[Hypothyroid myopathy: a case report]

Though proximal muscle weakness is characteristic of polymyositis, other agents may also lead to proximal muscle weakness, such as drugs, endocrine diseases, or infections. Here, we report a thirty year-old female suffering from proximal weakness which initially was thought to be a case of polymyositis with high serum creatine phosphokinase level. Very low thyroid hormone levels were found as the history inquiry revealed constipation, hoarseness and cold intolerance. The muscle biopsy showed no obvious inflammation. After thyroxine therapy, her muscle weakness recovered. Up to now, hypothyroid myopathy with muscle mitochondrial abnormalities shown by electron microscopic examination has not been reported in the medical literature in Taiwan. Hypothyroid myopathy, though it is rare, may be misdiagnosed as polymyositis clinically. Therefore, it is recommended that hypothyroid myopathy should be considered in the differential diagnosis of proximal muscle weakness.

Outcome of Graves' thyrotoxicosis after antithyroid drug treatment

To investigate the outcome of Graves' thyrotoxicosis after antithyroid drug management, data from 81 patients, treated in Chang Gung Memorial Hospital at Taipei and Linkou from October 1981 to March 1990, were analyzed. The gender ratio of female to male was 59:22. The mean age of onset was 33.1 +/- 10.5(15-60) year-old. All the patients were treated with antithyroid drug (Thionamide group) for a duration of 11 to 63 months (mean +/- SD = 28.1 +/- 9.8 months). Forty of 81 patients (49.4%) were remained remission after up to 2 years of follow-up. Those patients relapse usually occurred within 2 years after discontinuation of treatment (34/41), and only one exceptional case relapsed after 3 years. Three conditions affected the relapse rate. Patients with larger goiter (grade II-III) and shorter duration of treatment (< 23 months) had a higher relapse rate than those-with smaller goiter (grade O-I) [29/46 vs. 12/35; chi 2 = 6.576, p = 0.010; p = 0.015 in stepwise logistic regression (LR)] and longer duration of treatment (> or = 23 months) (15/20 vs. 26/61; chi 2 = 6.316, p = 0.012; p = 0.020 in LR). Patients with higher pre-treated serum triiodothyronine (T3) level (T3 > or = 300 ng/dl) had a higher relapse rate than those with lower T3 level (T3 < 300 ng/dl) in univariate analysis (30/50 vs. 11/31, chi 2 = 4.601, p = 0.032), but no significant difference by LR (P = 0.094). Other clinical parameters including age, sex, past history, family history, thyroxine (T4) level, T3/T4 ratio, thyroid autoantibodies, staging of ophthalmopathy, responsiveness to thyrotropin-releasing hormone stimulation test at the end of treatment, and whether combined treatment with thyroxine had no significant difference between the relapse and remission groups. These data suggest: (a) patients with larger goiter (grade II-III had higher relapse rate; (b) most of the recurrent thyrotoxicosis patients relapsed within two years after drug withdrawal; (c) continuing treatment for more than twenty-three months produces better outcome; (d) patients with Graves' thyrotoxicosis should be followed up for at least three years after withdrawal of antithyroid drug.

Comparison of the outcome between the calculated dosimetry and the estimated dosimetry of 131I in the treatment of hyperthyroidism

To compare the outcomes of different methods in prescribing the optimal dose of radioactive iodine (131I) for the treatment of hyperthyroidism, we retrospectively analyzed 52 patients with toxic diffuse goiter. They received single dose of 131I for the treatment of hyperthyroidism. In addition, all of them met the following criteria: 1) symptoms and signs of hyperthyroidism; 2) elevated blood triiodothyronine (T3) and thyroxin (T4) by radioimmunoassay (RIA) method; 3) diffuse goiter with increase of uptake proved by thyroid scintiscan; 4) only one dose of 131I was given during the follow-up period; 5) well-documented thyroid function test in the medical chart during the follow-up period (6 months, 1 year, 2 years and 5 years after 131I therapy). The enrolled patients were divided into estimated and calculated group. The dose of 131I in the calculated group was obtained from the measurement of size and 131I uptake of thyroid gland. The dose of 131I in the estimated group was prescribed according to the size of thyroid gland by physical examination, and the association with cardiac arrhythmia, congestive heart failure, or ischemic heart disease. The mean doses of 131I were 4.8 +/- 1.4 mCi and 7.0 +/- 1.1 mCi in the calculated and estimated group respectively. In this study, there were no significant difference in the incidence of euthyroidism, hyperthyroidism, and hypothyroidism between these two groups in thefollow-up period after 131I therapy. In view of simplicity and time-saving, it is a practical choice to prescribe the dose of 131I therapy for toxic diffuse goiter according to the size of thyroid gland and the associated cardiac condition.

Neurofibromatosis, acute myelomonocytic leukemia, and disseminated tuberculosis: an adult case report

Leukemia associated with neurofibromatosis has been reported to be predominantly nonlymphocytic and limited to childhood; it is rare in adulthood. An adult case is reported; the patient had nonfamilial peripheral neurofibromatosis (NF) (von Recklinghausen's disease), contracted acute myelomonocytic leukemia and disseminated tuberculosis (TB). After a four-month periods of anti-TB medication that disease was much improved, but the leukemic picture was still progressing. Chemotherapy was not given. This case further illustrated an association between acute nonlymphocytic leukemia (ANLL) and neurofibromatosis type 1 (NF-1) in adulthood. An attempt was made also to explain the relationship between disseminated tuberculosis and, in this instance, hematological abnormalities.