Vancouver, BC, Canada
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Santos Palacios S, Pascual-Corrales E, Galofre JC. Management of subclinical hyperthyroidism. Int J Endocrinol Metab 2012; 10:490-6. [PMID: 23843809 PMCID: PMC3693616 DOI: 10.5812/ijem.3447] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 12/03/2011] [Accepted: 12/06/2011] [Indexed: 12/16/2022] Open
Abstract
The ideal approach for adequate management of subclinical hyperthyroidism (low levels of thyroid-stimulating hormone [TSH] and normal thyroid hormone level) is a matter of intense debate among endocrinologists. The prevalence of low serum TSH levels ranges between 0.5% in children and 15% in the elderly population. Mild subclinical hyperthyroidism is more common than severe subclinical hyperthyroidism. Transient suppression of TSH secretion may occur because of several reasons; thus, corroboration of results from different assessments is essential in such cases. During differential diagnosis of hyperthyroidism, pituitary or hypothalamic disease, euthyroid sick syndrome, and drug-mediated suppression of TSH must be ruled out. A low plasma TSH value is also typically seen in the first trimester of gestation. Factitial or iatrogenic TSH inhibition caused by excessive intake of levothyroxine should be excluded by checking the patient's medication history. If these nonthyroidal causes are ruled out during differential diagnosis, either transient or long-term endogenous thyroid hormone excess, usually caused by Graves' disease or nodular goiter, should be considered as the cause of low circulating TSH levels. We recommend the following 6-step process for the assessment and treatment of this common hormonal disorder: 1) confirmation, 2) evaluation of severity, 3) investigation of the cause, 4) assessment of potential complications, 5) evaluation of the necessity of treatment, and 6) if necessary, selection of the most appropriate treatment. In conclusion, management of subclinical hyperthyroidism merits careful monitoring through regular assessment of thyroid function. Treatment is mandatory in older patients (> 65 years) or in presence of comorbidities (such as osteoporosis and atrial fibrillation).
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Affiliation(s)
- Silvia Santos Palacios
- Department of Endocrinology and Nutrition, University Clinic of Navarra, University of Navarra, Pamplona, Spain
| | - Eider Pascual-Corrales
- Department of Endocrinology and Nutrition, University Clinic of Navarra, University of Navarra, Pamplona, Spain
| | - Juan Carlos Galofre
- Department of Endocrinology and Nutrition, University Clinic of Navarra, University of Navarra, Pamplona, Spain
- Corresponding author: Juan Carlos Galofre, Department of Endocrinology and Nutrition, University Clinic of Navarra, Pio XII, 36. 31008, Pamplona, Spain. Tel.: +94-8255400, Fax: +94-8296500, E-mail:
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