methimazole and Exophthalmos

To compare the therapeutic effect and side effect of the treatments on hyperthyroid exophthalmos with the combination of acupuncture and medication and with medication only.. Fifty-two cases were randomly divided into an acupuncture and medication group (27 cases) and a medication group (25 cases). Acupuncture in combination of oral taking of Thiamazole and Euthyrox were adopted for the acupuncture and medication group. And acupoints such as Jingming (BL 1), Chengqi (ST 1) and Sizhukong (TE 23) etc. were selected. Western medication for oral taking was applied as the only treatment for the medication group. Objective eye syndrome marks, side effects and accidents were compared between two groups before and after treatment.. The improvement of the objective marks of eye syndrome in the acupuncture and medication group was better than that in the medication group (P < 0.01). There were 4 cases with hypoleucocytosis, 3 cases with rash and 3 cases with aggravated symptom of exophthalmos in the medication group during the treatment, while no case with side effects was observed in the acupuncture and medication group. However, 8 cases were found with hemorrhage and 8 with hematoma in the acupuncture and medication group.. Treatment with the combination of acupuncture and medication may not only enhance the therapeutic effect, but also reduce the side effects.

Topics: Acupuncture Points; Acupuncture Therapy; Adult; Combined Modality Therapy; Drug-Related Side Effects and Adverse Reactions; Exophthalmos; Female; Graves Ophthalmopathy; Humans; Male; Methimazole; Middle Aged; Thyroxine; Treatment Outcome; Young Adult

The chief clinical characteristics of Graves' disease are hyperthyroidism and ophthalmopathy. The relation between the two and the effect of treatment for hyperthyroidism on ophthalmopathy are unclear.. We studied 443 patients with Graves' hyperthyroidism and slight or no ophthalmopathy who were randomly assigned to receive radioiodine, radioiodine followed by a 3-month course of prednisone, or methimazole for 18 months. The patients were evaluated for changes in the function and appearance of the thyroid and progression of ophthalmopathy at intervals of 1 to 2 months for 12 months. Hypothyroidism and persistent nyperthyroiaism were promptly corrected.. Among the 150 patients treated with radioiodine, ophthalmopathy developed or worsened in 23 (15 percent) two to six months after treatment. The change was transient in 15 patients, but it persisted in 8 (5 percent), who subsequently required treatment for their eye disease. None of the 55 other patients in this group who had ophthalmopathy at base line had improvement in their eye disease. Among the 145 patients treated with radioiodine and prednisone, 50 (67 percent) of the 75 with ophthalmopathy at base line had improvement, and no patient had progression. The effects of radioiodine on thyroid function were similar in these two groups. Among the 148 patients treated with methimazole, 3 (2 percent) who had ophthalmopathy at base line improved, 4 (3 percent) had worsening of eye disease, and the remaining 141 had no change.. Radioiodine therapy for Graves' hyperthyroidism is followed by the appearance or worsening of ophthalmopathy more often than is therapy with methimazole. Worsening of ophthalmopathy after radioiodine therapy is often transient and can be prevented by the administration of prednisone.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antithyroid Agents; Combined Modality Therapy; Disease Progression; Exophthalmos; Female; Glucocorticoids; Graves Disease; Humans; Iodine Radioisotopes; Male; Methimazole; Middle Aged; Prednisone; Prospective Studies; Treatment Outcome

Topics: Adolescent; Antithyroid Agents; Blepharoptosis; Cholinesterase Inhibitors; Drug Therapy, Combination; Exophthalmos; Graves Ophthalmopathy; Humans; Male; Methimazole; Myasthenia Gravis; Pyridostigmine Bromide; Thyrotropin; Thyroxine; Tomography, X-Ray Computed; Triiodothyronine

A major problem with antithyroid drug (ATD) therapy in Graves' disease is the high relapse rate. Therefore, clinicians have sought prognostic indicators of permanent remission. Suppression of serum thyrotropin (TSH) when ATD therapy is stopped carries a poor prognosis, but little is known regarding the significance of elevated serum TSH concentrations in the course of ATD therapy. The objective of this study was to determine if elevated serum TSH concentrations during methimazole (MMI) therapy is associated with a favorable long-term prognosis.. We retrospectively studied patients with Graves' disease who were initially on MMI, in whom this drug was stopped because they had undetectable thyroid-stimulating antibodies (TSAbs) or were euthyroid after at least 24 months on MMI treatment. A strategy of high MMI doses plus T4 was not used in these patients. We identified 40 patients with elevated serum TSH concentration (>10 microIU/mL) during MMI therapy (H-TSH group). Eighty-five percent of the H-TSH group had negative tests for TSAb. The H-TSH group was sex- and age-matched with 37 patients who had similar selection criteria, but did not have elevated serum TSH concentration during MMI therapy (N-TSH group). The H-TSH and N-TSH groups were similar in gross thyroid size, percentage of patients with exophthalmos, serum free thyroxine, duration of MMI treatment, TSAb status, duration that their TSAb tests remained negative, and thyroid peroxidase antibody titers. The patients were followed for 24 months after stopping MMI.. In the H-TSH group, MMI-associated hypothyroidism typically occurred after 7-8 months of treatment with daily doses of 10-15 mg MMI. No patient had severe symptoms of hypothyroidism. The percentage of patients in remission at 6, 12, and 24 months after discontinuation of MMI was 90.0, 87.5, and 85.0, respectively, in the H-TSH group and 70.3, 67.6, and 54.1, respectively, in the N-TSH group (p  <  0.05 for the comparison of groups at 6 and 12 months and p  <  0.001 for comparison of the groups at 24 months).. In patients with Graves' disease who are treated with MMI for at least 2 years and become euthyroid, the occurrence of elevated serum TSH concentrations during MMI treatment is a favorable indicator for long-term remission and is independent of multiple other factors including TSAb status, duration of MMI treatment, and gross parameters of goiter size.

Topics: Adult; Antithyroid Agents; Autoantibodies; Exophthalmos; Female; Goiter; Graves Disease; Humans; Hypothyroidism; Immunoglobulins, Thyroid-Stimulating; Male; Methimazole; Middle Aged; Prognosis; Retrospective Studies; Thyrotropin; Thyroxine

Recent studies concerning the association between extraocular muscle (EOM) enlargement in thyroid-associated ophthalmopathy (TAO) and immunological and clinical activity have not been conclusive, probably due to a lack of uniform imaging methods (ultrasonography, computer tomography [CT] or magnetic resonance imaging [MRI]) and difficulties in the determination of EOM volume. The aim of the present study was to examine the significance of EOM enlargement as established by MRI-based volume determination, with reference to proptosis and the presence of autoantibodies, clinical activity and the duration of active disease.. We determined EOM volume using MRI in 15 patients concomitantly with the determination of TSH, thyroid hormones, thyrotropin receptor antibodies (TRab) thyroid peroxidase antibodies (TPOab) and clinical activity score (CAS) at entry. We also established the duration until cessation of clinically active TAO.. All 15 patients had bilateral EOM enlargement, but swelling of orbital fatty tissue was absent. Significant correlations between thickness of musculi rectales and proptosis, values of TRab, CAS, and duration of activity were observed.. Our results support the hypothesis of a role of thyrotropin receptor antibodies in the pathogenesis of TAO and suggest that only EOM enlargement is responsible for proptosis in TAO.

Topics: Adult; Antithyroid Agents; Autoantibodies; Exophthalmos; Female; Graves Ophthalmopathy; Humans; Hypertrophy; Iodide Peroxidase; Magnetic Resonance Imaging; Methimazole; Oculomotor Muscles; Receptors, Thyrotropin; Thyroid Hormones; Thyrotropin

To investigate whether variations over time of TSH-receptor antibodies (TRAb) and antibodies against G2s (G2sAb) and extraocular muscles (EMAb) can predict worsening of ophthalmopathy in Graves' patients treated with intravenous glucocorticoid (IVGC) therapy.. Of 65 consecutive patients with treated Graves' disease and severe and active ophthalmopathy (GO) chosen to undergo IVGC treatment, only 57 patients, persistently euthyroid under methimazole therapy, were studied longitudinally for ocular parameters, TRAb, G2sAb and EMAb before therapy, at the end of therapy and, subsequently, every month for 21 months.. TRAb was detected by radioimmunoassay (RIA), G2sAb by enzyme-linked immunosorbent assay (ELISA) and EMAb by indirect immunofluorescence.. Forty-three out of 57 patients (75.4%, group 1) responded positively to therapy [improvement in diplopia and decrease in proptosis and clinical activity score (CAS)] but 14 (24.6%) did not (group 2). During follow-up after IVGC therapy, 12 out of 43 patients in group 1 (28%) showed a worsening in GO (group 1a), while 31 (72%) had stable ocular conditions or further improvement (group 1b). At the start of the study, TRAb, G2sAb and EMAb were not significantly different among the three groups. At the end of IVGC therapy TRAb levels decreased significantly with respect to starting values in all three groups of patients, whereas G2sAb and EMAb decreased significantly in groups 1a and 1b but not in group 2. During the subsequent follow-up, 10 patients in group 1a one/two months before and all 12 patients at the time of GO worsening showed an increase in G2sAb and EMAb but not in TRAb, which were consistently absent or present at low titre in all patients in this group. In group 1b TRAb, G2sAb and EMAb further decreased or became negative during the follow-up period. In all patients, TRAb were positively correlated with both CAS and proptosis only at the start of the study; by contrast, a significant correlation between both G2sAb and EMAb and diplopia was observed in groups 1a and 1b at all the times during the study, except one/two months before the worsening of GO in group 1a.. Our results indicate that TRAb, G2sAb and EMAb can be considered sensitive markers of Graves' ophthalmopathy during the initial stages of ophthalmopathy, but that only G2sAb and EMAb seem to be good predictive markers of the outcome in patients after corticosteroid therapy. Thus, taking into account the cost/benefit ratio, a longitudinal evaluation of either EMAb or G2sAb could be useful in monitoring the intravenous glucocorticoid therapy in patients with severe and active ophthalmopathy to predict a possible worsening of Graves' ophthalmopathy.

Topics: Adult; Antithyroid Agents; Autoantibodies; Biomarkers; Diplopia; Exophthalmos; Eye; Eye Proteins; Female; Follow-Up Studies; Glucocorticoids; Graves Disease; Humans; Infusions, Intravenous; Male; Membrane Proteins; Methimazole; Methylprednisolone; Middle Aged; Receptors, Thyrotropin; Statistics, Nonparametric

The relationship between the method of treatment of hyperthyroidism due to Graves' disease and the course of Graves' ophthalmopathy is debated. Antithyroid drug therapy is associated with no change, or even amelioration, of ophthalmopathy. Although controversial, radioiodine may be followed by progression of eye disease, preventable by glucocorticoid administration. Whether thyroidectomy affects the course of ophthalmopathy is uncertain.. In a case control study, the course of non-severe Graves' ophthalmopathy after thyroidectomy was investigated and the results compared with those observed in patients treated with methimazole.. Thirty patients with Graves' hyperthyroidism and non-severe/absent ophthalmopathy were treated with near-total thyroidectomy (Group 1, Tx), after achievement of euthyroidism with methimazole. After surgery, all patients started levothyroxine replacement therapy. Sixty patients treated with methimazole, matched for age, sex, duration of hyperthyroidism, degree of ocular involvement and smoking habits, were used as controls (Group 2, MMI).. Patients were seen every 1-2 months for 12 months for thyroid tests and ocular evaluation.. In Group 1, ocular parameters did not change in 17 of 18 patients with pre-existing ophthalmopathy, and in 12 patients without ophthalmopathy. Eye manifestations worsened only in one (3.3%) patient with pre-existing ophthalmopathy. In Group 2, ocular parameters did not change in 58 patients (33 with, and 25 without ophthalmopathy), while new ophthalmopathy occurred in two without pre-existing eye disease. One of the 30 patients treated by surgery (3.3%) had permanent hypoparathyroidism.. Treatment of Graves' hyperthyroidism with near-total thyroidectomy in patients with non-severe or absent pre-existing ophthalmopathy is not associated in the short term with significant effects on the course of ophthalmopathy.

Topics: Adult; Antithyroid Agents; Case-Control Studies; Chi-Square Distribution; Exophthalmos; Female; Graves Disease; Humans; Male; Methimazole; Statistics, Nonparametric; Thyroidectomy; Treatment Failure; Visual Acuity

Topics: Antithyroid Agents; Combined Modality Therapy; Exophthalmos; Graves Disease; Humans; Iodine Radioisotopes; Methimazole; Prednisone

Topics: Antithyroid Agents; Exophthalmos; Graves Disease; Humans; Hyperthyroidism; Iodine Radioisotopes; Methimazole; Prednisone

The study investigated whether ciclosporin (C) affected the thyroid-stimulating immunoglobulins (TSI) in serum of patients with endocrine orbitopathy (EO). The effect of C was compared with that of prednisone (P). Fifteen patients with EO classes III-V received C (n = 7) or P (n = 8). In addition to the immunosuppressants, five patients with Graves' disease in each group received methimazole (MMI). The stimulation of the cAMP levels in the medium of thyrocyte cultures was determined as a parameter of TSI. The TSI levels were markedly lowered in both groups during and after therapy. C group: before therapy 6.2 pmol/ml +/- 1.63 (100%, mean +/- SEM), during treatment 4.6 pmol/ml +/- 2.28 (74%), after treatment 4.1 pmol/ml +/- 1.33 (66%). P group: before treatment 9.1 pmol/ml +/- 3.42 (100%), during treatment 5.9 pmol/ml +/- 2.90 (65%), after treatment 3.7 pmol/ml +/- 1.20 (41%). There is neither a significant difference between the two groups nor between the patients who received the combined therapy (MMI + immunosuppressants) or only received immunosuppressants (P more than 0.05). The mean cAMP value of the healthy reference group (n = 19) is 0.4 pmol/ml +/- 0.03. There is a significant difference between this value and the cAMP values of the patients both before and after therapy (P less than 0.01). Thus, both C and P markedly lower the TSI titers of patients with EO.

Topics: Adult; Aged; Cyclic AMP; Cyclosporins; Exophthalmos; Female; Graves Disease; Humans; Immunoglobulin G; Immunoglobulins, Thyroid-Stimulating; Male; Methimazole; Middle Aged; Prednisone; Thyroid Gland; Triiodothyronine

Peripheral T-Lymphocyte subsets were analyzed with monolateral antibodies in 40 patients with Graves' ophthalmopathy. The 20 patients with untreated hyperthyroid exophthalmos showed a slight statistically not significant decrease in the percentage of total T-Lymphocytes and a statistically significant decrease with percentage of the OK T8 cells. No significant changes were observed in the percentage of OK T3 and OK T4 and OK T8 cells in patients with euthyroid exophthalmos under the drug treatment. These findings indicate the significant association of quantitative abnormality of suppressor-cytotoxic cells with untreated hyperthyroid exophthalmos.

Topics: Exophthalmos; Female; Graves Disease; Humans; Male; Methimazole; Middle Aged; T-Lymphocytes

A patient experienced three separate episodes of apathetic hyperthyroidism. Each time, this clinical picture appeared after the patient had been euthyroid for one to three months and within one to three weeks of discontinuing antithyroid drug therapy. This rapid recurrence of apathetic hyperthyroidism represents evidence against the concept that this disorder represents "burnt-out," or exhaustion of, body reserves in long-standing, untreated hyperthyroidism. Initial recognition and diagnosis of thyrotoxicosis was delayed by contamination of her serum from therapeutic radioactive iodine and possible interference with thyroxine radioimmunoassay. The solution to this problem with double isotope counting is discussed.

Topics: Aged; Antithyroid Agents; Exophthalmos; Face; Female; Humans; Hyperthyroidism; Iodine Radioisotopes; Methimazole; Middle Aged; Personality Disorders; Recurrence; Thyroid Function Tests

Topics: Antithyroid Agents; Exophthalmos; Female; Graves Disease; Humans; Hyperthyroidism; Long-Acting Thyroid Stimulator; Male; Methimazole; Ophthalmoplegia; Prednisone; Thyroid Function Tests; Thyrotropin-Releasing Hormone

Topics: Animals; Exophthalmos; Goldfish; Graves Disease; Humans; Hyperthyroidism; Hypothyroidism; Methimazole; Muscles; Orbit; Sulfates; Sulfur Radioisotopes; Thyroid Diseases; Thyrotropin

Topics: Adult; Antibody Formation; Antithyroid Agents; Autoantibodies; Exophthalmos; Female; Graves Disease; Hemagglutination Tests; Humans; Imidazoles; Immunosuppressive Agents; Iodine Isotopes; Long-Acting Thyroid Stimulator; Male; Methimazole; Middle Aged; Myxedema; Thyroglobulin