methimazole and Thyrotoxicosis

Neonatal thyrotoxicosis (hyperthyroidism) is less prevalent than congenital hypothyroidism; however, it can lead to significant morbidity and mortality if not promptly recognized and adequately treated. Most cases are transient, secondary to maternal autoimmune hyperthyroidism (Graves disease [GD]). This article summarizes recommendations for screening and management of hyperthyroidism in both the fetal and neonatal periods, with a focus on neonatal thyrotoxicosis secondary to maternal GD. Early monitoring and treatment are crucial for optimizing short-term and long-term patient outcomes.

Topics: Adrenergic beta-Antagonists; Antithyroid Agents; Female; Fetal Diseases; Graves Disease; Humans; Hyperthyroidism; Immunoglobulins, Thyroid-Stimulating; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Methimazole; Pregnancy; Pregnancy Complications; Propranolol; Thyroiditis, Autoimmune; Thyrotoxicosis

A 29-year-old pregnant woman with Graves' disease presented with severe persistent hypocalcaemia after thyroidectomy. Six months prior to presentation she was diagnosed with Graves' disease and remained uncontrolled with methimazole. She was confirmed pregnant prior to radioactive iodine ablation (RAI), and underwent total thyroidectomy during her second trimester. After surgery, continuous intravenous calcium infusion was required until delivery of the fetus allowed discontinuation at postoperative day 18, despite oral calcium and calcitriol administration. A total of 38 g of oral and 7.5 g of intravenous elemental calcium was administered. We report an unusual case of recalcitrant hypocalcaemia thought to be due to a combination of postoperative hypoparathyroidism, combined with thyrotoxic osteodystrophy and pregnancy, after surgical correction of Graves' disease. Increased vigilance and early calcium supplementation should be a priority in the management of these patients.

Topics: Administration, Oral; Adult; Antithyroid Agents; Calcium; Drug Administration Schedule; Female; Graves Disease; Humans; Hypocalcemia; Hypoparathyroidism; Infusions, Intravenous; Methimazole; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Second; Thyroidectomy; Thyrotoxicosis; Time Factors; Treatment Outcome

Propylthiouracil (PTU), methimazole (MMI) and carbimazole are indicated for the treatment of hyperthyroidism in adult and pediatric patients. The aim of this review is to present all the relevant information regarding the use of antithyroid drugs (ATD) in pediatric thyrotoxic cases, the pediatric toxicology of ATD and the warning which has recently been issued for PTU by the FDA.. Epidemiology, diagnosis and treatment of pediatric thyrotoxicosis are all presented in this article. The authors also extensively discuss the details regarding the pharmacology, bioactivation, biodisposition, bioavailability and pharmacokinetic properties of the two main ATD (MMI and PTU).. The FDA recently reported that use of PTU is associated with a higher risk for clinically serious or fatal liver injury compared to MMI in both adult and pediatric patients. They also found that congenital malformations were reported approximately three times more often with prenatal exposure to MMI compared with PTU and especially with the use of MMI during the first trimester of pregnancy. The authors believe that PTU should not be used in pediatric patients unless the patient is allergic to or intolerant of MMI, and there are no other treatment options available. That being said, PTU may be the treatment of choice during, and just before, the first trimester of pregnancy.

Topics: Agranulocytosis; Animals; Antithyroid Agents; Carbimazole; Child; Child, Preschool; Evidence-Based Medicine; Female; Graves Disease; Humans; Hyperthyroidism; Liver Failure; Methimazole; Pregnancy; Propylthiouracil; Randomized Controlled Trials as Topic; Thyrotoxicosis; Vasculitis

Amiodarone is a potent antiarrhythmic drug associated with thyroid dysfunction. Its high iodine content causes inhibition of 5'-deiodinase activity. Most patients remain euthyroid. Amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH) may occur depending on the iodine status of individuals and prior thyroid disease. AIT is caused by excess iodine-induced thyroid hormone synthesis (type I AIT) or by destructive thyroiditis (type II AIT). If the medical condition allows it, discontinuation of the drug is recommended in type I AIT. Otherwise, large doses of thioamides are required. Type II AIT is treated with corticosteroids. Mixed cases require a combination of both drugs. Potassium perchlorate has been used to treat resistant cases of type I AIT but use is limited by toxicity. Thyroidectomy, plasmapheresis, lithium, and radioiodine are used in select cases of AIT. AIH is successfully treated with levothyroxine. Screening for thyroid disease before starting amiodarone and periodic monitoring of thyroid function tests are advocated.

Topics: Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Continuity of Patient Care; Glucocorticoids; Hormone Replacement Therapy; Humans; Hypothyroidism; Iodine Radioisotopes; Methimazole; Perchlorates; Plasmapheresis; Risk Factors; Thyroid Gland; Thyroid Hormones; Thyroidectomy; Thyrotoxicosis; Thyroxine; Ultrasonography

Despite being a common condition in pregnancy, and despite propylthiouracil (PTU) being perceived as safer than methimazole, there are virtually no epidemiological controlled studies on malformation rate an neurobehavioral outcomes with the former. This knowledge gap must be filled to ensure fetal safety.

Topics: Abnormalities, Drug-Induced; Antithyroid Agents; Drug Administration Schedule; Drug Monitoring; Female; Humans; Infant, Newborn; Knowledge; Maternal-Fetal Exchange; Methimazole; Milk, Human; Pregnancy; Propylthiouracil; Thyrotoxicosis

Topics: Antithyroid Agents; Autoantibodies; Diagnosis, Differential; Graves Disease; Humans; Immunoglobulins, Thyroid-Stimulating; Methimazole; Receptors, Thyrotropin; Thyroid Function Tests; Thyroiditis, Subacute; Thyrotoxicosis

Topics: Antithyroid Agents; Autoantibodies; Diagnosis, Differential; Female; Humans; Hyperthyroidism; Immunoglobulins, Thyroid-Stimulating; Infant, Newborn; Iodides; Maternal-Fetal Exchange; Methimazole; Mutation; Pregnancy; Receptors, Thyrotropin; Thyroiditis, Autoimmune; Thyrotoxicosis; Thyroxine

Topics: Agranulocytosis; Algorithms; Antithyroid Agents; Female; Graves Disease; Humans; Hyperthyroidism; Methimazole; Pregnancy; Pregnancy Complications; Propylthiouracil; Thyroid Gland; Thyrotoxicosis; Thyroxine; Triiodothyronine

We report three patients with bilateral choanal atresia in children prenatally exposed to methimazole (MMI) in order to define a MMI embryopathy clinical pattern. The combination of choanal atresia and other specific malformations strongly resembles previously reported patients exposed to MMI in utero. At present, propylthiouracil is considered the best treatment in pregnancies. However in Argentina and some other countries MMI is the only antithyroid drug, possibly posing a significant risk to the unborn fetus.

Topics: Antithyroid Agents; Choanal Atresia; Female; Humans; Infant; Infant, Newborn; Methimazole; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Thyrotoxicosis

We report a case of amiodarone-induced thyrotoxicosis, and a broad review of the literature. Amiodarone is a drug widely used in cardiovascular medicine. Since it is iodine-rich, it may cause changes in thyroid function tests in some patients under chronic treatment. In 14-18% of amiodarone-treated patients, there is overt thyroid dysfunction (hypothyroidism or thyrotoxicosis). We here describe thyrotoxicosis, which can be distinguished in two subtypes differing in pathogenesis and treatment. Type I is primarily related to an excess of iodine-induced thyroid hormone synthesis in an abnormal thyroid gland, and the main medical treatment consists of the simultaneous administration of thionamides and potassium perchlorate. Type II is due to amiodarone-related destructive thyroiditis and glucocorticoids are therapy of choice. Mixed forms frequently exist. Due to the low thyroidal iodine uptake, radioiodine therapy is usually not efficacious. Surgical treatment can be performed in cases resistant to medical therapy.

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Cardiomyopathy, Hypertrophic, Familial; Humans; Male; Methimazole; Tachycardia, Ventricular; Thyrotoxicosis; Treatment Outcome

A 48-year-old woman who was treated for thyrotoxicosis with methimazole developed agranulocytosis. The methimazole was stopped and treatment with subcutaneous granulocyte colony-stimulating factor (G-CSF) was initiated. Administration of the drug for 8 days did not effectively shorten the recovery period compared with the average reported in the literature without the drug, and may have triggered additional iatrogenic complications. A search of the literature yielded 15 instances of severe antithyroid-drug-induced granulocytopenia (ATDIA) (granulocyte count of less than 0.1 x 10(9)/L) treated with G-CSF. Of the 16 patients, including the 1 reported here, only 3 displayed significant shortening of the agranulocytic period after treatment. We conclude that routine therapeutic application of G-CSF in afebrile severe ATDIG is not justified, and in some cases may generate a cascade of iatrogenic adverse events.

Topics: Aged; Agranulocytosis; Antithyroid Agents; Female; Granulocyte Colony-Stimulating Factor; Humans; Methimazole; Thyrotoxicosis; Time Factors

The authors review the current knowledge of fetus and woman thyroid physiology during pregnancy. They analyze the abnormalities related to hyperthyroidism, and clinical and therapeutic aspects of thyrotoxicosis; in detail possible fetal complications. They suggest the practical management of thyrotoxicosis during pregnancy.

Topics: Adolescent; Adult; Embryonic and Fetal Development; Female; Humans; Hyperthyroidism; Maternal-Fetal Exchange; Methimazole; Pregnancy; Pregnancy Complications; Propylthiouracil; Thyrotoxicosis; Thyrotropin

Thyrotoxicosis is a rare condition in pediatric patients, and optimal treatment can be difficult to achieve in some children. To our knowledge, no studies have evaluated sex hormone-binding globulin (SHBG) levels in hyperthyroid children and adolescents in relation to age- and gender-related normative data.. SHBG serum levels were determined before and after 4 months of antithyroid therapy (ATT) in 10 children and adolescents with Graves' disease. A total of 903 healthy children and adolescents served as controls.. Serum SHBG levels were elevated (>2 SD) at diagnosis in all hyperthyroid children but normalized rapidly following ATT. At diagnosis, median SHBG was +2.51 SD (interquartile range 2.20-3.27) compared to healthy children without thyroid illness, and it declined significantly during ATT (-0.16 SD, -0.66 to 1.64; p < 0.05).. This is the first study to demonstrate that serum SHBG levels are markedly increased in children with Graves' disease, and we suggest that SHBG may be an additional marker of thyroid hormone action in children, as has been shown in adults.

Topics: Adolescent; Child; Female; Graves Disease; Humans; Hyperthyroidism; Male; Methimazole; Reference Values; Sex Factors; Sex Hormone-Binding Globulin; Thyrotoxicosis

β-adrenergic antagonists (β-blockers) are often used to attenuate the hyperadrenergic symptoms of Graves' disease (GD), including palpitation. Although β-blockers reduce the heart rate, cardiac output and oxygen consumption, no firm evidence exists regarding the effects of combined therapy with β-blockers and anti-thyroid drugs. The objective is to elucidate the effects of β-blockers on anti-thyroid drug therapy in GD.. Patients newly diagnosed with mild GD were randomly assigned to receive methimazole with or without β-blockers in a prospective multi-center survey. The heart rate and thyroid function were measured and the quality of life was assessed using original and SF-36 questionnaires at 0 and 4 weeks.. A total of 28 patients were enrolled in the study. Fourteen patients (one man, 13 women) were randomly assigned to the group treated with β-blockers and 14 patients (one man, 13 women) were randomly assigned to the group not treated with β-blockers. Although no significant differences in the improvement of thyroid function were observed between the two groups, the heart rates improved more significantly in the group treated with β-blockers. Specific symptoms, such as easy fatigability and shortness of breath, also improved more significantly with the β-blocker treatment. In addition, 'physical functioning' assessed with the SF-36 questionnaires significantly improved only in the group treated with β-blockers.. Although β-blockers may not reinforce the effects of anti-thyroid drugs on thyroid function, at least during the course of one month, they are effective in reducing heart rates and ameliorating specific symptoms in patients with mild GD.

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Drug Therapy, Combination; Dyspnea; Fatigue; Female; Graves Disease; Heart Rate; Humans; Incidence; Male; Methimazole; Middle Aged; Prospective Studies; Quality of Life; Surveys and Questionnaires; Thyroid Gland; Thyrotoxicosis; Treatment Outcome

Percutaneous radiofrequency thermal ablation (RTA) was reported as an effective tool for the management of thyroid nodules (TNs). The aim of this study was to investigate the effects of RTA and to establish whether they were treatment-related by comparison with a matched, untreated control group.. The study population included 40 patients with compressive TNs: 22 had nontoxic TNs, and 18 had toxic TNs and were treated with methimazole. In all patients, a fine-needle aspiration cytology was performed to exclude a thyroid malignancy.. Twenty patients were treated with RTA (group A), and 20 others did not receive any treatment (group B). At baseline, age, gender, and TN features did not differ significantly between groups. All patients were clinically, biochemically, and morphologically evaluated at baseline and after 1, 3, 6, and 12 months.. TN volume significantly decreased in group A (1.8 ± 0.3 ml at 12 months vs. 13.3 ± 1.8 ml at baseline; P < 0.0001) and remained stable in group B [11.7 ± 1.5 ml at 12 months vs. 11.2 ± 1.5 ml at baseline; P = not significant (NS)]. At 3-, 6-, and 12-month evaluations, TN volume was significantly lower in group A than in group B (P < 0.005). At the end of the follow-up, pressure symptoms were improved in all patients in group A but persisted unchanged in group B. In group A, hyperthyroidism completely recovered in 40% and improved in 40% of patients with toxic TNs, whereas it persisted in all patients with toxic TNs in group B. RTA was safe and well tolerated in all patients.. RTA induced a marked TN volume shrinkage resulting in parallel improvement of pressure symptoms. In most patients with toxic TNs, hyperthyroidism significantly improved as well. RTA may represent a valid therapeutic approach in patients with TNs not receiving conventional treatments.

Topics: Adult; Aged; Aged, 80 and over; Antithyroid Agents; Biopsy, Fine-Needle; Catheter Ablation; Combined Modality Therapy; Female; Humans; Male; Matched-Pair Analysis; Methimazole; Middle Aged; Thyroid Nodule; Thyrotoxicosis; Treatment Outcome; Tumor Burden; Ultrasonography

Combined treatment with anti-thyroid drugs (ATDs) and potassium iodide (KI) has been used only for severe thyrotoxicosis or as a pretreatment before urgent thyroidectomy in patients with Graves' disease. We compared methimazole (MMI) treatment with MMI + KI treatment in terms of rapid normalization of thyroid hormones during the early phase and examined the later induction of disease remission.. A total of 134 untreated patients with Graves' disease were randomly assigned to one of four regimens: Group 1, MMI 30 mg; Group 2, MMI 30 mg + KI; Group 3, MMI 15 mg and Group 4, MMI 15 mg + KI. For easy handling, KI tablets were used instead of saturated solution of KI. KI was discontinued when patients showed normal free thyroxine (FT4) levels but MMI was continued with a tapering dosage until remission. Remission rate was examined during a 4- to 5-year observation.. Serum FT4, FT3 and TSH were measured by chemiluminescent immunoassays. TSH receptor antibody (TRAb) was assayed with TRAb-ELISA. Goitre size was estimated by ultrasonography.. After 2 weeks of treatment, normal FT4 was observed in 29% of patients in Group 1 and 59% (P < 0.05) of patients in Group 2. Furthermore, normal FT4 after 2 weeks of treatment was observed in 27% of patients in Group 3 and 54% (P < 0.05) of patients in Group 4. Similarly, FT3 normalized more rapidly in Groups 2 and 4 than in Groups 1 and 3. None of the patients showed an increase in thyroid hormones or aggravation of disease during combined treatment with MMI and KI. The remission rates in Groups 1, 2, 3 and 4 were 34%, 44%, 33% and 51%, respectively, and were higher in the groups receiving combined therapy but differences among four groups did not reach significance.. Combined treatment with MMI and KI improved the short-term control of Graves' hyperthyroidism and was not associated with worsening hyperthyroidism or induction of thionamide resistance.

Topics: Adult; Antithyroid Agents; Drug Administration Schedule; Drug Therapy, Combination; Female; Graves Disease; Humans; Male; Methimazole; Middle Aged; Potassium Iodide; Remission Induction; Risk Assessment; Thyroid Function Tests; Thyroid Hormones; Thyrotoxicosis; Time Factors; Treatment Outcome; Young Adult

Patients with hyperthyroidism occasionally need rapid restoration to the euthyroid state. In view of the increased enterohepatic circulation of thyroxine (T4) and triiodothyronine (T3) in thyrotoxicosis, and metabolic effects of konjac glucomannan in gastrointestinal system, we aimed to determine the activity of glucomannan in treatment of hyperthyroidism.. A prospective, randomized, placebo-controlled, one-blind study design was used with newly diagnosed 48 hyperthyroid patients (30 patients with Graves' disease and 12 with multinodulary goitre). They were assigned to one of the following treatment groups: I) methimazole 2 x 10 mg, propranolol 2 x 20 mg, and glucomannan (Propol) 2 x 1.3 gr daily for two months; II) methimazole 2 x 10 mg, propranolol 2 x 20 mg, and placebo powder daily for two months.. No differences were detected from the point of view of the baseline thyroid hormone levels between groups (p > 0.05). Further analyses revealed that the patients receiving glucomannan at the end of the second, fourth and sixth weeks of the study had significantly lower serum T3, T4, FT3 and FT4 levels than the patients who received placebo (p < 0.05). TSH was not different between the two groups at any specific time (p > 0.05). At week 8, thyroid hormone levels were not shown any differences. The glucomannan-treated group had a more rapid decline in all four serum thyroid hormone levels than the placebo-treated group.. We believe our preliminary results indicate that glucomannan may be a safe and easily tolerated adjunctive therapeutic agent in the treatment of thyrotoxicosis. This combination therapy seems most effect during first weeks of treatment of a hyperthyroid patient.

Topics: Adult; Antithyroid Agents; Drug Therapy, Combination; Female; Graves Disease; Humans; Hyperthyroidism; Male; Mannans; Methimazole; Middle Aged; Propranolol; Prospective Studies; Thyroid Hormones; Thyrotoxicosis; Thyroxine; Treatment Outcome; Triiodothyronine

Hyperthyroidism is associated with altered growth hormone (GH) secretion. Many patients with thyroid dysfunction experience several poorly described complications such as symptoms and signs also seen in patients with growth hormone deficiency (GHD). We have therefore prospectively evaluated a possible relationship between the thyroid function, body composition, leptin levels and insulin-like growth factor (IGF) related peptides in patients with Graves' disease. DESIGN, PATIENTS, AND MEASUREMENTS: In a prospective group of 24 fasting female patients with Graves' disease (mean age (CI 95%): 40 years (33-47)), we measured serum thyroxine, triiodothyronine, thyrotropine (TSH), TSH receptor antibodies, anti-thyroid peroxidase, leptin, body composition, body mass index (BMI) and IGF-related peptides at diagnosis and after 12 months of treatment with thiamazol (ATD).. In thyrotoxic patients IGF-I plus IGF-II correlated positively with IGFBP-3 at baseline (r = 0.90, p < 0.1 x 10(16)) and after 12 months follow-up (r = 0.87, p < 0.1 x 10(-16)). In the thyrotoxic state total IGF-I, IGF-II, IGF binding protein 3 (IGFBP-3) and acid-labile subunit (ALS) but not free IGF-I decreased significantly from 223 microg/L (189-260) (mean (CI 95%), 877 microg/L (801-953), 4165 microg/L (3772-4577) and 22 mg/L (18-26)) to 198 microg/L (172-226), 788 microg/L (711-865), 3431 microg/L (3135-3741) and 19 mg/L (16-26) (p <0.006), respectively, after 12 months of ATD despite an increase in BMI from 22 (21-23) to 23 kg/m(2) (22-25) (p < 0.0004) but no significant changes in leptin.. The complex IGF systems seemed intact in thyrotoxic patients but change in body composition and the regulation of leptin and insulin secretion during treatment of autoimmune thyroid disease influence IGF-related peptides leaving the patient in a state somewhat similar to partial GHD, but the mechanism behind these alterations remains unclear.

Topics: Adult; Body Composition; Female; Graves Disease; Humans; Immunoglobulins, Thyroid-Stimulating; Insulin; Insulin-Like Growth Factor Binding Protein 3; Insulin-Like Growth Factor I; Insulin-Like Growth Factor II; Iodide Peroxidase; Leptin; Male; Methimazole; Middle Aged; Somatomedins; Thyroid Hormones; Thyrotoxicosis

Regardless the autoimmune origin of Graves' disease, the preferred method of its treatment remains antithyroid drug administration. Use of immunosuppressive agents (mostly steroids) is still limited to the therapy of disease complications, such as proliferative ophthalmopathy. The aim of the study was to assess the influence of early immunosuppressive treatment of autoimmune thyrotoxicosis with azathioprine on the course of the disease and the incidence of its complications. The study comprised 64 patients (47 females and 17 males aged 20-43 years) for the first time diagnosed with Graves' disease. The subjects were randomised into two groups. Group I consisted of 28 patients treated only with antithyroid drugs, the remaining 36 subjects additionally receiving azathioprine were included into group II. The dose of both drugs was adjusted during the treatment according to metabolic status of each patients. The treatment was continued for 8-14 months, the follow-up duration after therapy withdrawal was 5 years. Euthyreosis was achieved in all patients 2-8 weeks after treatment initiation. No drug intolerance symptoms were observed in group I. In four patients additionally treated with azathioprine, gastrointestinal side effects or leucopenia were present. The disease relapse was observed during the follow-up period in 15 (53.5%) patients of group I and in 3 (8.3%) of group II, the difference was statistically significant (p<0.01). Only one patient receiving additionally azathioprine presented ophthalmic symptoms compared with seven subjects (25%) treated only with antithyroid drugs (p<0.001). The patients of group I were also more frequently referred to surgical treatment due to rapid goitre growth (accordingly 5 (17.8%) and 1 (2.7%) patients, p=0.07), the difference between both groups not being statistically significant.. Additional early immunosuppressive treatment significantly decreased frequency of Graves' disease complications and thyrotoxicosis recurrence. The use of azathioprine may be advised in patients with contraindications to the radical Graves' disease treatment and in prophylaxis of its complications.

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Azathioprine; Drug Therapy, Combination; Female; Graves Disease; Humans; Immunosuppressive Agents; Male; Methimazole; Thyrotoxicosis; Treatment Outcome

Amiodarone-induced thyrotoxicosis (AIT) is a complex therapeutic challenge. Two major forms have been described: type I and type II. Methimazole (MMI) and potassium perchlorate (KCLO(4)) is the treatment of choice for the former, whereas corticosteroids are used for the latter. However, mixed forms appear frequently and it is not easy to prescribe corticosteroids because of side effects. The present study investigated the validity of a stepwise therapeutic approach to AIT. Twenty patients with AIT were given 30-50 mg/d of MMI and 1000 mg/d of KCLO(4) initially for a month. Euthyroidism or a significant decrease in serum thyroid hormone levels could be achieved in 12 of the patients (7 with type I, 5 type II). Prednisolone, 40-48 mg/d was added for the 8 nonresponding patients (7 type I, 1 type II) and euthyroidism was achieved in all. The prednisolone dose was decreased when free thyroxine (T(4)) levels normalized, and MMI was titrated, maintaining euthyroidism until urinary iodine excretion normalized. Mixed forms of AIT may prevail in iodine-deficient areas. Initial classification of the patients may cause unnecessary corticosteroid use in a substantial number of patients with AIT. A stepwise approach is feasible; however, when the patient is gravely ill, MMI, KCLO(4), and prednisolone could be prescribed simultaneously.

Topics: Amiodarone; Anti-Arrhythmia Agents; Anti-Inflammatory Agents; Antibodies; Antithyroid Agents; Female; Humans; Iodides; Iodine; Male; Methimazole; Middle Aged; Perchlorates; Potassium Compounds; Prednisolone; Prospective Studies; Thyroid Gland; Thyrotoxicosis; Thyroxine; Ultrasonography

For many years, breast-feeding was forbidden if methimazole (MMI) was being used. However, a few studies have demonstrated the relative safety of MMI. The purpose of this study was to evaluate thyroid function of breast-fed infants whose lactating mothers became hypothyroid while taking methimazole. Between 1990 and 2001, 134 thyrotoxic lactating mothers received MMI while breast-feeding. MMI therapy was initiated between 2-8 months postpartum, 10-30 mg for the first month and 5-10 mg from the second until the twelfth month. In 16 mothers, TSH was increased at the end of one month of MMI therapy (Group 1). Infants of 18 mothers whose serum TSH was normal at the end of the first month were included as controls (Group 2). Mothers and their infants were clinically evaluated and serum T4, T3 and TSH were measured before and at 1, 2, 4, 8 and 12 months after MMI therapy. Serum MMI was measured in 8 infants 2 h after breast-feeding. Mean +/- SD of FT4I and FT3I were not statistically different between the two groups of mothers before MMI therapy. In all 34 mothers thyroid indices decreased one month after MMI therapy; FT4I: Group 1 from 19.8 +/- 4.3 to 6.0 +/- 4.8 (p<0.001) and Group 2 from 20.3 +/- 4.7 to 11.4 +/- 4.1 (p<0.001); FT3I: Group 1 from 602 +/- 56 to 146 +/- 52 (p<0.001) and Group 2 from 562 +/- 42 to 186 +/- 39 (p<0.001). The difference in FT4I, FT3I and TSH (20 +/- 18 vs 2.1 +/- 1.1 mU/l, p<0.001) between the 2 groups was significant at the end of the first month of MMI therapy. There was no significant difference in thyroid function of infants of these two groups one month after MMI therapy and all tests remained within the normal range during 12 months of treatment of their lactating mothers. Serum MMI levels were less than 0.03 in 6 and 0.03 and 0.035 microg/ml in the other 2 infants. The results further indicate the safety of MMI therapy in breast-feeding thyrotoxic women.

Topics: Adult; Antithyroid Agents; Breast Feeding; Chi-Square Distribution; Contraindications; Female; Follow-Up Studies; Humans; Hypothyroidism; Infant; Lactation; Methimazole; Milk, Human; Puerperal Disorders; Retrospective Studies; Thyroid Function Tests; Thyroid Gland; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine

Acute changes in thyroid hormone levels before and after radioiodine therapy for Graves' disease were compared in 42 patients randomized to receive either antithyroid drug pretreatment or no pretreatment. Five patients (11.9%), including 3 in the pretreatment arm and 2 in the no pretreatment arm experienced a late exacerbation of thyrotoxicosis after radioiodine therapy. The majority (19 of 21, 90.5%) of pretreated patients experienced a transient increase in free T(4) and free T(3) after discontinuation of antithyroid drugs, with little further elevation after radioiodine therapy. After stopping antithyroid drugs and before radioiodine administration, mean serum free T(4) values rose from 14.7 +/- 6.9 to 21.6 +/- 12.1 pmol/L, representing a 46.9% increase, whereas serum free T(3) levels rose from 4.9 +/- 1.7 to 8.1 +/- 6.3 pmol/L, representing a 65.3% increase. The average pretreated patient experienced a 52.4% increase [95% confidence interval (CI), +26.4% to +78.5%] in free T(4) and a 61.8% increase (95% CI, +23.5% to +100.0%) in free T(3). Conversely, the majority (19 of 21, 90.5%) of nonpretreated patients experienced a rapid decline in thyroid hormone levels after radioiodine treatment. Over the 14 days after radioiodine therapy mean free T(4) values in nonpretreated patients fell from 85.8 +/- 60.4 to 58.0 +/- 76.5 pmol/L, representing a 32.4% decrease, whereas mean free T(3) levels fell from 16.1 +/- 8.0 to 10.8 +/- 11.1 pmol/L, representing a 32.9% decrease. The average nonpretreated patient experienced a 20.6% decrease (95% CI, -47.3% to +7.0%) in free T(4) and a 24.3% decrease (95% CI, -1.2% to -47.4%) in free T(3) during this time period. Excluding 2 patients with a late exacerbation after radioiodine, 19 nonpretreated patients experienced a decrease in mean free T(4) values from 76.8 +/- 46.6 to 36.6 +/- 19.8 pmol/L, representing a 52.3% decrease, whereas mean free T(3) levels fell from 15.5 +/- 7.7 to 7.8 +/- 3.6 pmol/L, representing a 49.7% decrease. The average decrease in free T(4) levels among this subgroup of patients was 30.1% (95% CI, -4.6% to -55.6%), whereas the average decrease in free T(3) was 34.4% (95% CI, -13.7% to -55.1%). High levels of TSH receptor autoantibodies at diagnosis were associated with an acute worsening of thyrotoxicosis after stopping antithyroid drug pretreatment. We conclude that pretreatment with antithyroid drugs does not protect against worsening thyrotoxicosis after radioiodine, but may allow such patients

Topics: Adult; Antithyroid Agents; Female; Graves Disease; Humans; Iodine Radioisotopes; Male; Methimazole; Middle Aged; Prospective Studies; Thyroid Hormones; Thyrotoxicosis; Thyroxine; Triiodothyronine

For many years, breast-feeding was forbidden if antithyroid drugs were being used. Recently, limited studies have shown the relative safety of propylthiouracil and methimazole (MMI). It is not known whether MMI therapy of lactating mothers for 1 yr is safe for breast-fed infants and does not cause alterations in thyroid function and intellectual development. Between 1988 and 1998, 139 thyrotoxic lactating mothers and their infants were studied. Fifty-one thyrotoxic lactating mothers were treated with MMI during pregnancy, and MMI was continued during breast-feeding. Eighty-eight mothers were given 10 mg MMI (n 46) or 20 mg MMI (n = 42) daily for 1 month, 10 mg daily for the second month, and 5-10 mg daily thereafter. Serum T4, T3, and TSH concentrations were measured in thyrotoxic lactating mothers and their infants, before and at 1, 2, 4, 8, and 12 months. Serum MMI was measured in the infants of thyrotoxic lactating mothers taking 20 mg MMI. Thyroid function, urinary iodine, thyroid antibodies, intelligence quotient (IQ), verbal and functional components (Wechsler and Goodenough tests) were performed on 14 children of thyrotoxic lactating mothers between 48 and 74 months of age and on 17 controls. Mean +/- SD of FT4I in thyrotoxic lactating mothers treated with 10 mg MMI for 1 month decreased from 19.4 +/- 4.1 to 11.6 +/- 4.4 and from 20.5 +/- 4.7 to 9.8 +/- 1.5 when treated with 20 mg MMI. Values for FT3I decreased from 462 +/- 52 to 194 +/- 52 with 10 mg MMI and from 481 +/- 92 to 171 +/- 38 with 20 mg MMI. FT4I and FT3I were normal from the third to the twelfth months. In all infants FT4I, FT3I, and TSH concentrations were normal before and up to 12 months of MMI therapy in their lactating mothers. The lowest T4 and T3 values were 108 and 1.87 nmol/L, and the highest TSH value was 4.0 mU/L. Serum MMI levels in infants were less than 0.03 microg/mL. Six mothers receiving 20 mg MMI had increased serum TSH concentrations ranging from 26-135 mU/L after 1 month of treatment. Their infants were euthyroid with serum TSH values less than 2.6 mU/L. At 48-74 months of age, height, weight, FT4I, FT3I, TSH, and antithyroid antibody titers were not different than controls. The mean IQ was 107 +/- 14 vs. 106 +/- 16 (Goodenough test) and 103 +/- 10 vs. 103 +/- 16 (Wechsler test) for infants of thyrotoxic lactating mothers and control infants, respectively. Similarly, there was no difference in verbal and performance IQ and their components between infants of thyrot

Topics: Adult; Antithyroid Agents; Breast Feeding; Female; Humans; Hyperthyroidism; Infant, Newborn; Intelligence; Intelligence Tests; Methimazole; Thyroid Function Tests; Thyroid Gland; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine

Low bone mineral density (BMD) and increased bone turnover are common features of untreated hyperthyroidism in adult patients. The effect of treatment on BMD is still controversial. BMD and bone metabolism in hyperthyroid children have not been thoroughly investigated. In the present study, we measured spinal and whole body BMD by dual-energy X-ray absorptiometry in a group of 13 girls (aged 5.0-14.9 years) at diagnosis of hyperthyroidism. The bone resorption rate was assessed by urine measurement of N-terminal telopeptide of type I collagen (NTX). Hyperthyroid patients have been studied longitudinally during treatment. BMD values and NTX urine concentrations have been also determined in 155 healthy Caucasian girls (aged 2.4-24.2 years). Spinal and whole body bone density measurements were significantly lower compared with healthy controls in untreated hyperthyroid girls, after correction for differences in age and anthropometric measurements (p

Topics: Adolescent; Adult; Antithyroid Agents; Biomarkers; Bone Density; Bone Resorption; Child; Child, Preschool; Collagen; Collagen Type I; Creatinine; Female; Humans; Hyperthyroidism; Longitudinal Studies; Methimazole; Peptides; Thyrotoxicosis; Thyroxine

Accelerated metabolism is a hallmark of thyrotoxicosis, but the underlying biochemical mechanisms are incompletely understood. In order to elucidate these metabolic events further, we studied 12 patients with newly diagnosed diffuse (10 patients) or nodular (two patients) toxic goitre (ten women, two men; age 42.8 +/- 3.2 yr; BMI: 21.6 +/- 0.7 kg/m2) before ("TOX") and after ("TRE") 11.2 +/- 1.0 weeks treatment with methimazole and compared these patients to a control group ("CTR") of 11 subjects (nine women, two men; age 40.5 +/- 3.9 yr; BMI 22.5 +/- 1.0 kg/m2). All were studied for three hours in the basal state, using indirect calorimetry, isotope dilution for measurement of glucose turnover and the forearm technique for assessment of muscle metabolism. Prior to treatment patients with thyrotoxicosis were characterized by: Increased (p < 0.05) levels of T3 (3.75 +/- 0.23 [TOX], 1.89 +/- 0.08 [TRE] and 1.75 +/- 0.11 [CTR] nmol/l), resting energy expenditure (130.5 +/- 3.5 [TOX], 107.7 +/- 2.7 [TRE] and 106.3 +/- 3.1 [CTR] percent of predicted), protein oxidation (0.67 +/- 0.03 [TOX], 0.54 +/- 0.06 [TRE] and 0.46 +/- 0.05 [CTR] mg/kg/min), lipid oxidation (1.34 +/- 0.08 [TOX], 1.00 +/- 0.06 [TRE] and 1.02 +/- 0.04 [CTR] mg/kg/min), endogenous glucose production (2.51 +/- 0.13 [TOX], 1.86 +/- 0.12 [TRE] and 1.85 +/- 0.12 [CTR] mg/kg/min), non-oxidative glucose turnover (1.28 +/- 0.16 [TOX], 0.75 +/- 0.18 [TRE] and 0.71 +/- 0.11 [CTR] mg/kg/min) and a 50% increase in total forearm blood flow. Glucose oxidation (1.23 +/- 0.09 [TOX], 1.13 +/- 0.10 [TRE] and 1.13 +/- 0.09 [CTR] mg/kg/min), exchange of substrates in the muscles of the forearm and circulating levels of insulin, C-peptide, growth hormone or glucagon were not influenced by hyperthyroidism. Propranolol (20 mg thrice daily) given to seven of the patients for two days did not affect circulating levels of thyroid hormones, energy expenditure or glucose turnover rates. These results suggest that all major fuel sources contribute to the hypermetabolism of thyrotoxicosis and that augmented non-oxidative glucose metabolism may further aggravate the condition. All abnormalities recede with medical treatment of the disease.

Topics: Adult; Antithyroid Agents; Energy Metabolism; Female; Glucose; Goiter; Goiter, Nodular; Humans; Male; Methimazole; Substrate Cycling; Thyroid Hormones; Thyrotoxicosis

Thyrotoxic patients exhibit increased levels of immune activation molecules (soluble interleukin-2 receptor [sIL-2R], intercellular adhesion molecule-1 [ICAM-1], and endothelial-leukocyte adhesion molecule-1 [ELAM-1]) in serum, although the clinical significance of these measurements remains unclear. In a randomized 4-week study, we have recently shown that in the treatment of hyperthyroidism, the combination of cholestyramine and methimazole (MMI) resulted in faster lowering of serum thyroid-hormone levels than did MMI alone. Stored serial serum samples from patients participating in this randomized treatment trial were analyzed for sIL-2R, soluble ICAM-1 (sICAM-1), and soluble ELAM-1 (sELAM-1). The levels of all three molecules were elevated in patients with hyperthyroidism. Although the levels of sICAM-1 and sELAM-1 remained elevated through the 4-week follow-up period in both groups of patients, the sIL-2R levels (normal levels, 1.0 to 4.2 ng/ml) decreased significantly in the 10 patients who received cholestyramine in addition to MMI (week 0, 14.2 +/- 1.5 ng/ml; week 2, 10.8 +/- 1.2 ng/ml; week 4, 8.9 +/- 1.5 ng/ml). In eight patients who received MMI alone, sIL-2R decreased less rapidly (week 0, 12.3 +/- 1.4 ng/ml; week 2, 12.3 +/- 1.3 ng/ml; week 4, 10.9 +/- 1.3 ng/ml). sICAM-1 and sELAM-1 were elevated at baseline but did not decrease during therapy. In the former group, free thyroxine and free triiodothyronine decreased faster. These data show that levels of sIL-2R in serum, but not those of sICAM-1 and sELAM-1, may be of clinical use in the early follow-up evaluation of medically treated patients.

Topics: Antithyroid Agents; Biomarkers; Cholestyramine Resin; E-Selectin; Female; Graves Disease; Humans; Intercellular Adhesion Molecule-1; Male; Methimazole; Multivariate Analysis; Randomized Controlled Trials as Topic; Receptors, Interleukin-2; Thyroid Hormones; Thyrotoxicosis

The purpose of the present study was to investigate by a computed tomography (CT) the Hounsfield unit (H.U.) of the thyroid in hyperthyroid and euthyroid Graves' disease and destructive thyrotoxicosis. The mean thyroid CT number in 95 controls was 122 +/- 18 H.U. (+/- SD) and did not change significantly with advancing age. The mean thyroid CT number (+/- SD) of 85 +/- 22 H.U. in 60 patients with hyperthyroid Graves' disease was significantly (P < 0.001) lower than either in normal controls or 116 +/- 22 H.U. in 11 patients with euthyroid Graves' disease (P < 0.001). Comparison of thyroid hormones and TSH receptor Ab values of untreated patients with a normal and an abnormally low thyroid CT number showed that serum total and free T3 were significantly (P < 0.05) higher in the latter group than in the former group. With respect to the effect of methimazole (MMI) on the thyroid CT number, in the untreated 10 patients with a low thyroid CT number, the initial mean CT number was 65 +/- 11 H.U. and increased significantly (P < 0.05) to 76 +/- 14 H.U. after treatment with MMI. In contrast, in 6 patients with a normal thyroid CT number prior to therapy, the initial mean thyroid CT number was 102 +/- 11 H.U. and fell significantly (P < 0.05) to 84 +/- 16 H.U. after treatment with MMI.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Female; Graves Disease; Humans; Male; Methimazole; Reference Values; Thyrotoxicosis; Tomography, X-Ray Computed

Initial therapy of thyrotoxicosis usually includes beta-blockade for symptom relief and thionamides to block new thyroid hormone synthesis. In view of the increased enterohepatic circulation of thyroxine (T4) and triiodothyronine (T3) in thyrotoxicosis, we proposed that cholestyramine, an anion exchange resin which binds iodothyronines, when used adjunctively with thionamides and a beta-blocker, would lower serum iodothyronine levels faster than would standard therapy alone.. A double blind placebo-controlled cross-over design was used with patients randomly assigned to either the treatment or control groups. They received their initial treatment for two weeks (Phase 1) followed by a one-week washout period, and then crossed to the opposite treatment for two weeks (Phase 2). Standard therapy included atenolol 50 mg daily, individualized dosages of methimazole and either 4 g of cholestyramine or 4 g of placebo powder four times per day.. Fifteen patients with thyrotoxicosis (14 Graves' disease, 1 toxic adenoma) participated in this study.. Total and free thyroxine and triiodothyronine, as well as thyroid-stimulating immunoglobulin and thyrotrophin-binding inhibitory immunoglobulin, were measured weekly.. Seven patients received cholestyramine and eight patients received placebo during Phase 1. A more rapid decline in all thyroid hormone levels was seen in the cholestyramine-treated group (F = 4-7, P < 0.01) than in the placebo group (F = 2-3.1, P = 0.05). In Phase 2, the eight patients who received cholestyramine showed an additional decline in free thyroxine from weeks one to two, but the overall rate of decline in hormone levels was not different between the groups. Immunoglobulin levels remained unaffected regardless of group, treatment, or time.. We conclude that cholestyramine is a safe and effective adjunctive agent in the treatment of thyrotoxicosis and that its greatest efficacy may be during the first few weeks of treatment.

Topics: Adult; Atenolol; Chemotherapy, Adjuvant; Cholestyramine Resin; Double-Blind Method; Female; Graves Disease; Humans; Male; Methimazole; Middle Aged; Thyroid Hormones; Thyrotoxicosis

Topics: Adolescent; Adult; Drug Therapy, Combination; Female; Humans; Male; Methimazole; Middle Aged; Propranolol; Thyrotoxicosis

Thyrotoxic periodic paralysis (TPP) is an acute complication of hyperthyroidism. Thyrotoxic periodic paralysis is treatable, and the management consists of potassium correction, beta-blockers, and antithyroid drug (ATD) therapy. While TPP is well described in the literature, we describe a case of TPP with urticarial dermographia (UD) that resolved with a short course of antihistamines while continuing ATD therapy. To the best of our knowledge, this is the first reported case of UD after methimazole (MMI) therapy in a TPP patient. A 25-year-old Cambodian active duty male with no significant past medical history presented to the emergency department with acute loss of lower extremity muscle tone with hypokalemia in the setting of previously undiagnosed Graves' disease (GD). He was started on MMI but within 2 weeks developed a rash consistent with UD. This was successfully treated with a second-generation antihistamine while continuing his MMI. Thyrotoxic periodic paralysis is primarily treated by controlling the underlying thyroid disease causing paralysis. Methimazole is commonly chosen as a treatment due to its rapid efficacy and long duration of action. However, adverse effects like UD can occur. Current recommendations are that minor cutaneous reactions can be treated with antihistamines for the management of Graves' disease. However, this case and others show that even moderate reactions can be managed in this manner. In a patient with TPP with UD after treatment with MMI, it is reasonable to attempt a trial of antihistamine before changing to another ATD.

Topics: Adult; Antithyroid Agents; Graves Disease; Humans; Male; Methimazole; Paralysis; Potassium; Thyrotoxicosis

Acute suppurative thyroiditis is an uncommon disorder caused by a bacterial infection, usually presenting with normal thyroid function. It is a serious condition that requires a prompt diagnosis and treatment with antibiotics and supportive measures. A 62 years-old female presented with a painful cervical induration and odynophagia a week after a fish bone had been removed from her pharynx. She was febrile, and tachycardic and, on physical examination, a painful thyroid mass was detected. High inflammatory parameters and thyrotoxicosis were confirmed: thyroid stimulating hormone (TSH) < 0.01 mIU/L (normal range [NR] 0.27-4.2); free thyroxine (FT4) 3.86 ng/dL (NR 0.9-1.7) and anti-TSH receptor antibodies (TRABs) 5.3 U/L (NR < 1.5). Thyroid scintigraphy showed a diffuse uptake of the thyroid parenchyma suggesting Graves disease. Cervical ultrasonography revealed an abscess of the left thyroid lobe of 36 × 36 mm and fine needle aspiration biopsy (FNAB) with partial drainage was performed.

Topics: Abscess; Acute Disease; Female; Graves Disease; Humans; Methimazole; Thyroiditis, Suppurative; Thyrotoxicosis

Extragonadal choriocarcinoma is rare and can be associated with hyperthyroidism when producing very high levels of human chorionic gonadotropin.. Severe thyrotoxicosis can represent an unusual initial presentation of metastatic choriocarcinoma in the setting of extreme elevation of beta-human chorionic gonadotropin. Primary gastric choriocarcinoma is an aggressive malignancy with very poor outcomes. The co-occurrence of severe thyrotoxicosis with advanced primary gastric choriocarcinoma and imminent liver failure complicates management options.

Topics: Choriocarcinoma; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Female; Hepatomegaly; Humans; Hyperthyroidism; Liver Failure; Male; Methimazole; Middle Aged; Neoplasms, Germ Cell and Embryonal; Pregnancy; Stomach Neoplasms; Testicular Neoplasms; Thyrotoxicosis; Tomography, X-Ray Computed

Topics: Electrocardiography; Female; Humans; Infant; Intensive Care Units, Neonatal; Methimazole; Neonatal Sepsis; Propranolol; Tachycardia, Sinus; Thyrotoxicosis; Treatment Outcome

Thyrotoxicosis is the state of thyroid hormone excess. But, in sub-Saharan Africa (SSA), specifically Northern Ethiopia, scientific evidence about thyrotoxicosis and its cardiac complications like dilated cardiomyopathy is limited. Therefore, this study aimed to explore the thyrotoxicosis presentation and management and identify factors associated with dilated cardiomyopathy in a tertiary hospital in Northern Ethiopia.. An institution-based cross-sectional study was conducted in Ayder Comprehensive Specialized Hospital from 2017 to 2018. Data from 200 thyrotoxicosis cases were collected using a structured questionnaire. After describing variables, logistic regression was conducted to identify independent predictors of dilated cardiomyopathy. Statistical significance was declared at p < 0.05.. Mean age at presentation of thyrotoxicosis was 45 years and females accounted for 89 % of the cases. The most frequent etiology was multinodular toxic goiter (51.5 %). As well, the most common symptoms and signs were palpitation and goiter respectively. Thyroid storm occurred in 6 % of the cases. Out of 89 patients subjected to echocardiography, 35 (39.3 %) of them had dilated cardiomyopathy. And, the odds of dilated cardiomyopathy were higher in patients who had atrial fibrillation (AOR = 15.95, 95 % CI:5.89-38.16, p = 0.001) and tachycardia (AOR = 2.73, 95 % CI:1.04-7.15, p = 0.040). All patients took propylthiouracil and 13.0 % of them experienced its side effects. Concerning β-blockers, propranolol was the most commonly (78.5 % of the cases) used drug followed by atenolol (15.0 %). Six patients underwent surgery.. In developing countries like Ethiopia, patients with thyrotoxicosis have no access to methimazole which is the first-line anti-thyroid drug. Besides, they greatly suffer from dilated cardiomyopathy (due to late presentation) and side effects of propylthiouracil. Therefore, we recommend that patients should get adequate health information about thyrotoxicosis and anti-thyroid drugs including their side effects. Additionally, hospitals and other concerned bodies should also avail of TSH tests and methimazole at an affordable cost. Furthermore, community awareness about iodized salt and iodine-rich foods should be enhanced.

Topics: Adolescent; Adult; Antithyroid Agents; Cardiomyopathy, Dilated; Cross-Sectional Studies; Developing Countries; Ethiopia; Female; Goiter, Nodular; Humans; Iodine; Male; Methimazole; Middle Aged; Sodium Chloride, Dietary; Thyrotoxicosis; Young Adult

A patient with underlying Hashimoto's thyroiditis developed amiodarone-induced thyrotoxicosis type 1 that was successfully treated using methimazole in combination with potassium iodide. A 35-year-old woman admitted for perinatal care of twin-to-twin transfusion syndrome was given amiodarone for 7 days for paroxysmal ventricular contraction following pulseless ventricular tachycardia 1 day after delivery. She developed thyrotoxicosis one month after the discontinuation of amiodarone therapy and was negative for thyroid-stimulating hormone receptor antibody. An increased peak velocity of the superior thyroid artery suggested amiodarone-induced thyrotoxicosis type 1. Her thyroid function recovered after combination therapy with methimazole and potassium iodide.

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Female; Hashimoto Disease; Humans; Methimazole; Potassium Iodide; Thyrotoxicosis; Treatment Outcome

The epidemiology and natural history of autonomously functioning thyroid nodules (AFTNs) have not been elucidated. Here we report the pregnant Japanese woman with an AFTN.. The patient was a 31-year-old woman who was hospitalized due to the placenta previa associated with threatened abortion at the 16 weeks of her third pregnancy. At her second pregnancy, she was euthyroid but had a single, 2.3 cm nodule on her right thyroid lobe. Her thyroid hormone level was trended increased with her pregnancy progression, and the thyrotoxic state was remained after delivery. Before her third pregnancy, her hyper-vascular nodule enlarged to 3.4 cm at regular monitoring. When she visited our hospital, she was at 16 weeks of pregnancy and had thyrotoxicosis with negative TSH-receptor antibody. She delivered a baby weighing 2615 g without hypothyroidism at 39 weeks of pregnancy by natural delivery. After delivery, a. This case showed that hCG stimulation during pregnancy caused thyroid nodule enlargement and enhanced thyroid hormone production. The pregnancy could be the pathological stimulus and provides chance to diagnosis for AFTNs.

Topics: Abortion, Threatened; Adult; Antithyroid Agents; Disease Progression; Female; Humans; Methimazole; Placenta Previa; Pregnancy; Pregnancy Complications; Radionuclide Imaging; Thyroid Nodule; Thyrotoxicosis

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Humans; Hypokalemic Periodic Paralysis; Male; Methimazole; Potassium Chloride; Propranolol; Thyrotoxicosis

Agranulocytosis occurs in 0.2-0.5% of patients treated with the antithyroid drugs (ATDs) methimazole and propylthiouracil. The objectives of this study were to evaluate the risk of ATD-related agranulocytosis in patients with amiodarone-induced thyrotoxicosis (AIT), and to compare it with the agranulocytosis risk in patients with thyrotoxicosis due to other etiologies treated with ATDs.. This was a retrospective cohort study. Participants were 14,781 adult patients with thyrotoxicosis, newly treated with an ATD between January 1, 2002, and December 31, 2015. Among them were 593 patients treated by ATDs due to AIT. The main outcome measures were incidence rates and crude and adjusted hazard ratios using univariate and multivariable Cox regression models for ATD-related agranulocytosis within one year of treatment initiation, in association with AIT.. Agranulocytosis occurred in 28 (0.19%) of patients newly treated with methimazole or propylthiouracil during the first year of follow-up. Of these 28 patients, 8/593 (1.35%) were AIT patients and 20/14,188 (0.14%) were thyrotoxic patients that was not AIT related (p < 0.001). Incidence rates were 22 (9.47-43.36) cases/1000 person-years of follow-up in AIT, and 1.79 (1.09-2.76)/1000 person-years of follow-up in non-AIT thyrotoxicosis (p < 0.0001). In univariate Cox regression analysis, risk for ATD agranulocytosis associated with AIT was 9.71 (4.28-22.05) compared to the risk in non-AIT thyrotoxicosis. In a multivariable model, adjusting for age, sex, body mass index, smoking history, year of cohort entry, diabetes mellitus, hypertension, renal failure, beta blockers, calcium channel blockers, anti-aggregants, and dose of ATDs, the risk associated with AIT was 5.70 (2.14-15.21). In a model adjusted for a propensity score to receive amiodarone, risk for ATD agranulocytosis associated with AIT was 6.32 (1.22-32.70).. ATD use is associated with a higher risk for agranulocytosis in patients with AIT.

Topics: Adult; Aged; Agranulocytosis; Amiodarone; Antithyroid Agents; Female; Humans; Male; Methimazole; Middle Aged; Proportional Hazards Models; Propylthiouracil; Retrospective Studies; Risk; Thyrotoxicosis

Syncope is a common emergency department (ED) chief complaint, with many known but also unknown causes. Here we present a novel ED presentation of a young woman with new-onset hyperthyroidism that masqueraded as a syncopal event with head trauma. A 21-year-old woman arrived in the ED with head trauma as the result of seemingly unprovoked syncope, due to her history as well as the nature of her trauma. Persistent tachycardia during her ED course after an unremarkable full trauma evaluation prompted ordering of additional lab testing, which revealed evidence of thyrotoxicosis. Here we consider the possibility of thyroid dysfunction resulting in syncope.

Topics: Antithyroid Agents; Craniocerebral Trauma; Diagnosis, Differential; Electrocardiography; Female; Humans; Methimazole; Syncope; Tachycardia; Thyroid Function Tests; Thyrotoxicosis; Young Adult

Diffuse toxic goiter accounts for about 15% of all childhood thyroid diseases. There is great controversy over the management of Graves' disease in children and adolescents. This article reports our experience in 304 children and juvenile patients with Graves' disease.. Between 1981 and 2015, 304 patients aged 5-19 years with diffuse toxic goiter were studied, of whom 296 patients were treated with antithyroid drugs (ATD) for 18 months. Patients with persistent or relapsed hyperthyroidism who refused ablative therapy with surgery or radioiodine were managed with continuous methimazole (MMI) treatment.. In 304 patients (245 females and 59 males), the mean age was 15.6±2.6 years. After 18 months of ATD therapy, 37 remained in remission and of the 128 who relapsed, two, 29 and 97 patients chose surgery, continuous ATD and radioiodine therapy, respectively. Of the 136 patients who received radioiodine, 66.2% became hypothyroid. Twenty-nine patients received continuous ATD therapy for 5.7±2.4 years. The mean MMI dose was 4.6±12 mg daily, no serious complications occurred and all of them remained euthyroid during the follow-up. Less abnormal thyroid-stimulating hormone (TSH) values were observed in these patients, as compared to patients who were on a maintenance dose of levothyroxine after radioiodine induced hypothyroidism.. Original treatment with ATD and subsequent radioiodine therapy remain the mainstay of treatment for juvenile hyperthyroidism. Continuous ATD administration may be considered as another treatment modality for hyperthyroidism.

Topics: Adolescent; Adult; Antithyroid Agents; Child; Child, Preschool; Combined Modality Therapy; Female; Follow-Up Studies; Goiter; Hospitals, University; Humans; Iodine Radioisotopes; Iran; Male; Methimazole; Outpatient Clinics, Hospital; Patient Acceptance of Health Care; Radiopharmaceuticals; Recurrence; Remission Induction; Retrospective Studies; Thyroid Gland; Thyrotoxicosis; Young Adult

Thyrotropin-secreting adenoma (TSHoma) is rare. Even though the thyrotoxicosis is mild in patients with TSHoma, it is still a rare cause of arrhythmia, ignore of mild disfunction of thyroid function of TSHoma can lead to the delayed diagnosis of pituitary tumor or leading to recurring of complications. Graves' disease is an auto-immue endocrinological disorder. Association of TSHoma and Graves's disease is extremely rare. Coexistence of these two diseases made the diagnosis and treatment complicated.. This patient was a 55-year-old man who had been referred to the department of endocrinology and metabolism of the West China Hospital due to recurrent atrial fibrillation (AF) and thyroxicosis.. Examinations revealed pituitary thyrotropin-secreting macroadenoma with Graves' disease.. We conducted transsphenoidal surgery. Thyrozol was used to treat the recurrence of Graves' disease after pituitary surgery.. The TSHoma was successfully cured, and recurrent Graves' disease was controlled very well.. The association of TSHoma and Graves' disease is extremely rare. Even though the clinical features of thyrotoxicosis are milder in patients with TSHoma, thyroid function tests are still important clinical assessment of patients with AF, which is an arrhythmia associated with hyperthyroidism. TSHoma is a rare cause of thyrotoxicosis; however, ignoring of the mild disfunction caused by TSHoma can lead to the delayed diagnosis of pituitary tumors or to recurring of complications of TSHoma.

Topics: Antithyroid Agents; Atrial Fibrillation; Catheter Ablation; China; Graves Disease; Humans; Magnetic Resonance Imaging; Male; Methimazole; Middle Aged; Neurosurgical Procedures; Pituitary Gland; Pituitary Neoplasms; Recurrence; Thyrotoxicosis; Thyrotropin

Thyrotoxicosis and diabetic ketoacidosis (DKA) both may present as endocrine emergencies and may have devastating consequences if not diagnosed and managed promptly and effectively. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other. Furthermore, thyrotoxicosis is complicated by some degree of cardiomyopathy in at least 5% de patients; but the coexistence of DKA, thyroxin (T₄) toxicosis, and acute cardiomyopathy is extremely rare. We describe a case of a man, previously diagnosed with DM but with no past history of thyroid disease, who presented with shock and severe DKA that did not improve despite optimal therapy. The patient evolved with acute pulmonary edema, elevated troponin levels, severe left ventricular systolic dysfunction, and clinical and laboratory evidence of thyroxin (T₄) toxicosis and thyrotoxic cardiomyopathy. Subsequently, the patient evolved favorably with general support and appropriate therapy for DKA and thyrotoxicosis (hydrocortisone, methimazole, Lugol's solution) and was discharged a few days later.

Topics: Adult; Cardiomyopathies; Diabetic Ketoacidosis; Diagnosis, Differential; Echocardiography; Heart Failure, Systolic; Humans; Hydrocortisone; Iodides; Male; Methimazole; Pulmonary Edema; Radiography; Thyrotoxicosis; Treatment Outcome; Troponin

We report the case of a 61-year-old woman with persistent thyrotoxicosis for 7 years despite low thyroidal radioiodine uptake and methimazole treatment. Her initial I whole-body scan (WBS) was read as negative. Upon evaluation in our institution, she remained hyperthyroid after discontinuation of methimazole. Repeat WBS with SPECT/CT revealed low 24-hour thyroidal uptake (RAIU = 2%) and intensely focal radioiodine uptake in a large heterogeneous left pelvic mass, consistent with left adnexal struma ovarii. Resection of this mass confirmed benign struma ovarii. This case illustrates the advantage of fusion SPECT/CT imaging with planar I-WBS for diagnosis of extrathyroidal thyrotoxicosis.

Topics: Female; Humans; Iodine Radioisotopes; Methimazole; Middle Aged; Single Photon Emission Computed Tomography Computed Tomography; Struma Ovarii; Thyrotoxicosis; Whole Body Imaging

Treatment choices are limited, when deciding how to manage thyrotoxicosis and moderate to severe Graves ophthalmopathy (GO) with suspected optic nerve damage in patients with elevated liver transaminase levels. The situation become even more complicated, if methimazole induced hepatotoxicity is suspected and intravenous methylprednisolone is co-administrated.. A 74-year-old woman presented with spontaneous retro-bulbar pain, eyelid swelling and inconstant diplopia.. Thyrotoxicosis and severe GO with suspected optic nerve damage and drug induced liver injury (DILI).. Intravenous methylprednisolone pulse therapy was administered to treat GO and methimazole was continued for thyrotoxicosis. Dose of methimazole was reduced after exclusion of concurrent infection and active liver disease.. The GO symptoms (eyelid swelling, sight loss, proptosis, retro-bulbar pain, diplopia) markedly decreased after the treatment course. Liver transaminases spontaneously returned to normal ranges and remained normal during the next 12 months until the Graves' disease until the treatment was completed.. 1. The interaction of methimazole and methylprednisolone may result in DILI. 2. In a patient without concomitant liver diseases MP can be continued if the methimazole dose is reduced if no other treatment options are available.

Topics: Administration, Intravenous; Aged; Antithyroid Agents; Chemical and Drug Induced Liver Injury; Dose-Response Relationship, Drug; Female; Glucocorticoids; Graves Ophthalmopathy; Humans; Liver Function Tests; Medication Therapy Management; Methimazole; Methylprednisolone; Optic Nerve Diseases; Pulse Therapy, Drug; Symptom Assessment; Thyrotoxicosis; Treatment Outcome

Topics: Acute Disease; Adult; Drug Therapy, Combination; Emergency Service, Hospital; Follow-Up Studies; Humans; Hypokalemia; Lower Extremity; Male; Methimazole; Paralysis; Potassium; Propranolol; Recovery of Function; Thyrotoxicosis; Treatment Outcome

Thyrotoxic periodic paralysis is a potentially life-threatening condition associated with recurrent episodes of muscle weakness and hypokalaemia due to hyperthyroidism. Diagnosis is often delayed or misdiagnosed due to its rarity in the western world and subtle features of hyperthyroidism on initial presentation. Here we present the case of a 25-year-old man who presented to the emergency department (ED) with sudden onset weakness of bilateral upper and lower extremities. His labs revealed hypokalaemia with elevated T4 and suppressed thyroid-stimulating hormone and he was diagnosed with thyrotoxic periodic paralysis. He was treated with potassium repletion, atenolol and methimazole with complete reversal of his paralysis within the next day. Unfortunately, he failed to keep the follow-up appointment after discharge, ran out of his methimazole and landed up in the ED again.

Topics: Adrenergic beta-1 Receptor Antagonists; Adult; Antithyroid Agents; Atenolol; Humans; Hypokalemia; Hypokalemic Periodic Paralysis; Male; Methimazole; Potassium; Thyrotoxicosis; Thyrotropin; Thyroxine

Topics: Abortion, Therapeutic; Adult; Antithyroid Agents; Cardiopulmonary Resuscitation; Female; Heart Arrest; Humans; Hyperemesis Gravidarum; Hyperthyroidism; Methimazole; Pregnancy; Pregnancy Complications; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine; Ventricular Fibrillation

Thyrotoxicosis after total thyroidectomy is mostly iatrogenic. Rarely, a hyperfunctional thyroid remnant or ectopic tissue may be the cause. There are few cases of Graves' disease arising from thyroid tissue located in the mediastinum and none in which Graves' disease was diagnosed only after surgery. We report the case of a patient with Graves's disease in a mediastinal thyroid mass presenting 7 years after total thyroidectomy for nontoxic goiter.. A 67-year-old Caucasian woman presented with palpitations, fatigue and weight loss. She had a history of total thyroidectomy for nontoxic multinodular goiter at the age of 60 without any signs of malignancy on microscopic examination. She had been medicated with levothyroxine 100 μg/day since the surgery without follow-up. She was tachycardic, had no cervical mass or eye involvement. Her thyroid-stimulating hormone levels were suppressed (0.000 μU/mL) and her free thyroxine (3.22 ng/dL) and free triiodothyronine (8.46 pg/mL) levels increased. Neither mediastinal enlargement nor trachea deviation was found on chest roentgenogram. Levothyroxine treatment was stopped but our patient showed no improvement on free thyroxine or free triiodothyronine 10 days later. Thyroglobulin was increased to 294 mg/mL. A cervical ultrasound scan revealed no thyroid remnant. Her anti-thyroid-stimulating hormone receptor antibodies were high (19.7 U/L). Corporal scintigraphy demonstrated increased intrathoracic radioiodine uptake. A computed tomography scan confirmed a 60 × 40 mm mediastinal mass. Methimazole 10 mg/day was started. Three months later, her thyroid function was normal and she underwent surgical resection. Microscopic examination showed thyroid tissue with no signs of malignancy.. Although thyrotoxicosis after total thyroidectomy is mostly due to excessive supplementation, true hyperthyroidism may rarely be the cause, which should be kept in mind. The presence of thyroid tissue after total thyroidectomy in our patient may correspond to a remnant or ectopic thyroid tissue that became hyperfunctional in the presence of anti- thyroid-stimulating hormone receptor antibodies.

Topics: Aged; Antithyroid Agents; Fatigue; Female; Goiter; Graves Disease; Humans; Mediastinal Diseases; Methimazole; Thyroidectomy; Thyrotoxicosis; Thyroxine; Tomography, Emission-Computed; Treatment Outcome; Weight Loss

Overt hyperthyroidism and methimazole (MMI) treatment are frequently associated with abnormal liver function tests (LFTs). We describe the serial changes of LFTs in MMI-treated hyperthyroid patients.. We retrospectively analyzed all 77 patients presenting with newly diagnosed overt hyperthyroidism (59 Graves diseases, 11 toxic nodular goiters, 4 toxic adenomas, 3 amiodarone-induced thyrotoxicosis) between 2012 and 2014. All patients started MMI at 10 to 60 mg/day that was gradually tapered. We measured thyroid-stimulating hormone, free thyroxine, alanine aminotransferase (ALT) and aspartate aminotrasnferase (AST) at baseline and at 6 weeks, 4.5 months and 10 months after starting the MMI treatment. The concomitant medication was stable during MMI treatment.. At baseline, 25 patients (32.5%) had abnormal LFT, of which 5 had ALT or AST levels >2× the upper limit of normal (ULN). In most patients with baseline abnormal LFT, MMI treatment resulted in a normalization of serum ALT and AST. Thirteen patients with normal baseline LFT had <2× the ULN elevations of LFT sometime during treatment. There was a case of significant hepatotoxicity. During treatment, there were no significant differences in LFT levels between patients with initially normal or abnormal LFT. In a Cox proportional hazard regression model, abnormal LFT at baseline, abnormal thyroid function at the last evaluation, and MMI dose were not predictors of abnormal LFT at the final evaluation.. MMI treatment can induce insignificant LFT elevation, <2× the ULN. MMI can be safely administered in hyperthyroid patients with abnormal LFT, and normalization of increased AST and ALT levels should be anticipated.. ALT = alanine aminotransferase AST = aspartate aminotransferase fT4 = free thyroxine HCV = hepatitis C virus LFT = liver function test LOCF = last observation carried forward MMI = methimazole PTU = propylthiouracil TSH = thyroid-stimulating hormone ULN = upper limit of normal.

Topics: Adult; Aged; Alanine Transaminase; Antithyroid Agents; Aspartate Aminotransferases; Female; Humans; Hyperthyroidism; Liver; Liver Function Tests; Male; Methimazole; Middle Aged; Thyrotoxicosis

Amiodarone-induced thyrotoxicosis (AIT) type I describes inducement of clinical hyperthyroidism by excessive thyroidal iodine in the setting of latent Graves disease, and therapy differs from that used for AIT type II. A 65-year-old man previously on amiodarone for atrial fibrillation developed clinical hyperthyroidism. Diagnosis of AIT was made, but the type was not clear. Tc sestamibi thyroid scan showed diffusely increased uptake and retention in an enlarged thyroid gland, a pattern consistent with AIT type I. Methimazole was initiated and controlled the thyrotoxicosis. I iodide thyroid scan and uptake study performed later was consistent with Graves disease.

Topics: Aged; Amiodarone; Antithyroid Agents; Graves Disease; Humans; Male; Methimazole; Potassium Channel Blockers; Radionuclide Imaging; Technetium Tc 99m Sestamibi; Thyrotoxicosis

Topics: Adult; Anti-Arrhythmia Agents; Antithyroid Agents; Humans; Hypokalemic Periodic Paralysis; Male; Methimazole; Metoprolol; Muscle Strength; Potassium; Tachycardia, Sinus; Thyroid Gland; Thyroid Hormones; Thyrotoxicosis; Treatment Outcome; Ultrasonography

Topics: Adult; Antithyroid Agents; Biomarkers; Electrocardiography; Graves Disease; Humans; Hypokalemic Periodic Paralysis; Male; Methimazole; Potassium Chloride; Thyrotoxicosis; Treatment Outcome; Turkey

Race/ethnicity may be a newly recognized risk factor for Graves' disease.. The aim of this study was to examine the prevalence of thyrotoxicosis by race/ethnicity in Americans aged 12-49 years using three National Health and Nutritional Examination Surveys (NHANES).. Data were analyzed from 17,939 participants in NHANES III (1988-1994), NHANES 1999-2002, and NHANES 2007-2010 with available thyroid function test results. Thyrotoxicosis was defined as a serum thyrotropin (TSH) of ≤0.1 mIU/L or subjects taking methimazole or propylthiouracil, and overt thyrotoxicosis was defined as high serum thyroxine and a serum TSH of ≤0.1 mIU/L. Logistic regression was performed accounting for the complex sampling design of NHANES, and the results from all three NHANES surveys were combined using a random-effects model.. There were 75 study participants with point prevalent thyrotoxicosis, representing a pooled prevalence of 0.4% for Americans aged 12-49 years. Prevalent thyrotoxicosis was nearly three times more likely in non-Hispanic black subjects compared with non-Hispanic whites (OR=2.9 [CI 1.5-5.7]), while there was no difference between the prevalence of thyrotoxicosis in Mexican Americans compared to non-Hispanic whites (OR=1.2 [CI 0.6-2.4]; I2 for heterogeneity=0% for both). Among 27 patients with overt thyrotoxicosis, the odds ratio was 8.7 [CI 0.7-112.6] for non-Hispanic blacks and 4.6 [CI 0.4-59.3] for Mexican Americans compared with non-Hispanic whites.. The results suggest there are race/ethnicity differences in the prevalence of thyrotoxicosis. Future studies should address whether these differences are due to heritable factors, environmental exposures, or a combination of both.

Topics: Adolescent; Adult; Antithyroid Agents; Black or African American; Child; Cross-Sectional Studies; Female; Humans; Logistic Models; Male; Methimazole; Mexican Americans; Middle Aged; Nutrition Surveys; Prevalence; Propylthiouracil; Risk Factors; Thyrotoxicosis; Thyrotropin; United States; White People; Young Adult

Increasing attention has focused on the prevalence and outcomes of hyperthyroidism in pregnancy, given concerns for hepatotoxicity and embryopathy associated with antithyroid drugs (ATDs).. In an integrated health care delivery system, we examined the prevalence of thyrotoxicosis and gestational ATD use (propylthiouracil [PTU] or methimazole [MMI]) in women with delivered pregnancies from 1996 to 2010. Birth outcomes were compared among all infants and those born to mothers with diagnosed thyrotoxicosis or ATD therapy during gestation, with examination of ATD-associated hepatotoxicity and congenital malformations in the latter subgroups.. Among 453,586 mother-infant pairs (maternal age 29.7±6.0 years, 57.1% nonwhite), 3.77 per 1000 women had diagnosed thyrotoxicosis and 1.29 per 1000 had gestational ATD exposure (86.5% PTU, 5.1% MMI, 8.4% both). Maternal PTU-associated hepatotoxicity occurred with a frequency of 1.80 per 1000 pregnancies. Infants of mothers with diagnosed thyrotoxicosis (odds ratio [OR] 1.28, 95% confidence interval [CI 1.05-1.55]) or gestational ATD use (OR 1.31 [1.00-1.72]) had an increased risk of preterm birth compared to those born to mothers without thyrotoxicosis or ATD. The risk of neonatal intensive care unit (NICU) admission was also higher with maternal thyrotoxicosis (OR 1.30 [1.07-1.59]) and ATD exposure (OR 1.64 [CI 1.26-2.13]), adjusting for prematurity. Congenital malformation rates were low and similar among infants born to mothers with thyrotoxicosis or ATD exposure (30-44 per 1000 infants).. Gestational ATD exposure occurred in 1.29 per 1000 mother-infant pairs while a much larger number had maternal diagnosed thyrotoxicosis but no drug exposure during pregnancy. Infants of mothers with gestational ATD use or diagnosed thyrotoxicosis were more likely to be preterm and admitted to the NICU. The rates of congenital malformation were low for mothers diagnosed with thyrotoxicosis and did not differ by ATD use. Among women with gestational PTU therapy, the frequency of PTU-associated hepatotoxicity was 1.8 per 1000 delivered pregnancies. These findings from a large, population-based cohort provide generalizable estimates of maternal and infant risks associated with maternal thyrotoxicosis and related pharmacotherapy.

Topics: Adult; Antithyroid Agents; Chemical and Drug Induced Liver Injury; Cohort Studies; Congenital Abnormalities; Delivery of Health Care, Integrated; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Methimazole; Pregnancy; Pregnancy Complications; Premature Birth; Prevalence; Propylthiouracil; Thyrotoxicosis; Young Adult

Neonatal immune hyperthyroidism is a rare but potentially fatal condition. It occurs in 1-5% of infants born to women with Graves' disease (GD). In most of the cases it is due to maternal antibodies transferred from the mother into the fetal compartment, stimulating the fetal thyroid by binding thyrotropin (thyroid-stimulating hormone, TSH) receptor. We present a case of neonatal thyrotoxicosis due to maternal GD detected at 25 days of age and discuss the potential pitfalls in the diagnosis.

Topics: Antithyroid Agents; Female; Graves Disease; Humans; Infant, Newborn; Iodides; Male; Methimazole; Pregnancy; Pregnancy Complications; Propranolol; Thyrotoxicosis

To evaluate the effect of idiopathic orthostatic edema and the effect of thyrotoxicosis on weight fluctuation and fluid retention in the presence of surgically induced panhypopituitarism and diabetes insipidus controlled with hormone replacement.. Dextroamphetamine sulfate was used for weight gain when no other etiologic factor was found. Methimazole was used when weight loss occurred when serum T4 and free T4 indicated thyrotoxicosis.. Sympathomimetic amine therapy very effectively controlled the weight gain and methimazole controlled the weight loss.. Hypopituitarism and diabetes insipidus controlled with hormone replacement do not protect against fluid retention from idiopathic edema.

Topics: Antidiuretic Agents; Antithyroid Agents; Deamino Arginine Vasopressin; Dextroamphetamine; Diabetes Insipidus; Edema; Female; Humans; Hypopituitarism; Methimazole; Middle Aged; Posture; Sympathomimetics; Thyrotoxicosis; Weight Gain; Weight Loss

Therapeutic plasma exchange (TPE) is one possible treatment for patients resistant to conventional antithyroid drugs or requiring urgent attention for thyrotoxicosis. We report a 35-yr-old man with thyrotoxicosis, ultimately attributed to Graves' disease in whom antithyroid drug used initially was soon discontinued, due to abnormal liver function, and replaced by Lugol's solution. Three weeks later, an escape phenomenon (to Lugol's solution) was apparent, so we performed TPE to control the thyrotoxicosis. Two courses of TPE by a centrifugal type machine resulted in diminished levels of thyroid hormone levels, which then rebounded after another two courses of membrane filtration type TPE. However, the patient could be treated with radioactive iodine therapy without any complications at present.

Topics: Adult; Antithyroid Agents; Cetirizine; Graves Disease; Hepatitis B, Chronic; Humans; Iodides; Iodine Radioisotopes; Male; Methimazole; Plasmapheresis; Thyroid Gland; Thyrotoxicosis

Coexisting of Graves' disease and functioning struma ovarii is a rare condition. Although the histology of struma ovarii predominantly composed of thyrocytes, the majority of the patients did not have thyrotoxicosis. The mechanism underlying the functioning status of the tumor is still unclear but the presence of thyroid stimulating hormone receptor (TSHR) is thought to play a role. Here we describe the patient presentation and report the TSHR expression of the tumor.. A 56-year old Asian woman presented with long standing thyrotoxicosis for 23 years. She was diagnosed with Graves' disease and thyroid nodules. She had bilateral exophthalmos and had high titer of plasma TSHR antibody. Total thyroidectomy was performed and the histologic findings confirmed the clinical diagnosis. The patient had persistent thyrotoxicosis postoperatively. Thyroid uptake demonstrated the adequacy of the thyroid surgery and the whole body scan confirmed the presence of functioning thyroid tissue at pelvic area. The surgery was scheduled and the patient had hypothyroidism after the surgery. The pathological diagnosis was struma ovarii at right ovary. We performed TSHR staining in both the patient's struma ovarii and in 3 cases of non-functioning struma ovarii. The staining results were all positive and the intensity of the TSHR staining of functioning struma ovarii was the same as that in other cases of non-functioning tumors, suggesting that the determinant of functioning struma ovarii might be the presence of TSHR stimuli rather than the intensity of the TSHR in the ovarian tissue.. In patients with Graves' disease with persistent or recurrent thyrotoxicosis after adequate ablative treatment, the possibility of ectopic thyroid hormone production should be considered. TSHR expression is found in patients with functioning and non-functioning struma ovarii and cannot solely be used to determine the functioning status of the tumor.

Topics: Antithyroid Agents; Female; Graves Disease; Humans; Hysterectomy; Methimazole; Middle Aged; Ovarian Neoplasms; Ovariectomy; Salpingectomy; Struma Ovarii; Thyroidectomy; Thyrotoxicosis; Treatment Outcome

Topics: Adult; Apgar Score; Eyelids; Female; Fetal Growth Retardation; Graves Disease; Heart Rate, Fetal; Humans; Infant, Newborn; Male; Methimazole; Potassium Iodide; Pregnancy; Propranolol; Thyrotoxicosis; Thyroxine; Ultrasonography; Weight Loss

A 26-year-old Hispanic man with no significant medical history presented to our emergency room with gradual onset weakness of his lower extremities. He was haemodynamically stable and examination revealed loss of motor function in his lower limbs up to the level of hips. Laboratory data revealed hypokalaemia. The patient was started on potassium supplementation and he recovered his muscle strength. Differential diagnosis included familial hypokalaemic periodic paralysis and thyrotoxic periodic paralysis (TPP). Further investigations revealed a low thyroid-stimulating hormone and high free thyroxine levels. Radio iodine 123 scan revealed an enhanced homogeneous uptake in the thyroid suggesting Graves' disease. Thyroid stimulating antibodies were also found to be elevated. The patient was started on methimazole and propranolol and he never had another attack of TPP even at 1 year follow-up.

Topics: Adult; Diagnosis, Differential; Graves Disease; Hispanic or Latino; Humans; Hypokalemia; Hypokalemic Periodic Paralysis; Immunoglobulins, Thyroid-Stimulating; Iodine Radioisotopes; Male; Methimazole; Muscle Strength; Muscle Weakness; Potassium; Propranolol; Thyroid Gland; Thyrotoxicosis; Thyrotropin; Thyroxine

The aim of this study was to evaluate clinical manifestations, laboratory findings, and effects of antithyroid drugs in younger children with Graves' disease (GD).. A retrospective and collaborative study.. Nine facilities in Chiba prefecture, Japan.. We analyzed 132 children and adolescents with GD. The subjects were divided according to the median age into a group of young children (group I, 4.1-12.4 years, n=66) and an adolescent group (group II, 12.5-15.9 years, n=66).. Clinical manifestations, laboratory findings, incidence of adverse effects, and remission rates 5 years after initial therapy were assessed.. The mean height SD score of group I (1.0) was higher than that of group II (0.3, p<0.001). The mean BMI SD score of group I (-0.7) was lower than that of group II (-0.3, p<0.05). The most common presentations were goiter, sweating, and hyperactivity in group I, whereas the most common presentations were goiter, sweating, and easy fatigability in group II. Hyperactivity was more frequent in group I (56.7%) than in group II (37.9%, p<0.05). Liver dysfunction appeared more often in group I (14.3%) than in group II (1.9%, p<0.05). There was no difference in the appearance of adverse effects between the two groups. The remission rate was slightly lower in group I (23.1%) than in group II (31.3%), but was not significant.. Thyrotoxicosis had more influence on the growth and liver function in younger children.

Topics: Adolescent; Antithyroid Agents; Child; Child, Preschool; Female; Graves Disease; Growth; Humans; Japan; Liver; Male; Methimazole; Propylthiouracil; Retrospective Studies; Thyrotoxicosis; Treatment Outcome

Topics: Aged; Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Atrial Fibrillation; Febrile Neutropenia; Female; Humans; Methimazole; Thyrotoxicosis

We report a case of apathetic hyperthyroidism associated with unrecognized slowly growing functional thyroid adenoma (Plummer's disease), atrial fibrillation and heart failure. An 81-year-old woman with worsening thyroid dysfunction was admitted to our hospital for the treatment of heart failure. The patient had developed heart failure associated with chronic atrial fibrillation at 76 years of age, and one year later was found to have asymptomatic hyperthyroidism. Anti-thyroid autoantibodies were negative, but thyroid echography showed a 32-mm tumor devoid of internal blood flow in the left lower lobe. Free thyroxine 4 (FT4) decreased from 3.30 to 2.60 ng/dl without treatment. The patient was diagnosed with transient thyroiditis and was followed-up without treatment. However, a repeat thyroid echography showed growth of the tumor to 41 mm in 4 years. Thyroid scintigraphy showed uptake that matched the thyroid mass. Based on these findings, the established diagnosis was Plummer's disease complicated with heart failure. The patient was treated with anti-thyroid drugs, which resulted in improvement of FT4 and reduced the severity of heart failure. In this rare case of an elderly patient, Plummer's disease was associated with a slowly-growing functional thyroid adenoma, apathetic hyperthyroidism, repeated episodes of atrial fibrillation and heart failure. Since symptoms of thyrotoxicosis are likely to be missed in the elderly, it is necessary to include hyperthyroidism in the pathoetiology of heart failure and atrial fibrillation in this population.

Topics: Aged, 80 and over; Antithyroid Agents; Atrial Fibrillation; Female; Goiter, Nodular; Heart Failure; Humans; Hyperthyroidism; Methimazole; Receptors, Thyrotropin; Recurrence; Thyrotoxicosis; Treatment Outcome

Topics: Graves Disease; Humans; Hypokalemic Periodic Paralysis; Intracellular Fluid; Ion Transport; Male; Methimazole; Middle Aged; Potassium; Radionuclide Imaging; Recurrence; Thyrotoxicosis

Population-based estimates of the prevalence of thyrotoxicosis (TTX), the frequency of antithyroid drug (ATD) use, and risk of adverse events in pregnant women and their infants are lacking. Therefore, our objective was to obtain epidemiologic estimates of these parameters within a large population-based sample of pregnant women with TTX.. A retrospective claims analysis was performed from the MarketScan Commercial Claims and Encounters health insurance database for the period 2005-2009. Women aged 15-44 years, enrolled for at least 2 years, and who had a pregnancy during the study period were included. Diagnosis of TTX was based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes using narrow (TTX-1=ICD 242.0) and broad (TTX-2=ICD 242.0 or 242.9) definitions. ATD use was based on prescriptions filled for propylthiouracil (PTU) or methimazole (MMI). Adverse events in mothers and infants were determined from the ICD-9-CM diagnosis codes recorded on submitted claims.. The database contained 904,497 eligible women. The average yearly prevalence per 1000 pregnant women was 2.46 for TTX-1 and 5.88 for TTX-2. Thirty-nine percent used ATD at any time during the study period. Compared to women without a TTX diagnosis, there was more than a twofold increase for liver disease among women with TTX (odds ratio [OR]=2.08, p<0.001) and a 13% increased risk for congenital anomalies (OR=1.13, p=0.014), but no association was observed with ATD use. The rates of congenital defects (per 1000 infants) associated with ATD use were 55.6 for MMI, 72.1 for PTU, and 65.8 for untreated women with TTX, compared to 58.8 among women without TTX.. There was some indication of an elevated risk of liver disease and congenital anomalies in women with TTX, but the risk did not appear to be related to the ATD use. There seems to be a higher pregnancy termination rate for women with TTX on MMI, which likely reflects elective pregnancy terminations.

Topics: Abnormalities, Drug-Induced; Adolescent; Adult; Antithyroid Agents; Chemical and Drug Induced Liver Injury; Congenital Abnormalities; Drug Prescriptions; Female; Hepatic Insufficiency; Humans; Infant; Infant, Newborn; Insurance, Health; International Classification of Diseases; Methimazole; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prevalence; Propylthiouracil; Retrospective Studies; Thyrotoxicosis; United States; Young Adult

11β hydroxylase deficiency (OHD) is one of the main causes of congenital adrenal hyperplasia. There have been only a few reported cases of nonclassic 11β OHD, a milder form of the disease. It is difficult to detect occult nonclassic 11β OHD because patients present with no or mild symptoms. We herein present a case of thyrotoxic periodic paralysis (TPP) with Graves' disease leading to the discovery of a hidden nonclassic 11β OHD. In this case, increased levels of thyroid hormone seem to have induced symptoms of occult nonclassic 11β OHD and aggravated TPP.

Topics: Adrenal Hyperplasia, Congenital; Diagnosis, Differential; Drug Therapy, Combination; Graves Disease; Humans; Hypokalemic Periodic Paralysis; Male; Methimazole; Mutation; Polymerase Chain Reaction; Polymorphism, Genetic; Potassium; Propranolol; Risk Assessment; Severity of Illness Index; Steroid 11-beta-Hydroxylase; Thyrotoxicosis; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

Maternal thyrotoxicosis, predominantly secondary to Graves' disease, affects 0.2% of all pregnancies. The Endocrine Society guidelines recommend the use of propylthiouracil as a first-line drug for thyrotoxicosis in pregnancy because of associations between carbimazole or methimazole and congenital anomalies. However, recent studies have highlighted the risk of severe liver injury with propylthiouracil. Here, we report another case with multiple congenital anomalies following in utero exposure to carbimazole and review the literature to consider the risks and benefits of available pharmacological treatments for thyrotoxicosis in pregnancy.

Topics: Antithyroid Agents; Carbimazole; Ectodermal Dysplasia; Face; Female; Graves Disease; Humans; Infant; Lacrimal Apparatus Diseases; Methimazole; Pregnancy; Pregnancy Complications; Propylthiouracil; Thyrotoxicosis; Thyroxine

Periodic paralysis in the setting of hypokalemia can be the result of several underlying conditions, requiring systematic evaluation. Thyrotoxic periodic paralysis (TPP), a curable cause of hypokalemic periodic paralysis, can often be the first manifestation of thyrotoxicosis. Because the signs and symptoms of thyrotoxicosis can be subtle and clouded by the clinical distress of the patient, the diagnosis of the underlying metabolic disorder can be overlooked. The authors report a case of TPP in a young Chinese man in whom the diagnosis of thyrotoxicosis was initially missed. This case illustrates the lack of awareness of TPP among many physicians, delay in the diagnosis of TPP and the importance of performing thyroid function testing in all cases of periodic paralysis.

Topics: Antithyroid Agents; Delayed Diagnosis; Diagnosis, Differential; Humans; Hypokalemic Periodic Paralysis; Male; Methimazole; Thyrotoxicosis; Young Adult

Jaundice related to thyrotoxicosis and not as an effect of antithyroid drugs is a rare complication that usually occurs in the presence of heart failure (HF) or hepatitis. We report a case of a 54-year-old white woman with hyperthyroidism caused by Graves's disease and jaundice despite methimazole suspension. Bilirubin fluctuated at high values, between 30.0 and 52.3 mg/dL, transaminases were slightly increased, on admission ALT = 46 U/L and AST = 87 U/L; coagulation indices and serum proteins were on the lower limit of the normal range with PT 68% and albumin = 2.5 g/dL. Serology for hepatitis was negative. After the first radioiodine therapy (RT), bilirubin reached its maximum, which coincided with the worst period of HF exacerbation. Bilirubin normalized 4 weeks after the second RT, with the stabilization of HF and normalization of thyroid hormones. We discuss the possible etiologies of severe jaundice in hyperthyroid patients, as well as the difficult anticoagulant therapy with warfarin.

Topics: Antithyroid Agents; Cardiomyopathies; Female; Heart Atria; Humans; Jaundice; Methimazole; Middle Aged; Severity of Illness Index; Thrombosis; Thyrotoxicosis

The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital disorder characterized by aplasia of the uterus and the upper part of the vagina in an XX individual with normal development of secondary sexual characteristics. Individuals with this syndrome may also present with renal and skeletal abnormalities. We report a case of a 16-year-old girl presenting with thyrotoxicosis and primary amenorrhea. After being diagnosed with Graves disease, this patient was placed on antithyroid medication. Although her thyroid function normalized, she did not start to menstruate. Therefore, we assessed her primary amenorrhea and diagnosed the patient with MRKH syndrome through pelvic imaging. To our knowledge, an association between Graves disease and MRKH syndrome has not yet been reported.

Topics: 46, XX Disorders of Sex Development; Abnormalities, Multiple; Adolescent; Amenorrhea; Antithyroid Agents; Congenital Abnormalities; Diagnosis, Differential; Female; Graves Disease; Humans; Kidney; Methimazole; Mullerian Ducts; Pelvis; Somites; Spine; Thyrotoxicosis; Tomography, X-Ray Computed; Uterus; Vagina

During pregnancy, changes in maternal physiology influence thyroid status. In addition, maternal thyroid disease can have substantial adverse effects on the fetus. Therefore, evaluating and treating women with thyroid disease during pregnancy requires careful observation and management to ensure favorable pregnancy outcomes. To evaluate thyroid hormone levels during gestation, gestational age-specific values should be used. When hyperthyroidism is treated, the goals of therapy are to achieve a subclinical hyperthyroid state and monitor fetal development. Care must be taken so as not to induce a state of maternal hypothyroidism during pregnancy, since such a diagnosis is also associated with adverse outcomes for both mother and infant.. Consideration should be given to routine screening of pregnant women and all women of childbearing age for thyroid disease.

Topics: Female; Fetus; Graves Disease; Humans; Hyperthyroidism; Hypothyroidism; Infant, Newborn; Infant, Newborn, Diseases; Methimazole; Pregnancy; Pregnancy Complications; Thyroid Diseases; Thyroid Gland; Thyrotoxicosis; United States

A 15-year-old female presented to a pediatric emergency department with glycosuria, ketonuria, and hyperglycemia and was admitted with a presumed diagnosis of diabetes mellitus. The patient required no insulin therapy and only minor dietary modification to maintain euglycemia. Clinical examination and laboratory findings revealed a primary diagnosis of Graves' hyperthyroidism with associated impaired glucose tolerance. Here, we review the mechanisms of thyrotoxicosis resulting in impaired glucose metabolism.

Topics: Adolescent; Adrenergic beta-Antagonists; Antithyroid Agents; Blood Glucose; Female; Graves Disease; Humans; Hyperglycemia; Iodine Radioisotopes; Methimazole; Propranolol; Thyrotoxicosis; Thyroxine

Topics: Antithyroid Agents; Atenolol; Chorea; Dibenzothiazepines; Female; Goiter, Nodular; Humans; Hyperthyroidism; Iodine Radioisotopes; Methimazole; Patient Compliance; Prednisone; Propylthiouracil; Quetiapine Fumarate; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine; Young Adult

Topics: Adult; Antithyroid Agents; Biomarkers; Female; Hashimoto Disease; Humans; Methimazole; Thyroid Function Tests; Thyrotoxicosis; Thyrotropin; Thyroxine; Treatment Outcome

Treatment of toxic nodular goiter with ¹³¹I is a first-line therapy for hyperthyroidism. To avoid a thyrotoxic storm, ¹³¹I is usually administered after pretreatment with antithyroid drugs, with thyroid-stimulating hormone (TSH) increase and functional recruitment of inhibited normal tissue. Therefore, both autonomous nodule(s) and normal tissue are irradiated. This may be a reason for late hypothyroidism occurring in 15-25% of patients. This study aimed at assessing different pretreatment modalities with combined methymazole and triiodothyronine, achieving euthyroidism with suppressed TSH.. After diagnosis of autonomously functioning toxic nodule, patients were subjected to thyrostatic medication. Two months later, TSH was checked; if >0.5 mU/L triiodothyronine treatment was associated. After 2 more months, if the TSH level was suppressed, patients received ¹³¹I-therapy. A total of 149 patients were consecutively enrolled, 41 of whom with uninodular and 108 with multinodular goiter. They were evaluated at diagnosis, pretreatment, 3 and 6 months after therapy and at late follow-up (6.8+/-4.2 years; range: 1-22 years).. Administered activity was calculated according to ¹³¹I uptake and gland weight. Methymazole was discontinued 6 days before treatment and T3 was maintained until administration of ¹³¹I-therapy. Euthyroidism was achieved in 88% of patients. At late follow-up, subclinical hypothyroidism was observed in 10 patients (6.7%) and overt hypothyroidism in 5 patients (3.3%). No pathological consequences or side effects of ¹³¹I-therapy were found during the 6.8+/-4.2 year follow-up period.. Treatment of toxic nodular goiter with ¹³¹I-therapy, under combined thyrostatic-thyromimetic treatment is a simple, safe, well-tolerated, and effective procedure.

Topics: Adult; Aged; Aged, 80 and over; Antithyroid Agents; Combined Modality Therapy; Female; Goiter, Nodular; Humans; Hypothyroidism; Iodine Radioisotopes; Male; Methimazole; Middle Aged; Thyrotoxicosis; Time Factors; Triiodothyronine

Thymic hyperplasia is associated with Graves' disease, particularly in young patients. The degree of thymic transformation is minimal in most but not all patients. In the latter group radiological measurements of thyroid size and their change with treatment have rarely been reported. We present two patients with Graves' disease and relatively rapid resolution of thymic enlargement after successful treatment of their hyperthyroidism.. Three patients with thyrotoxicosis secondary to Graves' disease and marked thymic enlargement were seen at our institution during a 2-year period. On computed tomography (CT) studies their volumes were 67, 81, and 54 cm(3). Thymic hyperplasia in the setting of Graves' disease was the diagnosis of exclusion. Two of the patients returned for follow-up after successful treatment of thyrotoxicosis as requested. On repeat CT their thymic volumes had decreased by 72% and 78%, respectively. Two types of histological modifications of the thymus have been described in association with Graves' disease, namely, thymic parenchyma hyperplasia and medullary lymphoid hyperplasia. The mechanisms underlying thymic transformation in patients with Graves' hyperthyroidism are not completely elucidated, but autoimmune processes underlying Graves' disease are presumed to play a role. The clinical course of our patients is consistent with earlier literature, indicating that thymic enlargement may occur in conjunction with Graves' hyperthyroidism, and that it usually resolves as hyperthyroidism is treated, but there is little quantitative pre- and posttreatment of hyperthyroidism data.. Although every patient must be individually considered, it appears that thymic hyperplasia can be diagnosed in most Graves' hyperthyroid patients by considering the clinical context and appropriate radiologic studies such as CT. Raising awareness of the association of thymic hyperplasia in patients with Graves' hyperthyroidism and its resolution with the reversibility of the hyperthyroid state should prevent unnecessary thymic evaluation and surgery with its attendant risks.

Topics: Adrenergic beta-Antagonists; Adult; Anti-Inflammatory Agents; Antithyroid Agents; Calcium Channel Blockers; Diltiazem; Female; Graves Disease; Humans; Male; Methimazole; Middle Aged; Organ Size; Prednisone; Propanolamines; Propranolol; Radiography; Thymus Gland; Thymus Hyperplasia; Thyroidectomy; Thyrotoxicosis; Thyrotropin; Thyroxine; Treatment Outcome; Triiodothyronine; Young Adult

Monomorphic ventricular tachycardia (VT) is a unique manifestation of hyperthyroidism. We present the case of a 41-year-old male with a history of hyperthyroidism presenting with palpitations secondary to non-sustained episodes of monomorphic VT. Cardiac arrhythmias due to thyrotoxicosis are perpetually supraventricular in origin. Monomorphic VT in the setting of thyrotoxicosis in the absence of structural heart disease is exceedingly rare. After starting propranolol and increasing the dose of methimazole, the patient had no further episodes of VT. It is important to recognize repetitive monomorphic VT as an understated but important manifestation of thyrotoxicosis. Propranolol is associated with an excellent response in these patients and anti-thyroid medications such as methimazole effectively reverse thyrotoxicity.

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Humans; Male; Methimazole; Propranolol; Tachycardia, Ventricular; Thyrotoxicosis

Type 2 amiodarone-induced thyrotoxicosis (AIT) is a destructive thyroiditis usually responsive to glucocorticoids; however, recent surveys showed that many expert thyroidologists worldwide use thionamides for type 2 AIT patients.. The objective of the study was to compare the effectiveness of methimazole (MMI) or prednisone (GLU) in type 2 AIT patients who had a short cure time according to a published predictive model.. This was a matched retrospective cohort study.. The study was conducted at a university center.. Forty-two untreated type 2 AIT patients with a predicted cure time < or = 40 d were divided into two groups (MMI and GLU groups). After matching for the predicted cure time, patients in the GLU group were selected in a 1:1 ratio to patients in the MMI group.. Patients were treated with GLU or MMI for 40 d. Patients still thyrotoxic after 40 d continued glucocorticoids if in the GLU group or were switched to prednisone (MMI-GLU group) if in the MMI group.. Time and rate of cure (healing) at 40 d were measured.. Patients still thyrotoxic after 40 d were 23.8 +/- 9.3% in the GLU group and 85.7 +/- 7.6% in the MMI group (P = 0.000). The GLU and MMI-GLU groups did not significantly differ in the nonhealing rate at 40 d (P = 0.730). When patients in the MMI group were treated with glucocorticoids, 94.1% patients achieved euthyroidism within 40 d. However, the global median cure time (MMI period + prednisone period) was longer (60 d, 95% confidence interval 53.5-66.5 d) in the MMI-GLU group than the GLU group (21 d, 95% confidence interval 15.1-26.9 d).. Glucocorticoids are the first-line treatment in type 2 AIT, whereas thionamides play no role in this destructive thyroiditis.

Topics: Academic Medical Centers; Adult; Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Case-Control Studies; Cohort Studies; Female; Glucocorticoids; Humans; Kaplan-Meier Estimate; Male; Methimazole; Middle Aged; Prednisone; Retrospective Studies; Thyroiditis; Thyrotoxicosis

We present 4 patients with Graves' disease who developed spontaneous hypothyroidism during follow-up. The two most plausible physiopathologic mechanisms for this development were progressive autoimmune-mediated destruction of the thyroid follicular epithelium and a predominance of blocking antibodies to the thyroid-stimulating hormone (TSH) receptor at the expense of stimulating antibodies in the same patient. Description of these patients not only illustrates the heterogeneous nature of this disease, but also the interrelation among its distinct clinical forms.

Topics: Adult; Aged; Autoantibodies; Disease Progression; Female; Goiter; Graves Disease; Humans; Hypothyroidism; Immunoglobulins, Thyroid-Stimulating; Male; Methimazole; Middle Aged; Receptors, Thyrotropin; Thyroid Hormones; Thyrotoxicosis; Thyroxine

We present an interesting case of a patient with thyrotoxicosis who developed both arterial and venous thrombosis. Although there have been reports of thrombosis in such patients, there has been no case reporting arterial and venous thrombosis in the same patient. We describe the case and discuss the medical literature. We feel that any patient with unexplained hypercoagulability should be thoroughly evaluated for thyroid dysfunction.

Topics: Anticoagulants; Antithyroid Agents; Blood Coagulation; Humans; Infarction, Middle Cerebral Artery; Male; Methimazole; Middle Aged; Propranolol; Pulmonary Embolism; Thyrotoxicosis; Treatment Outcome; Venous Thrombosis

Topics: Adult; Antihypertensive Agents; Antithyroid Agents; Emergencies; Follow-Up Studies; Genetic Predisposition to Disease; Graves Disease; Humans; Hypokalemic Periodic Paralysis; Jews; Male; Methimazole; Potassium; Prevalence; Propranolol; Recurrence; Thyrotoxicosis; Time Factors; Treatment Outcome

Topics: Adult; Antithyroid Agents; Catheter Ablation; Female; Humans; Methimazole; Minimally Invasive Surgical Procedures; Thyroid Gland; Thyroid Nodule; Thyrotoxicosis; Ultrasonography

Thyrotoxicosis affects 0.2% of pregnant women and antithyroid drugs are the treatment of choice during pregnancy. Several case reports have suggested a relationship between the prenatal use of methimazole (MMI) and choanal atresia in the offspring. However, two epidemiological studies did not find an increased teratogenic risk for MMI. This multicenter case-control study compared the frequency of maternal hyperthyroidism treated with MMI during pregnancy, in children with choanal atresia (cases) and a control group randomly selected (three matched controls according to maternal age for each case). Mothers of cases (N = 61) and controls (N = 183) were interviewed for socio-demographic questions, obstetrical and genetic history, and exposure during pregnancy to different agents; specifically detailed information regarding hyperthyroidism and MMI intake was obtained. Prenatal exposure to maternal hyperthyroidism treated with MMI was identified in 10/61 cases (16.4%) compared to 2/183 (1.1%) in the control group (OR = 17.75; CI95% = 3.49-121.40). Cases and controls did not differ in their parental degree of education, paternal occupation, twinning, maternal parity, and other exposures during pregnancy. Facial features in exposed cases showed some similarities. Our data suggest that prenatal exposure to maternal hyperthyroidism treated with MMI is associated with choanal atresia. In addition, based on our cases and a critical literature review, we propose that the mother's disease might be the causal factor and not the MMI treatment.

Topics: Abnormalities, Drug-Induced; Adolescent; Antithyroid Agents; Argentina; Case-Control Studies; Child; Child, Preschool; Choanal Atresia; Female; Humans; Male; Maternal Exposure; Methimazole; Pregnancy; Thyrotoxicosis

Thyrotoxicosis is known to induce a broad range of changes in carbohydrate metabolism. Recent studies have identified the sympathetic and parasympathetic nervous system as major regulators of hepatic glucose metabolism. The present study aimed to investigate the pathogenesis of altered endogenous glucose production (EGP) in rats with mild thyrotoxicosis. Rats were treated with methimazole in drinking water and l-thyroxine (T(4)) from osmotic minipumps to either reinstate euthyroidism or induce thyrotoxicosis. Euthyroid and thyrotoxic rats underwent either a sham operation, a selective hepatic sympathetic denervation (Sx), or a parasympathetic denervation (Px). After 10 days of T(4) administration, all animals were submitted to a hyperinsulinemic euglycemic clamp combined with stable isotope dilution to measure EGP. Plasma triiodothyronine (T(3)) showed a fourfold increase in thyrotoxic compared with euthyroid animals. EGP was increased by 45% in thyrotoxic compared with euthyroid rats and correlated significantly with plasma T(3). In thyrotoxic rats, hepatic PEPCK mRNA expression was increased 3.5-fold. Relative suppression of EGP during hyperinsulinemia was 34% less in thyrotoxic than in euthyroid rats, indicating hepatic insulin resistance. During thyrotoxicosis, Sx attenuated the increase in EGP, whereas Px resulted in increased plasma insulin with unaltered EGP compared with intact animals, compatible with a further decrease in hepatic insulin sensitivity. We conclude that chronic, mild thyrotoxicosis in rats increases EGP, whereas it decreases hepatic insulin sensitivity. Sympathetic hepatic innervation contributes only to a limited extent to increased EGP during thyrotoxicosis, whereas parasympathetic hepatic innervation may function to restrain EGP in this condition.

Topics: Animals; Autonomic Denervation; Blood Glucose; Glucose; Glucose Clamp Technique; Hyperinsulinism; Insulin; Kinetics; Liver; Male; Methimazole; Parasympathectomy; Phosphoenolpyruvate Carboxykinase (GTP); Rats; Rats, Wistar; RNA, Messenger; Sympathectomy; Thyroid Hormones; Thyrotoxicosis; Thyroxine

Although transient thyrotoxicosis occurring after antithyroid drug (ATD) withdrawal in patients with Graves' hyperthyroidism has been reported, the prevalence of transient thyrotoxicosis after ATD therapy is as yet unknown. When patients with transient hyperthyroidism are mistakenly regarded as recurrences, they receive unnecessary therapy. The aim of this study was to investigate the prevalence of transient thyrotoxicosis after ATD withdrawal.. We selected 110 consecutive patients with Graves' disease whose ATD therapy was stopped from December 2002 to September 2004 prospectively. Patients were observed for more than 1 year after ATD withdrawal, and 12 patients dropped out. Serum levels of free thyroxine (FT(4)), thyrotropin, and thyrotropin-binding inhibitor immunoglobulin were measured at ATD withdrawal, and 3, 6, and 12 months after withdrawal. When the patients showed mild thyrotoxicosis (serum FT(4) level of less than 3.00 ng/dL), we followed them up for 1 month without medication.. The remission rate of the study group was 61.8% (68/110). Twenty-eight patients became euthyroid after transient thyrotoxicosis, equivalent to 41.2% of the remission patients. Eight of 28 patients showed overt thyrotoxicosis, and the rest subclinical thyrotoxicosis. Transient thyrotoxicosis occurred mostly 3-6 months after ATD withdrawal.. Transient thyrotoxicosis after ATD withdrawal in patients with Graves' disease is not a rare phenomenon. Clinicians should be aware that the recurrence of Graves' disease after the withdrawal of ATD may be transient.

Topics: Adult; Antithyroid Agents; Autoantibodies; Female; Follow-Up Studies; Graves Disease; Humans; Immunoglobulins, Thyroid-Stimulating; Male; Methimazole; Middle Aged; Prevalence; Prospective Studies; Recurrence; Substance Withdrawal Syndrome; Thyrotoxicosis; Thyrotropin; Thyroxine; Time Factors

A 41-year-old man with progressive limb weakness manifested fluctuating muscle weakness as seen in myasthenia gravis (MG). Laboratory investigations revealed hyperthyroidism without the complication of MG. Electrophysiological studies demonstrated abnormal features of neuromuscular transmissions resembling those of the Lambert-Eaton myasthenic syndrome rather than those of MG. A CT scan showed a mediastinal mass that suggested thymic hyperplasia which often complicates MG or hyperthyroidism. Medical treatment of hyperthyroidism resulted in resolution of MG-like symptoms and regression of thymic hyperplasia on CT concomitant with normalization of thyroid function. This case highlights the fact that careful investigations are needed to differentiate MG-like symptoms from genuine MG in cases of hyperthyroidism with thymic lesions.

Topics: Adult; Antithyroid Agents; Diagnosis, Differential; Graves Disease; Humans; Male; Methimazole; Muscle Weakness; Myasthenia Gravis; Thymus Hyperplasia; Thyrotoxicosis

We report the treatment of four thyrotoxic patients. Two were cases of type I amiodarone-induced thyrotoxicosis (AIT) treated with methimazole. The third Graves' disease patient, who became hypothyroid 25 years after subtotal thyroidectomy, developed type II AIT. Furthermore, one case with heart failure and ventricular tachycardia, who developed an adverse reaction to antithyroid agents and was prescribed amiodarone, underwent total thyroidectomy. The clinical course was uneventful, and the patient is doing well. Since amiodarone contains a large amount of iodine, it is frequently difficult to make a differential diagnosis. Surgical treatment of Graves' disease patients is recommended when immediate control of hyperthyroidism and heart failure is required.

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Arrhythmias, Cardiac; Diagnosis, Differential; Graves Disease; Humans; Male; Methimazole; Middle Aged; Thyroidectomy; Thyrotoxicosis

Aplastic anemia (AA) is mediated by T-cell autoimmunity in the majority of cases; it is rare and mostly idiopathic in children. We describe a child, who developed AA following Graves' disease which could not be attributed to antithyroid drugs. We hypothesized that both diseases were caused by similar autoimmune process. We monitored the blood counts and did not administer any conventional treatment for AA assuming that the existing anti- hematopoietic stem cell humoral and cellular immunity might subside with induction of remission of Grave's disease. The child went into complete remission with the treatment of the Graves' disease.

Topics: Anemia, Aplastic; Antithyroid Agents; Blood Cell Count; Bone Marrow; Child; Female; Graves Disease; Hormone Replacement Therapy; Humans; Iodine Radioisotopes; Methimazole; Pancytopenia; Recurrence; Remission Induction; Thyrotoxicosis; Thyroxine; Treatment Refusal

Patients who have either hyperthyroidism or hypothyroidism can present with cardiovascular complications. These manifestations of thyroid disease-congestive heart failure, atrial tachyarrhythmias, atrioventricular conduction disorders, and mitral valve dysfunction-are well known to the clinician. Pericardial effusion is considered a complication of hypothyroidism; as an expression of thyrotoxicosis, it is extremely rare.Herein, we present the case of a 76-year-old woman who had pericardial effusion associated with thyrotoxicosis. She was treated with high-dose beta-blockers, methimazole, diuretics, and short-term steroids. She recovered completely, which precluded the need for pericardiocentesis. We suggest that thyrotoxicosis be considered in the differential diagnosis of pericardial effusion.

Topics: Adrenergic beta-Antagonists; Aged; Anti-Inflammatory Agents; Antithyroid Agents; Diuretics; Female; Furosemide; Glucocorticoids; Humans; Methimazole; Pericardial Effusion; Prednisone; Thyrotoxicosis

Clinical hyperthyroidism is found in approximately 5% of women with a hydatidiform mole, as human chorionic gonadotropin secreted by molar tissue is structurally similar to thyroid-stimulating hormone. A hydatidiform mole occasionally presents with a co-existing viable fetus. Surgical evacuation may be indicated for significant hemorrhage or preeclampsia. Perioperative management in the presence of hyperthyroidism may be complicated by a thyroid storm. We report a case of total intravenous anesthesia with propofol and remifentanil, combined with an esmolol infusion, to control sympathetic hyperactivity during surgery.

Topics: Abortion, Induced; Adrenergic beta-Antagonists; Adult; Anesthesia, Intravenous; Anesthetics, Intravenous; Antihypertensive Agents; Antithyroid Agents; Female; Follow-Up Studies; Humans; Hydatidiform Mole; Methimazole; Piperidines; Pregnancy; Pregnancy Complications, Neoplastic; Propanolamines; Propofol; Propranolol; Remifentanil; Thyroid Function Tests; Thyrotoxicosis; Uterine Neoplasms

Thyrotoxicosis occurs more frequently during the post-partum period than at other times in women of childbearing age. Graves' disease and post-partum thyroiditis are two major causes of thyrotoxicosis in this period. The major task lies in differentiation of these two diseases in the post-partum period; since throtoxicosis caused by post-partum thyroiditis usually does not require treatment. The radioiodine uptake is elevated or normal in Graves' disease and low in post-partum thyroiditis, and TSH-receptor antibodies are positive in Graves' and negative in post-partum thyroiditis. Post-partum thyrotoxicosis due to Graves' disease may be treated with radioiodine but it requires radiation safety measurements for infant and is contraindicated if the mother is breast-feeding. Antithyroid drugs are the mainstay of the treatment of post-partum thyrotoxicosis. Recent investigations conclude that neither propylthiouracil nor methimazole cause any alterations in thyroid function and physical and mental development of infants breast-fed by lactating thyrotoxic mothers, and both can be safely administered in moderately high doses during lactation.

Topics: Antithyroid Agents; Breast Feeding; Female; Graves Disease; Humans; Infant, Newborn; Iodine Radioisotopes; Methimazole; Propylthiouracil; Puerperal Disorders; Radiotherapy; Thyroidectomy; Thyroiditis; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine

To study the treatment modalities and the outcome of treatments of children with thyrotoxicosis or Graves' disease.. A retrospective study of 56 patients diagnosed with thyrotoxicosis from January 1992 to December 2004 was conducted. There were 44 girls and 12 boys (female to male ratio 3.7:1). The average age at diagnosis was 11.9 +/- 3.4 years.. All patients were initially treated with antithyroid drugs, either propylthiouracil (n = 53) or methimazole (n = 3). All patients achieved euthyroidism within 8.4 +/- 3.3 weeks. Eleven patients are still on the treatment, and 45 patients have completed the treatment. Of these 45 patients, 38 (84.4%) remitted after antithyroid drug treatment of an average duration of 37.4 +/- 16.5 months (range 12-90), 4 patients (8.9%) chose radioactive iodine treatment and three patients (6.7%) underwent thyroidectomy. Of the 38 patients remitted with antithyroid drugs, eleven (28.9%) relapsed within 4-24 months. The relapsed patients remitted with a second course of antithyroid drugs in three patients, underwent radioactive iodine in seven patients, and thyroidectomy in one patient. Therefore, of the total 45 patients who had completed the treatment, 30 patients (66.7%) remitted with antithyroid drugs, eleven patients (24.4%) received radioactive iodine, and four patients (8.9%) underwent thyroidectomy. Using stepwise multivariate logistic regression, the authors could not identify any factors (including age, gender, family history of thyroid diseases, size of goiter, level of free T4, dosage and duration of antithyroid drugs) that would predict the remission of thyrotoxicosis with antithyroid drugs.. Antithyroid drugs should remain the first-line therapy for treatment of thyrotoxicosis in children with a remission rate of 66.7%. The patients who are noncompliant or relapse after treatment with antithyroid drugs should be treated with radioactive iodine.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Iodine Radioisotopes; Logistic Models; Male; Methimazole; Propylthiouracil; Recurrence; Retrospective Studies; Thyroidectomy; Thyrotoxicosis; Treatment Outcome

We investigated whether thyroid receptor antibodies (TRAb) could result in transient neonatal thyroid disease by transfer through milk from mothers treated for thyrotoxicosis.. To analyse whether breast milk content of TRAb in euthyroid mothers with treated thyrotoxicosis resulted in neonatal thyroid disease and whether extended breastfeeding prolonged the neonatal disease.. We tested three TRAb-positive mothers and the course, treatment and outcome for their offspring with neonatal thyrotoxicosis, and six healthy and two TRAb-negative euthyroid mothers with treated thyrotoxicosis during breastfeeding.. TRAb was analysed in serum and breast milk by a radioreceptor assay.. TRAb in serum was detectable in all treated mothers, in one mother during her four pregnancies, resulting in all neonates requiring treatment for thyrotoxicosis. Serum TRAb concentration in neonates decreased continuously with time after birth. Breast milk TRAb was detectable in all cases but not in the controls or in TRAb-negative mothers treated for thyrotoxicosis. The calculated half-life for offspring serum and breast milk TRAb was calculated as approx. 3 weeks and 2 months, respectively.. Euthyroid TRAb-positive mothers may cause transient neonatal thyroid disease which seems to be worse and more prolonged during breastfeeding as a consequence of TRAb in breast milk.

Topics: Adult; Autoantibodies; Control Groups; Female; Humans; Immunoglobulins, Thyroid-Stimulating; Infant, Newborn; Male; Maternal-Fetal Exchange; Methimazole; Milk, Human; Pregnancy; Receptors, Thyrotropin; Reproducibility of Results; Risk; Thyroid Diseases; Thyrotoxicosis

Thionamides are the main therapeutic arsenal for treating hyperthyroidism. Perhaps the first case of a patient who developed a transient pituitary hyperthyroidism after discontinuation of a lengthy intake of a thionamide is reported.. A 48-year-old woman presented with menstrual irregularities when hypothyroidism with pituitary enlargement was detected. She had been undergoing treatment with methimazole for Graves's hyperthyroidism since the age of 34. Three months after discontinuation of methimazole she presented with clinical and laboratory evidence of thyrotoxicosis, with elevated thyroid-stimulating hormone (TSH) levels and blunted response to thyrotropin releasing hormone (TRH). This secondary hyperthyroidism was self-limited and resolved a few months later.. Chronic primary hypothyroidism caused by lengthy use of thionamides can result in pituitary hyperplasia and transient thyrotrope dysfunction.

Topics: Anti-Anxiety Agents; Chronic Disease; Female; Follow-Up Studies; Humans; Hyperthyroidism; Hypothyroidism; Methimazole; Middle Aged; Propranolol; Thyroid Gland; Thyrotoxicosis; Thyrotropin; Thyroxine; Time Factors; Treatment Outcome; Triiodothyronine; Ultrasonography

Amiodarone-induced thyrotoxicosis (AIT) type 1 occurs in subjects with an underlying thyroid disease, whereas type 2 AIT is a form of destructive thyroiditis. Our hypothesis was that the common practice of thyroid testing before prescription of amiodarone would reduce the incidence of pure type 1 AIT, though a stringent classification may be difficult (mixed type AIT).. Thyroid testing before and after treatment of AIT (n = 12) and the response to combined antithyroid and glucocorticoid treatment (n = 11) were recorded in a consecutive series of patients seen at a university hospital.. Some criteria for type 1 AIT were fulfilled in 3 patients, but the diagnosis of a mixed form AIT was more likely in 2 of these. Type 2 AIT was diagnosed in the other 9 patients, while 6 patients had diffuse hypoechoic goitre. The median time to euthyroidism (defined as normal fT3 concentration) under thionamide and prednisolone (starting dose 20 to 75 mg/d) was 2 months (interquartile range 1 to 2.7 months). Thionamide treatment was stopped after a median duration of 5.7 months (interquartile range 4.2 to 8.7 months) and glucocorticoids were completely withdrawn after 6.7 months (5.5 to 8.7 months).. Nowadays, isolated type 1 AIT is rarely found and destructive thyroiditis (as type 2 AIT or mixed form) is the predominant cause of AIT. To accelerate recovery, we prescribed thionamide and glucocorticoids simultaneously as first-line therapy once contraindications for the use of steroids had been ruled out.

Topics: Adult; Aged; Amiodarone; Antithyroid Agents; Carbimazole; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Male; Methimazole; Middle Aged; Prednisolone; Prospective Studies; Thyroiditis; Thyrotoxicosis; Treatment Outcome

Appropriate methimazole dosing for initial treatment of childhood Graves' disease is uncertain. A retrospective chart review was performed on 5 to 17 year-old children treated for Graves' disease. Patients were divided into two groups depending on initial methimazole dosing: low-dose and high-dose regimens using <0.5 mg/kg/day and >0.5 mg/kg/day, respectively. The low-dose regimen was effective in 5/12 (42%) of patients and the high-dose regimen was effective in 27/33 (82%) of patients (p = 0.016). There was also a statistically significant dose/time interaction for levels of free thyroxine (T4) (p = 0.025). During treatment, 63.3% of diagnosable samples showed unambiguous hyperthyroidism or triiodothyronine (T3) toxicosis, 16.7% elevated free T3 with normal free T4 and T3 levels, indicating borderline hyperthyroidism, and 20% showed thyroid-stimulating hormone (TSH) suppression with normal or low levels of free T4 and free T3, indicating delayed recovery of pituitary TSH secretion. Free T3 levels combined with concurrent TSH levels permit differentiation of mild hyperthyroidism from delayed pituitary recovery.

Topics: Adolescent; Antithyroid Agents; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Graves Disease; Humans; Hyperthyroidism; Male; Methimazole; Pituitary Diseases; Retrospective Studies; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine

Thyrotoxic hypokalemic periodic paralysis (THPP) is a very rare complication of thyrotoxicosis in whites, but is more frequently reported in individuals of Asian descent. Hypokalemia, with associated flaccid paralysis, and signs of hyperthyroidism, are the hallmark. We have reported a case of a 28-yr-old white man with Graves' disease presenting with a 2-wk history of episodic flaccid quadriplegia. Physical examination disclosed a resting tachycardia and symmetrical, proximal weakness involving both arms and legs. Electrocardiogram and electrolyte analysis showed a severe hypokalemia, and thyroid function tests revealed hyperthyroidism. The patient was diagnosed as having Graves' hyperthyroidism and THPP. Paralysis resolved with potassium supplements. He was treated with propranolol and, subsequently, methimazole. He had no further episodes of hypokalemic paralysis. To the best of the author's knowledge, and after a Medline search, THPP has not been described previously in a Turkish man.

Topics: Adult; Antithyroid Agents; Electrocardiography; Graves Disease; Humans; Hypokalemia; Hypokalemic Periodic Paralysis; Male; Methimazole; Potassium Chloride; Thyrotoxicosis; Water-Electrolyte Balance

Thyrotoxicosis may present with a variety of cardiovascular symptoms. Sinus tachycardia is the most frequently encountered electrocardiographic abnormality and conduction disturbances are extremely uncommon. We present a case of first degree atrio-ventricular block in a patient with newly diagnosed hyperthyroidism and discuss the underlying pathophysiological mechanisms and the clinical implications from the internist's standpoint.

Topics: Acute Disease; Adult; Anti-Arrhythmia Agents; Antithyroid Agents; Female; Heart Block; Humans; Hyperthyroidism; Methimazole; Propranolol; Thyrotoxicosis

The risk of iodine-induced thyrotoxicosis in euthyroid patients receiving iodine-containing contrast agents is known to be low, but data on this risk in patients with latent hyperthyroidism are scarce. We investigated the role of thyroid scintigraphy using Tc-99m preceding the application of iodine-containing contrast material to estimate the risk of iodine-induced thyrotoxicosis in patients with low levels of TSH. In a prospective study on 91 patients, thyroid scintigraphy was performed before coronary angiography (CA). In patients with technetium thyroid uptake (TCTU) less than 1%, CA was done without prophylactic drugs (n = 56). Patients with TCTU greater than 1% were treated either with 900 mg of perchlorate or, depending on the autonomous volume, combined with 20 to 60 mg thiamazole. In the 56 patients with TCTU less than 1%, no case of iodine-induced hyperthyroidism occurred within 4 wk after CA. In the patients who received prophylactic drugs, two cases of mild thyrotoxicosis were observed. Our data suggest that in patients with low levels of TSH, the risk of hyperthyroidism after application of iodine-containing contrast media is negligible if TCTU is less than 1%. In these patients, CA can be performed without administration of prophylactic drugs.

Topics: Aged; Antithyroid Agents; Contrast Media; Coronary Angiography; Female; Humans; Incidence; Iodine; Male; Methimazole; Middle Aged; Perchlorates; Prospective Studies; Risk Assessment; Technetium; Thyroid Gland; Thyrotoxicosis; Thyrotropin

Recent studies have shown normal thyroid function in infants whose mothers receive methimazole (MMI) during breast-feeding. This study evaluates the long-term effect of MMI on thyroid function and intellectual development of such children.. Eighty-two children aged between 48 and 86 months were studied. Forty-two children had been breast-fed while their thyrotoxic lactating mothers received daily doses of MMI 20-30 mg in the first, 10 mg in the second and 5-10 mg for additional 10 months of therapy. Thyroid function of infants remained normal during the one year of MMI therapy of their mothers. Forty other infants served as controls. Serum T4, T3, and TSH concentrations, urinary iodine, thyroid antibodies, intelligence quotient (IQ), verbal and functional (performance) components (Wechsler and Goodenough tests) were measured in all children of the two groups.. Height, weight, serum T4, T3, TSH and antithyroid antibody titers were not different between children in the two groups. The mean IQ was 107 +/- 17 vs 106 +/- 16 (Goodenough test) and 103 +/- 10 vs 103 +/- 16 (Wechsler test) for children of thyrotoxic mothers and control children, respectively. There was no difference in verbal and functional IQ and their components between children of thyrotoxic MMI treated mothers and control children.. Thyroid function and physical and intellectual development of breast-fed infants whose thyrotoxic lactating mothers were treated with 20-30 mg doses of MMI daily are normal at age 48 to 86 months.

Topics: Breast Feeding; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Intelligence; Intelligence Tests; Iodine; Isoantibodies; Male; Methimazole; Mothers; Pregnancy; Retrospective Studies; Thyroid Function Tests; Thyroid Gland; Thyrotoxicosis; Thyrotropin; Thyroxine; Time Factors; Triiodothyronine

Hypokalemic Periodic Paralyses comprise diverse diseases characterized by acute and reversible attacks of severe muscle weakness, associated with low serum potassium. The most common causes are Familial Hypokalemic Periodic Paralysis (FHypoKPP), an autosomal dominant disease, and Thyrotoxic Hypokalemic Periodic Paralysis (THypoKPP), secondary to thyrotoxicosis. Symptoms of paralysis are similar in both diseases, distinguished by thyrotoxicosis present in THypoKPP. FHypoKPP is caused by mutations in ionic channel genes calcium (CACN1AS), sodium (SCN4A) and potassium (KCNE3). Since both diseases are similar, we tested the hypothesis that THypoKPP could carry the same mutations described in FHypoKPP, being the paralysis a genetically conditioned complication of thyrotoxicosis. In 15 patients with THypoKPP, using target-exon PCR, CSGE screening, and direct sequencing, we excluded known mutations in CACN1AS and SCN4A genes. On the other hand, we were able to identify the R83H mutation in the KCNE3 gene in one sporadic case of THypoKPP, a man who had been asymptomatic until developing thyrotoxicosis caused by Graves' disease; we confirmed the disease-causing mutation in 2 of 3 descendants. R83H was recently found in two FHypoKPP unrelated families, in which the mutant decreased outward potassium flux, resulting in a more positive resting membrane potential. We, therefore, identified the first genetic defect in THypoKPP, a mutation in the KCNE3 gene.

Topics: Adult; Antithyroid Agents; Genetic Predisposition to Disease; Humans; Hypokalemic Periodic Paralysis; Iodine Radioisotopes; Male; Membrane Potentials; Methimazole; Mutation; Pedigree; Polymerase Chain Reaction; Potassium Channels; Potassium Channels, Voltage-Gated; Potassium Chloride; Thyrotoxicosis

Radioactive iodine ((131)I) has become the most widely used therapy for patients with hyperthyroidism caused by Graves' disease in the United States. There remains, however, significant variability among (131)I dosing regimens, and it is clear that most patients ultimately develop hypothyroidism after therapy. To avoid persistent hyperthyroidism, we adopted a high dose (131)I therapy protocol based on measurement of 24-h thyroid (123)I uptake designed to deliver 8 mCi (296 MBq) to the thyroid gland 24 h after (131)I administration. To evaluate the efficacy of this protocol, we reviewed our clinical experience over a 7-yr period. We treated 261 patients (219 women and 42 men) with hyperthyroidism caused by Graves' disease with (131)I [mean dose, 14.6 mCi (540 MBq)] between 1993 and 1999. Before treatment, 207 (79%) had received an antithyroid drug (109 propylthiouracil and 98 methimazole). We determined their thyroid status 1 yr after treatment in relation to age, pretreatment with an antithyroid drug, pretreatment thyroid size, and dose of (131)I retained in the thyroid 24 h after treatment. Among the 261 patients, 225 (86%) were euthyroid or hypothyroid 1 yr after treatment, and 36 patients (14%) had persistent hyperthyroidism and required a second treatment. The patients who had persistent hyperthyroidism were younger (P < 0.01), had larger thyroid glands (P < 0.01), higher pretreatment thyroid (123)I uptake values (P < 0.01), and higher serum T(4) concentrations (P < 0.01) and were more likely to have taken antithyroid medication before administration of (131)I (P = 0.01). Five of these patients developed transient hypothyroidism, followed by thyrotoxicosis. There was an asymptotic, inverse relationship between the retained dose of (131)I at 24 h and persistent hyperthyroidism, revealing a 5-10% failure rate despite delivery of up to 400 microCi (14.8 MBq)/g. A dose of (131)I that results in accumulation of 8 mCi (296 MBq) in the thyroid gland 24 h after administration is an effective treatment for the majority of patients with Graves' hyperthyroidism. Young patients with larger thyroid glands, higher serum T(4) concentrations, and higher 24-h thyroid (123)I uptake values, and those pretreated with antithyroid medication for greater than 4 months are at higher risk for treatment failure. A higher dose of (131)I may be advisable in such patients.

Topics: Adult; Antithyroid Agents; Dose-Response Relationship, Radiation; Female; Graves Disease; Humans; Hypothyroidism; Iodine Radioisotopes; Male; Methimazole; Middle Aged; Propylthiouracil; Retreatment; Retrospective Studies; Thyrotoxicosis; Treatment Outcome

We report a 49-year-old man with primary hyperthyroidism who presented with pancytopenia. The patient presented with leg edema, sinus tachycardia, cardiomegaly, and pleural effusions, all from congestive heart failure. Laboratory data showed pancytopenia and primary hyperthyroidism; echocardiogram showed diffuse hyperkinesis of the left ventricular wall and right ventricular overloading. The bone marrow was moderately hypercellular and compatible with arrested hematopoiesis. Pancytopenia and heart failure improved after administration of methimazole and diuretics. However, high levels of thyroid hormone recurred with pancytopenia 4 months after admission. Therefore, subtotal thyroidectomy was performed, and the levels of thyroid hormones and peripheral blood cell counts have remained normal. Pancytopenia may be caused by hyperthyroidism.

Topics: Antithyroid Agents; Blood Cell Count; Bone Marrow; Cardiomegaly; Diuretics; Edema; Heart Failure; Humans; Leg; Male; Methimazole; Middle Aged; Pancytopenia; Pleural Effusion; Recurrence; Tachycardia, Sinus; Thyroidectomy; Thyrotoxicosis

Cardiac structure and function are affected both by acromegaly and hyperthyroidism. Whereas the former is mainly characterized by ventricular hypertrophy as well as diastolic and systolic impairment, the latter frequently leads to increased heart rate and enhancement of contractility and cardiac output. To further investigate this issue, we designed this two-arm study. In the first cross-sectional study, we compared echocardiography and radionuclide angiography results obtained in eight hyperthyroid acromegalic patients, eight hyperthyroid nonacromegalic patients, and eight healthy subjects. All acromegalic patients were receiving treatment for acromegaly at the onset of hyperthyroidism. In the second longitudinal study, performed in the group of acromegalic patients, we compared the cardiovascular results obtained during hyperthyroidism with the retrospective data obtained at the initial diagnosis of acromegaly and after 1-yr treatment for this disease and those prospective data obtained during the remission of hyperthyroidism. In the cross-sectional study, hyperthyroid acromegalic patients showed an increase in the left ventricular (LV) mass index (LVMi) compared to healthy and hyperthyroid controls (P < 0.05), with evidence of LVMi hypertrophy in five of them (62.5%). A significant correlation was found between LVMi and GH levels (r = 0.785; P < 0.05). The LV ejection fraction (LVEF) at rest was higher in the control hyperthyroid population than in healthy controls (P < 0.05), whereas the LVEF response to exercise was reduced in acromegalic patients (P < 0.05 vs. healthy controls). In acromegalics, the exercise-induced change in LVEF was significantly reduced compared to that in healthy controls (P < 0.001), but not to that in hyperthyroid controls (P < 0.07), being abnormal (<5% increase vs. baseline values) in six patients. Four of these six patients (66%) had elevated GH and insulin-like growth factor I levels during the treatment of acromegaly. An inverse correlation between GH and LVEF at rest (r = -0.896;P < 0.05) and at peak exercise (r = -0.950; P < 0.001) was recorded. The peak filling rate was reduced in hyperthyroid acromegalic patients compared to those in both control populations (P < 0.05). In the longitudinal study, acromegalic patients showed an increased LVMi during hyperthyroidism compared to that observed after successful treatment of acromegaly (P < 0.05); resting LVEF was increased compared to both basal (P < 0.001) and posttreatme

Topics: Acromegaly; Antithyroid Agents; Echocardiography; Female; Heart Diseases; Human Growth Hormone; Humans; Hypertrophy, Left Ventricular; Insulin-Like Growth Factor I; Iodine Radioisotopes; Longitudinal Studies; Male; Methimazole; Middle Aged; Radionuclide Angiography; Thyrotoxicosis; Ventricular Function, Left

An unusual presentation of periodic paralysis in a Mexican man with thyrotoxicosis is presented. The patient suffered paralysis of the lower extremities without apparent precipitating factors such as hypokalemia, exercise, carbohydrate or alcohol ingestion. Hyperthyroidism was managed first with a thyroid suppressant (methimazole) and propranolol. Prednisone was added after another episode of paralysis. Definitive treatment of hyperthyroidism was achieved with radioactive iodine, which subsequently required substitution therapy with thyroxine. A moderate dose of thyroxine (100 microg) caused muscular weakness. Treatment of thyrotoxicosis and flaccid paralysis as well as the effects of glucocorticoids on thyroid function are discussed.

Topics: Adult; Drug Therapy, Combination; Humans; Male; Methimazole; Paralysis; Potassium; Prednisone; Propranolol; Recurrence; Thyroid Function Tests; Thyrotoxicosis; Thyroxine

In this study, the risk of iodine-induced thyrotoxicosis in unselected patients from an iodine-deficient area was investigated. The patients were consecutively enrolled. Thyroid hormone values and urinary iodine excretion were determined before, as well as 1, 4 and 12 weeks after iodine contamination by coronary angiography. Two of 788 unselected patients developed hyperthyroidism within 12 weeks. The two patients did not belong to a risk group for iodine-induced thyrotoxicosis (i.e. old people, patients with goiter or possible thyroid autonomy, low TSH). Both patients had normal TSH levels at baseline and ultrasound of the thyroid was without evidence of nodules. The study shows that in euthyroid unselected patients from an iodine-deficient area short-term iodine contamination by contrast media rarely leads to hyperthyroidism. On account of these facts, prophylactic therapy, e.g. by perchlorate or thiamazole, is not generally recommended, because the risk of side-effects is perhaps even greater than the risk of iodine-induced thyrotoxicosis.

Topics: Adult; Aged; Aged, 80 and over; Antithyroid Agents; Contrast Media; Coronary Angiography; Female; Humans; Hypothyroidism; Iodide Peroxidase; Iodine; Male; Methimazole; Middle Aged; Thyroid Gland; Thyrotoxicosis; Thyrotropin; Thyroxine

The appearance of moderate jaundice with mildly raised levels of plasma bilirubin is an uncommon complication of thyrotoxicosis and is usually accompanied by signs of right heart failure. Some described cases were actually related, at least in part, to autoimmune chronic hepatitis. In this paper we describe a case of thyrotoxicosis accompanied by deep jaundice with very high levels of bilirubin occuring in the absence of cardiac failure and with no signs of hepatitis. Jaundice disappeared shortly after the start of thyrostatic drug treatment, supporting a possible detrimental effect of hyperthyroidism on the hepatic bilirubin metabolism.

Topics: Alkaline Phosphatase; Antithyroid Agents; Bilirubin; gamma-Glutamyltransferase; Humans; Hyperbilirubinemia; Iodine Radioisotopes; Male; Methimazole; Middle Aged; Thyrotoxicosis; Thyroxine; Triiodothyronine

Iodine-induced thyrotoxicosis or "jodbasedow phenomenon" has been reported throughout the world since iodine has been administered to treat endemic goitre. Nowadays, iodinated radiocontrast agents and the antiarrhythmic drug amiodarone are the most common sources of excess iodine load subsequently leading to iodine-induced thyrotoxicosis, especially in elderly patients with underlying goitre. The aim of the study was to identify the number of cases of iodine-induced thyrotoxicosis among patients with thyrotoxicosis in a large urban hospital. Over an 18-month period thyrotoxicosis has been diagnosed in a total of 39 patients. Eight patients with iodine-induced thyrotoxicosis (5 female, 3 male; mean age 60.6 years) have been identified (20%). In all patients with iodine-induced thyrotoxicosis, iodine exposure with a mean iodine dose of 21.5 g was documented 2 to 16 weeks before diagnosis (iodinated radiocontrast agents in 5 patients, amiodarone in 2 patients, kelp tablets in 1 patient). Clinical features were predominantly tachyarrhythmias and heart failure, while 6 of 8 patients had goitre (thyroid volume 31 to 193 ml). Thyroid antibodies were not detected. Diagnosis was confirmed in 5 of 8 patients with increased urinary iodine concentrations (3436 to > 6000 nmol/24 h), and in 3 of 8 patients with a low tracer uptake in thyroid scintigraphy (1 to 4%). Treatment consisted of methimazole in all patients, additional tional beta-blockers and lithium in 4 patients, and prednisone in 5 patients. The mean treatment ment duration was 9.2 months, and patients became euthyroid after a mean treatment duration of 6.4 weeks. One patient (with still elevated free thyroxine levels) died of myocardial infarction 4 weeks after antithyroid drug therapy had been installed. The incidence, mechanisms and features of iodine-induced thyrotoxicosis are discussed. Iodine-induced thyrotoxicosis is a common disease, and the recognition and treatment of iodine-induced thyrotoxicosis, particularly in elderly patients and patients with goitre, are of clinical importance.

Topics: Adult; Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Contrast Media; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Graves Disease; Humans; Iodine; Male; Methimazole; Middle Aged; Thyroid Function Tests; Thyrotoxicosis

Since amiodarone was introduced in Japan in 1992, the incidence of the drug-induced thyroid dysfunction has been increasing. We studied the thyroid function of 13 patients with amiodarone-induced thyrotoxicosis (AIT) and 11 patients with amiodarone-associated hypothyroidism (AAH) who had been referred to our Institute in the last 6 years. AIT and AAH developed after 39+/-21 and 20+/-16 months of amiodarone treatment, respectively. One patient developed AAH followed by AIT. The AIT ranged from subclinical to overt thyrotoxicosis. Four patients with moderate to marked AIT were treated with methimazole. Their thyrotoxicosis persisted for 3 to 9 months, despite administration of antithyroid agents. One patient with mild thyrotoxicosis was treated with prednisolone, resulting in a euthyroid state in a few months. Eight patients with asymptomatic to moderate thyrotoxicosis resolved spontaneously without any treatment. In four asymptomatic patients with AIT, serum levels of T3 and T4 were in the upper normal range or slightly high (< 12 microg/dl), accompanied by suppressed TSH (<0.1 microU/ml) and high thyroglobulin levels, suggesting destruction-induced thyrotoxicosis. Such a subclinical thyrotoxicosis developed repeatedly in one patient. Ultrasonographic studies revealed no nodular lesion in the thyroid, and color flow Doppler sonography demonstrated no hypervascularity in the thyroid gland in any AIT patient. Although it is postulated in Europe that there are two types of AIT, namely type I, which develops in patients with latent Graves' disease or toxic multinodular goiter, and type II, which develops in an apparently normal thyroid as destructive thyroiditis, all AIT patients we have seen so far had developed destructive type AIT. Sufficient intake of iodide and a very low incidence of toxic multinodular goiter may account for the rare incidence of type I AIT in our country. Mild to moderate AIT resolved spontaneously without discontinuing amiodarone, but it was discontinued in two of 13 AIT patients because of extrathyroidal adverse reactions.

Topics: Adult; Aged; Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Female; Humans; Hypothyroidism; Japan; Male; Methimazole; Middle Aged; Prednisolone; Thyrotoxicosis; Thyrotropin; Thyroxine; Time Factors; Triiodothyronine

The thyroid stimulating immunoglobulins are generally believed to be the cause of hyperthyroidism in Graves' disease. Placental transfer of these antibodies from a mother with autoimmune thyroid disease can result in fetal thyroid disorders. We report the case of a 31-year-old woman who had a history of Graves' disease. She received thyroxine therapy for post thyroidectomy hypothyroidism. Two years after the thyroidectomy, she became pregnant. Unfortunately, intrauterine fetal death occurred in midgestation. One year later, she became pregnant again. In the 26th week of gestation, fetal thyrotoxicosis was diagnosed using clinical pictures, including fetal tachycardia and cardiomegaly, and a hormonal evaluation of a periumbilical blood sampling (T4: 18 micrograms/dl, T3: 65.3 ng/dl, TSH: < 0.03 microU/ml) was performed. Antimicrosomal antibodies were not detectable in either the maternal or fetal blood. In this case, high levels of TBII were detected during pregnancy and crossed the placenta to result in a thyrotoxic fetus in the second pregnancy. We recommend that both the regular monitoring of the thyrotropin receptor antibodies of pregnant women with a history of autoimmune thyroid disease, and routine measurements of the fetal heart rate and intrauterine growth during gestation be mandatory for the early detection of fetal thyroid disorders. Cordocentesis for measuring fetal thyroid function is helpful in reaching a definite diagnosis and for guiding therapy.

Topics: Adult; Autoantibodies; Female; Fetal Diseases; Fetal Growth Retardation; Graves Disease; Humans; Immunoglobulins, Thyroid-Stimulating; Infant, Newborn; Male; Methimazole; Pregnancy; Pregnancy Complications; Receptors, Thyrotropin; Recurrence; Thyrotoxicosis

Development of muscle weakness and atrophy are well known complications of thyrotoxicosis, although little is known about its clinical course. The present longitudinal study was therefore undertaken to monitor muscle mass and strength before and during treatment of hyperthyroidism.. Five patients (2 male, 3 female; Age 41 +/- 6 years; BMI 22.2 +/- 1.1 kg/m2) with newly diagnosed hyperthyroidism were studied with respect to muscle area, muscle strength, body composition and substrate metabolism at baseline and after 1, 3, 6, 9 and 12 months of treatment.. Midthigh muscle areas were assessed by computed tomography (CT), while bioelectrical impedance analysis (BIA) was used for assessment of body composition. The isometric strength of the biceps brachialis and quadriceps muscles was assessed by means of a dynamometer and the maximal static ins- and ex-piratory mouth pressures were measured with a respiratory pressure module.. Prior to treatment thyrotoxic patients all displayed elevated levels of total and free T3 and T4 together with suppressed TSH. BMI, fat mass and lean body mass increased significantly during the treatment period, while energy expenditure (EE) decreased. Thigh muscle areas increased by 24% (101.5 +/- 11.5 vs. 125.3 +/- 13.1 cm2, P < 0.05) from entry to peak. Peak time was 9 +/- 0.9 months. During treatment a significant (P < 0.01) increase in muscle strength was observed; arm capacity increased by 48%, while leg capacity increased by 51%. Peak time (months) was: Right arm: 8 +/- 3, left arm: 7 +/- 2, right leg: 5 +/- 3, left leg: 9 +/- 2. Respiratory muscle strength, expressed as maximal ins- or ex-piratory mouth pressure, was significantly impaired among patients at entry. A significant increase in inspiratory and expiratory strength was found from entry to peak (P < 0.05), as inspiratory strength increased by 35% and expiratory by 19%. Inspiratory strength peaked after 7 +/- 1 months, expiratory muscle strength after 6 +/- 1 months.. In conclusion we find that in patients with thyrotoxicosis muscle mass is reduced by approximately 20% and muscle strength by approximately 40% and that between 5 and 9 months elapse before normal muscle mass and function are reestablished.

Topics: Adult; Analysis of Variance; Antithyroid Agents; Body Composition; Body Mass Index; Calorimetry, Indirect; Female; Humans; Longitudinal Studies; Male; Methimazole; Muscle Contraction; Muscle, Skeletal; Respiratory Muscles; Thigh; Thyrotoxicosis; Thyroxine

Topics: Adrenergic beta-Antagonists; Antithyroid Agents; Atenolol; Chronic Disease; Diagnosis, Differential; Drug Therapy, Combination; Female; Graves Disease; Humans; Methimazole; Middle Aged; Thyrotoxicosis

Thyroid hormones and leptin are both involved in the regulation of energy metabolism. Serum leptin concentrations were measured in women with thyrotoxicosis (n = 21, mean age 45 years) or hypothyroidism (n = 14, mean age 44 years) before and 3 months after restoration of the euthyroid state. Serum leptin concentration tended to increase in both hypothyroid (14.7+/-3.5 vs 17.8+/-3.9 ng/ml, p = 0.06) and thyrotoxic (11.9+/-1.7 vs 14.4+/-2.0, p = 0.08) women after treatment (values given as mean +/- SE in the untreated and the euthyroid state respectively). Body mass index (BMI) was lower in thyrotoxic women than in hypothyroid women in the untreated state (22.1+/-0.7 vs. 26.2+/-1.9, p < 0.05). BMI was not different between both groups after treatment (24.5+/-0.7 vs. 26.3+/-2.1, p = 0.37), due to an increase of BMI in the thyrotoxic women; BMI did not change in the hypothyroid group. After controlling for BMI in a multivariate regression analysis, serum leptin concentrations were lower in hypothyroid women than in thyrotoxic women (p < 0.05), whereas posttreatment values of leptin did not differ (p = 0.44). When leptin concentrations were expressed as standard deviation scores (Z-scores) from the mean value of female controls matched for BMI and age as reported earlier, Z-scores were lower in the hypothyroid than in the thyrotoxic women (-0.63+/-0.21 vs. 0.53+/-0.18, p = 0.001). After treatment, Z-scores did not deviate from the expected values (0.05+/-0.28 vs. 0.08+/-0.16, p = 0.98). Z-scores differed before and after treatment in both hypothyroid (p = 0.01) and thyrotoxic (p = 0.02) patients. In conclusion, these data obtained in thyrotoxic and hypothyroid women indicate that thyroid states modulates serum leptin concentrations independent of BMI, with a small decrease in hypothyroidism and a small increase in thyrotoxicosis.

Topics: Adult; Aged; Body Mass Index; Female; Humans; Hypothyroidism; Leptin; Methimazole; Middle Aged; Multivariate Analysis; Propylthiouracil; Proteins; Regression Analysis; Thyroid Hormones; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine

Amiodarone-induced thyrotoxicosis (AIT) occurs both in abnormal thyroid glands (nodular goiter, latent Graves' disease) (type I AIT) or in apparently normal thyroid glands (type II AIT). Differentiation of the two forms is crucial, because type I AIT responds well to methimazole and potassium perchlorate combined treatment, whereas type II AIT is effectively managed by glucocorticoids. Differential diagnosis is often difficult, although thyroid radioactive iodine uptake is usually low-to-normal in type I and low-suppressed in type II, and serum interleukin-6 levels are normal/slightly elevated in type I, markedly elevated in type II. Color flow Doppler sonography (CFDS) is a technique that shows intrathyroidal blood flow and provides real-time information on thyroid morphology and hyperfunction. To investigate the usefulness of CFDS in differentiating the two types of AIT, 27 consecutive AIT patients, 11 type I and 16 type II, were evaluated by CFDS before starting antithyroid treatment. Gender, age, severity of thyrotoxicosis, and cumulative amiodarone dose were similar in the two groups. All type II AIT patients had a CFDS pattern 0 (ie, absent vascularity), in agreement with the pathogenesis of the disease, due to thyroid damage. Likewise, nine patients with subacute thyroiditis, another destructive process of the thyroid gland, also had a CFDS pattern 0. Eleven patients with type I AIT had a CFDS pattern ranging from pattern I (presence of parenchymal blood flow with patchy uneven distribution) (7 patients, 64%) to pattern II (ie, mild increase of color flow Doppler signal with patchy distribution) (1 patient, 9%) and pattern III (markedly increased color flow Doppler signal with diffuse homogeneous distribution)(3 patients, 27%), similar to that found in patients with untreated Graves' disease patients, thus indicating a hyper-functioning gland. Control subjects and euthyroid patients under long-term amiodarone treatment had absent thyroid hypervascularity and a CFDS pattern 0. These findings demonstrate that CFDS distinguishes type I and II AIT. Because of its rapidity and noninvasive features, CFDS represents a valuable tool for a quick differentiation between the two types of AIT. This can avoid any delay in initiating the appropriate treatment for a rapid control of thyrotoxicosis in patients whose tachyarrhythmias or other cardiac disorders make thyroid hormone excess extremely deleterious.

Topics: Adult; Aged; Amiodarone; Antithyroid Agents; Diagnosis, Differential; Female; Glucocorticoids; Goiter, Nodular; Graves Disease; Humans; Male; Methimazole; Middle Aged; Perchlorates; Potassium Compounds; Thyrotoxicosis; Ultrasonography, Doppler, Color

In 35 infants of lactating mothers with thyrotoxicosis who were receiving 5 to 20 mg methimazole daily, serum levels of thyroxine, triiodothyronine, thyrotropin were within normal ranges 1 month after the start of breast-feeding. Thyroid function in breast-feeding infants of six lactating mothers receiving methimazole, 20 mg for the first, 10 mg for the second, and 5 mg for an additional 4 months, remained normal. These results suggest the safety of methimazole therapy in lactating mothers.

Topics: Adult; Antithyroid Agents; Breast Feeding; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Methimazole; Pregnancy; Pregnancy Complications; Puerperal Disorders; Thyroid Function Tests; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine

Amiodarone-induced thyrotoxicosis (AIT) occurs in both abnormal (type I) and apparently normal (type II) thyroid glands due to iodine-induced excessive thyroid hormone synthesis in patients with nodular goiter or latent Graves' disease (type I) or to a thyroid-destructive process caused by amiodarone or iodine (type II). Twenty-four consecutive AIT patients, 12 type I and 12 type II, were evaluated prospectively. Sex, age, severity of thyrotoxicosis, and cumulative amiodarone dose were similar. Type II patients had higher serum interleukin-6 (IL-6; median, 440 vs. 173 fmol/L; P < 0.001), but lower serum thyroglobulin levels. Several weeks of thionamide therapy in eight type II or prolonged glucocorticoid administration in two type I patients had previously failed to control hyperthyroidism. Type II patients were given prednisone (initial dose, 40 mg/day) for 3 months and achieved normal free T3 and IL-6 after an average of 8 and 6 days, respectively. Exacerbation of thyrotoxicosis with increased serum IL-6 values, observed in 4 patients while tapering steroid, was promptly corrected by increasing it. Type I patients, given methimazole (30 mg/day) and potassium perchlorate (1 g/day), achieved normal free T3 and IL-6 concentrations after an average of 4 weeks. Exacerbation of thyrotoxicosis with markedly increased IL-6 was controlled by prednisone in 3 of 4 cases. Distinction of different forms of AIT is essential for its successful management. Type II AIT should be treated with glucocorticoids; type I AIT should be treated with methimazole and potassium perchlorate. Exacerbation of thyrotoxicosis, which may occur in both forms and is probably related to destructive processes, should be controlled by the addition/increase in glucocorticoids.

Topics: Adult; Aged; Amiodarone; Drug Therapy, Combination; Female; Humans; Interleukin-6; Male; Methimazole; Middle Aged; Perchlorates; Potassium Compounds; Prednisone; Prospective Studies; Thyrotoxicosis; Triiodothyronine

The haemopoietic growth factors are relatively new additions to the treatment of drug-induced bone marrow suppression. Treatment with growth factors may induce primitive cells to enter into cell cycle. In clinical practice they have beneficial effects on the neutropenia following cytotoxic chemotherapy, bone marrow transplantation, and it may be effective in severe chronic neutropenia by cause drugs. One of the classes of drugs which cause serious agranulocytosis are the antithyroid drugs. A thyrotoxic patient with methimazole-induced agranulocytosis was treated with recombinant human granulocyte-monocyte colony-stimulating factor (rHu GM-CSF). Seven days following treatment with daily subcutaneous injection of 270 micrograms rHu GM-CSF combined with antibiotics and glucocorticosteroids, granulocytes reappeared in the peripheral blood and the sepsis resolved. No side effects of the treatment were observed. The combination of rHu GM-CSF and glucocorticosteroids was successful in restoring normal granulocyte count.

Topics: Aged; Agranulocytosis; Antithyroid Agents; Female; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Methimazole; Recombinant Proteins; Thyrotoxicosis

Thionamides are often used acutely to control the symptoms of thyrotoxicosis associated with Graves' disease before definitive treatment with radioiodine. Several reports have suggested that pretreatment with thionamides reduces the efficacy of radioiodine therapy in patients with Graves' disease, but other data refute this. This study retrospectively reviewed the records of 95 patients with Graves' disease treated with radioiodine. Pretreatment with thionamides resulted in significantly greater (2 1/2-fold) treatment failure rate than in patients not pretreated with thionamides but given a comparable dose of radioiodine. Higher serum thyroxine concentration at the time of diagnosis was also an independent factor associated with radioiodine treatment failure.

Topics: Adult; Chi-Square Distribution; Contraindications; Discriminant Analysis; Female; Graves Disease; Humans; Iodine Radioisotopes; Male; Methimazole; Middle Aged; Propylthiouracil; Retrospective Studies; Thyrotoxicosis; Thyroxine; Treatment Failure

Thyrostatic treatment of pregnant women with Graves' disease is a special problem. Observation of 46 pregnancies of 35 women suffering from Graves' disease has been summarized. The outcome was successful in 45 cases. Methimazole and propylthiouracil was administered to the patients without thyroxine. Therapy was needed for the two thirds of the mothers. At the end of the second trimester the thyrostatic agent could have been withdrawn in the 77% of the cases. Antithyroid treatment administered in low dose at the time of conception did not affect the outcome. Premature delivery rate and the number of neonates with low weight did not increased. Transient hyperthyrotropinaemia was observed in one case. Likewise, one infant suffered from neonatal thyrotoxicosis. 37% of the mothers had postpartal recurrence of hyperthyroidism.. the free thyroxin level monitoring is essential during thyrostatic treatment. Thyrotropin receptor antibody investigation, having predictive value for neonatal thyrotoxicosis, should be done, too. Postpartal thyroid control is necessary for elucidate a hyperthyroid relapse, the rate of which was almost 40%.

Topics: Adult; Antithyroid Agents; Female; Graves Disease; Humans; Hyperthyroidism; Infant, Newborn; Maternal-Fetal Exchange; Methimazole; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prognosis; Recurrence; Thiouracil; Thyrotoxicosis; Thyroxine; Treatment Outcome

Topics: Adult; Carbimazole; Female; Fetus; Graves Disease; Humans; Maternal-Fetal Exchange; Methimazole; Pregnancy; Pregnancy Complications; Propylthiouracil; Thyroid Function Tests; Thyroid Gland; Thyrotoxicosis

Plasma immunoreactive atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP), serum thyroxine (T4), triiodothyronine (T3), and thyrotropin (TSH) concentrations were measured in 11 patients with thyrotoxicosis and atrial fibrillation (group 1), in 5 patients with thyrotoxicosis and sinus cardiac rhythm (group 2) and in 8 healthy subjects in comparable age. Patients with thyrotoxicosis were studied before and after treatment with methimazole (3 x 20 mg daily) during 10 days. During treatment sinus cardiac rhythm returned in 6 patients with initial fibrillation (group 1a) while 5 patients still presented atrial fibrillation at the end of the study (group 1b). All patients from group 2 maintained a sinus cardiac rhythm throughout the study. Median plasma concentrations of ANP and cGMP before treatment in patients from group 1 were higher: 43.8 pmol/l and 11.0 nmol/l, respectively than in patients from group 2: 20.0 pmol/l (p < 0.005) and 6.5 nmol/l (p < 0.01), respectively. In all groups of patients methimazole treatment resulted in a significant decrease of plasma ANP and cGMP concentrations in parallel to a reduction of serum T3 and T4 levels. After therapy, plasma ANP and cGMP levels in patients from group 1a were not significantly different from those in patients from group 2, while in patients from group 1b remained slightly elevated. Presented results suggest that atrial fibrillation in patients with thyrotoxicosis represents an important factor augmenting plasma ANP and cGMP levels, in addition to the stimulatory effect exerted by thyroid hormones. However, the marked reduction of serum thyroid hormones produced by short-term methimazole treatment in patients with thyrotoxicosis was associated with parallel decrease of plasma ANP and cGMP levels toward normal values. Therefore, the influence of thyroid hormones on plasma ANP and cGMP concentrations seems relatively more important than the effect of atrial fibrillation.

Topics: Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Cyclic GMP; Female; Humans; Methimazole; Middle Aged; Thyroid Hormones; Thyrotoxicosis

Topics: Agranulocytosis; Clozapine; Drug Therapy, Combination; Female; Humans; Methimazole; Middle Aged; Thyrotoxicosis

Psychological changes during hyperthyroidism are well known. However, no studies were performed in order to quantify or evaluate them in numerical details. We have studied the personality of 15 women with Graves' disease by means of the 16PF Cattell Test, before and after treatment of hyperthyroidism with surgery or radioactive iodine. The first test was performed when patients relapsed the thyrotoxicosis after a period of euthyroidism, achieved through the treatment with antithyroid drugs during one year. At the time of the second test all patients had 6-12 months of euthyroidism. Hormonal circulating levels were as follow (mean +/- SEM): a) at the first test, T3 = 320 +/- 27 ng/dl, T4 = 19.7 +/- 1.2 micrograms/dl, TSH < 0.2 microU/ml; b) at the second test, T3 = 128 +/- 9 ng/dl, T4 = 8.8 +/- 0.8 micrograms/dl, TSH = 1.9 +/- 0.4 microU/ml. Differences between both tests were expressed for each factor as the mean difference +/- SEM (paired "t" test). After treatment patients were: 1) more relaxed and emotionally trustful and cooperative (factor A + 1.06 +/- 0.39, p < 0.02); 2) better and faster intellectual comprehension (factor B + 0.80 +/- 0.31, p < 0.05); 3) more capable of analysis (factor Q1 + 0.93 +/- 0.41, p < 0.05); 4) lower in lingering anxiety and tension (factor Q4-0.87 +/- 0.36, p < 0.05); 5) more independent, less submissive (factor QIV + 0.88 +/- 0.41, p < 0.05); 6) more relaxed (factor QI-0.69 +/- 0.20, p < 0.01). The other factors remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Female; Humans; Iodine Radioisotopes; Methimazole; Middle Aged; Personality; Personality Tests; Thyrotoxicosis; Thyroxine; Triiodothyronine

The present report illustrates the clinical and biochemical outcome in two amiodarone iodine-induced thyrotoxicosis (AIIT) patients submitted to plasmapheresis. Amiodarone was discontinued, and treatment with MMI (40 mg/day) was started. In addition, patients were submitted to two sessions of plasma-exchange, with a one-day interval between the two session. In both patients serum total T3 (TT3) and free T3 (FT3) concentrations decreased promptly but in contrast to the serum TT3, FT3 levels remained steadily above the normal range. A similar behaviour was observed for total T4 and free T4 plasma concentrations. Interestingly, a clearcut clinical amelioration was observed in both patients even before a reduction of circulating free thyroid hormone concentrations could be documented. In conclusion, our experience indicates that plasmapheresis may be useful in order to obtain a rapid amelioration of severe clinical picture of thyrotoxicosis, but cannot be considered as a definite therapy in AIIT. It should be considered that plasmapheresis is not devoid of risks and is also a very expensive procedure.

Topics: Aged; Amiodarone; Combined Modality Therapy; Female; Humans; Male; Methimazole; Middle Aged; Plasmapheresis; Thyrotoxicosis; Thyroxine; Triiodothyronine

Topics: Abdominal Pain; Adolescent; Constipation; Humans; Male; Methimazole; Thyrotoxicosis

Selective immunoglobulin (Ig) A deficiency is reported to occur in 1 in 16,000 in Japan and has been reported to be complicated with various autoimmune diseases. A 49-year-old woman was diagnosed as having autoimmune thyroid disease. Her serum IgA, IgM and IgG were revealed to be 4.1, 154 and 1930 mg/dl, respectively. Severe skin eruption which occurred with 30 mg/day of methimazole (MMI) or 300 mg/day of propylthiouracil (PTU), was relieved by reducing MMI to 15 mg/day and administering anti-allergic drugs. Although the influence of IgA deficiency on autoimmunity and allergy still remains unclear, this is a report of IgA deficiency associated with autoimmune thyroid disease.

Topics: Autoimmune Diseases; Diagnosis, Differential; Female; Humans; IgA Deficiency; Immunoglobulins; Methimazole; Middle Aged; Propylthiouracil; Thyroid Gland; Thyroid Hormones; Thyrotoxicosis

In a patient chronically treated with amiodarone, subclinical iodine-induced hypothyroidism occurred as a result of excess iodine released from the amiodarone molecule. The patient was maintained on amiodarone and developed thyrotoxicosis as a result of a destructive process into the thyroid follicles. Amiodarone was withdrawn and methylprednisolone and methimazole treatment was started with resolution of the thyrotoxic phase. Months later, off therapy, the patient developed subclinical hypothyroidism. This is the first description of hypo- and hyperthyroidism in the same patient caused by amiodarone therapy. This unusual observation suggests that patients treated with amiodarone are at risk to develop hyperthyroidism even if they show laboratory findings consistent with hypothyroidism.

Topics: Amiodarone; Antibodies; Humans; Hypothyroidism; Male; Methimazole; Methylprednisolone; Middle Aged; Tachycardia, Supraventricular; Thyroglobulin; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine

Four hundred and fifty two patients having clinical features of thyrotoxicosis have been studied for their hormonal (T4, T3 and TSH) content, I131 uptake levels and FNAB at repeated intervals. Four hundred and twenty seven had presented with diffuse enlargement and rest 25 cases with nodular enlargements. Of the primary hyperthyroidism cases 342 (82.4%) were of Grave's disease without exophthalmos and 73 (17.6%) with exophthalmos. T4, T3 and I131 uptake levels have correlated well with the degree of morphological changes as observed on FNAB. Degree of nuclear pleomorphism has correlated well with the duration of disease. Critical evaluation of morphological changes on FNAB has been done in all cases of primary hyperthyroidism being treated with neomercazole and radioactive iodine therapy. Treatment with neomercazole had shown, good correlation between time lag and the retrogressive changes. This was not so in cases treated with radioactive iodine therapy. Various known complications of radioactive treatment e.g. development of hypothyroidism, refractory and recurrent hyperthyroidism, exacerbation of the disease, radiation thyroiditis, and severe degree of dysplastic changes could be demonstrated in some cases on serial aspirations.

Topics: Biopsy, Needle; Female; Humans; Hyperplasia; Hyperthyroidism; Iodine Radioisotopes; Male; Methimazole; Thyroid Hormones; Thyrotoxicosis

We describe a case with unilateral chorea associated with thyrotoxicosis. A 23-year-old female with no family history of neurological diseases acutely developed choreic movements of the left extremities during gross thyrotoxicosis. CT scan and MRI study demonstrated no abnormality. Single-photon emission CT with technetium Tc 99m-labeled hexamethylpropyleneamine oxime revealed normal cerebral perfusion. Although the choreic movements were partially improved by dopamine antagonist, they persisted for two months until successful treatment of the thyrotoxicosis finally abolished these movements. Increased sensitivity of dopamine receptors may be responsible for persistent choreic movements in thyrotoxicosis.

Topics: Adult; Athetosis; Chlorpromazine; Chorea; Female; Humans; Magnetic Resonance Imaging; Methimazole; Thyrotoxicosis; Tomography, Emission-Computed, Single-Photon

We report a case of thyrotoxicosis with prolonged post-treatment muscle cramp and hypocalcemia. A 36 year-old woman with hyperthyroidism was treated with Methimazole (MMI). As plasma levels of T4 and T3 were normalized, hypocalcemia was noted and severe cramp of skeletal muscle appeared so that the patient was unable to walk. The cramp was gradually relieved as the levels of thyroid hormones re-increased by discontinuance of MMI, and recurred as the hormone levels were normalized by readministration of MMI. The plasma levels of free calcium ion was positively correlated with those of thyroid hormones, and the muscle cramp was worsened with lowering of the calcium level. Serum examination also revealed vitamin D-deficiency, which was probably due to an unbalanced diet of the patient. A therapeutic trial with 1 alpha-vitamin D3 and calcium lactate in addition to MMI improved both thyrotoxicosis and muscle cramp. These findings suggested that hypocalcemia due to vitamin D-deficiency was involved in the exceptionally prolonged muscle cramp associated with the treatment of hypothyroidism in this patient.

Topics: Adult; Cholecalciferol; Female; Humans; Hypocalcemia; Lactates; Lactic Acid; Methimazole; Muscle Cramp; Thyrotoxicosis; Vitamin D Deficiency

Retrospective analysis of 11 Chinese patients with Graves' thyrotoxicosis developing agranulocytosis during anti-thyroid treatment was done. Seven of them received methimazole and 4 received carbimazole. None of the 11 patients had taken propylthiouracil. The major chief complaints were high fever (100%), chillness (91%), and sore throat (73%). The duration of drug treatment prior to the detection of agranulocytosis ranged from 13 to 63 days (mean +/- 1SE: 33.1 +/- 16.1). At the time of agranulocytosis detected, the peripheral leukocyte counts were 0.5 to 2.1 X 1000/mm3 (mean +/- 1SE: 1.05 +/- 0.47 X 1000/mm3), absolute neutrophil counts 0 to 450/mm3 (mean +/- 1SE: 54.27 +/- 132.12/mm3), and hemoglobin 8.2 to 15.9 g/dl (mean +/- 1SE: 11.85 +/- 2.24 gm/dl). Three of the 11 patients had positive bacterial blood cultures. The recovery time of absolute neutrophil counts above 500/mm3 ranged from 3 to 25 days (mean +/- 1SE: 10.5 +/- 6.6) after discontinuation of antithyroid drugs. Mortality was found in 2 of them (18%).

Topics: Adolescent; Adult; Agranulocytosis; Antithyroid Agents; Carbimazole; Female; Graves Disease; Humans; Male; Methimazole; Middle Aged; Thyrotoxicosis

Activation of T lymphocytes has been found to be associated with an increase in soluble interleukin-2 receptor (sIL-2R) levels. The aim of this study was to investigate serum levels of sIL-2R in 20 untreated patients with Graves' disease and to relate these levels to disease activity and to TSH-receptor, anti-thyroglobulin, anti-microsomal and anti-eye muscle antibodies. sIL-2R levels were significantly increased in newly diagnosed Graves' patients compared with controls (667 +/- 270 vs 205 +/- 45 U/ml) (P less than 0.001). The sIL-2R levels were higher in patients with active infiltrative ophthalmology than in those without eye symptoms (810 +/- 313 vs 525 +/- 180 U/ml). All patients were treated with methimazole for at least 12 months. sIL-2R levels were normalized by methimazole treatment in the majority of patients without ophthalmopathy but not in those with ophthalmopathy. In five patients sIL-2R serum levels were studied after interruption of thyrostatic therapy. An increase was observed in three patients and hyperthyroidism subsequently relapsed in two of these. Furthermore, a correlation was found between soluble interleukin-2 receptor levels and TSH-receptor antibodies but not with other immune parameters examined. Serum sIL-2R represents a useful marker of immunological activity in Graves' disease.

Topics: Autoantibodies; Eye Diseases; Female; Graves Disease; Humans; Male; Methimazole; Prednisolone; Receptors, Interleukin-2; Receptors, Thyrotropin; Thyrotoxicosis

The purpose of the study was to determine whether such factors as: initial exacerbation of thyrotoxicosis, blood group (ABO) and the presence of HLA A1, B8 antigens have an influence on the effectiveness of the conservative treatment of thyrotoxicosis in Graves-Basedow disease (G-B disease). Studies were carried out in two groups of 32 women each with G-B disease. The patients in group I were 28-61 years of age, in whom euthyroid state lasting at least 5 years was attained after treatment with methimazole on average over a 15.4 month cycle. The age of the patients in group II was 27-61 years, in whom at least one relapse occurred in 5-year follow-up. The groups of patients did not differ significantly in the clinical exacerbation of thyrotoxicosis measured in the scale of Zgliczyński. The frequencies of occurrence of the particular clinical symptoms of thyrotoxicosis did not differ in both groups, except diarrhoea with occurred significantly more frequently in women of group II (47%) in comparison with group I (15.6%). No characteristic differences were found between both groups in the occurrence of blood group O, A, B, AB and antigen HLA A1. Statistically significant difference was found in the occurrence of antigen HLA B8 and phenotype HLA A1 B8, both between the patient groups and control. Their influence expressed by odds ratio OR = 3 indicated that the chances of effective conservative treatment for the patients in group II were three times smaller than for those in group I.

Topics: ABO Blood-Group System; Adult; Female; Graves Disease; HLA Antigens; Humans; Methimazole; Middle Aged; Thyrotoxicosis

The paper deals with agranulocytosis as one of the side effects of methimazole. The analysis of 7 cases allows some conclusions in respect to prevention, early detection and treatment of this rare but serious complication.

Topics: Adult; Aged; Agranulocytosis; Humans; Methimazole; Middle Aged; Thyrotoxicosis

Topics: Arthritis; Humans; Methimazole; Thyrotoxicosis

The outcome of radioiodine therapy of Graves' hyperthyroidism was retrospectively evaluated in 274 consecutive patients treated from 1975 to 1984. At 1-yr follow-up, permanent hypothyroidism occurred in 36.9% of patients and the cumulative incidence of hypothyroidism progressively increased up to 79.3% after 7-10 yr. At the end of the follow-up period, 148 patients (54%) were hypothyroid, 115 (42%) euthyroid and 11 (4%) still hyperthyroid. The prevalence of hypothyroidism was significantly higher in patients with small goiters (less than or equal to 50 g) than in those with large goiters (greater than 90 g). Moreover, hypothyroidism was more frequent in patients with high thyroglobulin antibodies titers (greater than or equal to 1:25,600) than in those with low titers or negative tests, and occurred earlier in the former group than in the latter ones Correction of thyrotoxicosis was obtained after the administration of a single dose of 131I in 187 patients (63.6%); 69 patients required two doses and 11 three or more doses. Seven patients refused further treatment with 131I after the first dose. In an effort to identify possible factors affecting the efficacy of 131I therapy, we evaluated the results obtained after the administration of the first dose of radioiodine. We found that large goiters, rapid iodide turnover and adjunctive therapy with methimazole shortly after radioiodine were associated with a higher rate of persistence of thyrotoxicosis, whereas an increased prevalence of hypothyroidism was observed in patients with small goiters and in those not treated with methimazole up to one week after 131I.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Female; Graves Disease; Humans; Hyperthyroidism; Hypothyroidism; Iodine Radioisotopes; Male; Methimazole; Middle Aged; Radiotherapy; Thyroid Gland; Thyrotoxicosis

There was presented a case of a therapy-resistant paroxysmal supraventricular tachycardia 130-140/min lasting about 100 days in a 21 years old barmaid drinking 5-6 glasses of natural coffee a day within last 3 years. Supraventricular tachycardia did not impair her working abilities; she was treated with propranolol within last 3 weeks before the admission to hospital. After 4 day therapy with 800 mg of quinidine, 10% potassium chloride and 75 mg of hydroxyzine performed electrocardioversion restored the sinus rhythm 90/min, but unfortunately supraventricular tachycardia returned 4 hours later. Thyroid hormones examination revealed isolated increase of serum T3 level to 3.0 ng/ml (normal value range 0.8-1, 6 ng/ml). Ultrasound examination showed mild parenchymatous goitre. Authors diagnosed a rare type of thyrotoxicosis-triiodothyronine toxicosis+, which was only manifested by long-lasting supraventricular tachycardia without clinical state impairment. Thiamazole-40 mg/day (60 mg from the 28th day of therapy), propranolol-160 mg/day as well as sedatives, 10% KCl and vitamins C and B6 were started to be given. After 72 days of treatment, when serum T3 level lowered to 2.35 ng/ml sinus rhythm 88/min returned, which was proved by 24 hour ECG Holter monitoring. The woman put on weight 10.5 kg during hospitalization and discharged from hospital to out-patient follow-up in good condition. Other authors emphasized that T3-Thyrotoxicosis did not clinically stray from the toxic multinodular or Graves-Basedow's goitre. Three year coffee overdosage deceived physicians at the start of therapy, because its abuse is a known factor inducing supraventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Drug Therapy, Combination; Electrocardiography; Female; Humans; Methimazole; Propranolol; Tachycardia, Supraventricular; Thyrotoxicosis; Triiodothyronine

Topics: Adjuvants, Immunologic; Adolescent; Adult; Age Factors; Aged; B-Lymphocytes; Drug Therapy, Combination; Female; Humans; Leukocyte Count; Levamisole; Lymphopenia; Male; Methimazole; Middle Aged; T-Lymphocytes; Thyrotoxicosis; Zymosan

Topics: Colitis, Ulcerative; Humans; Male; Methimazole; Middle Aged; Thyrotoxicosis

For the first time in Bulgaria a case of hypokalemic periodic paralysis in thyrotoxicosis is described. Three periods of paralysis were observed and documented in a hospital. The thyrotoxicosis was well manifested with disturbed carbohydrate tolerance and responded favourably to methizole treatment. It is suggested that the mechanism for the development of the hypokalemic periodic paralysis is the intracellular blockade of potassium by the surplus of thyroid hormones.

Topics: Adult; Drug Therapy, Combination; Humans; Hypokalemia; Male; Methimazole; Paralyses, Familial Periodic; Propranolol; Thyrotoxicosis

The placenta contains iodothyronine 5-deiodinase activity (P5-Dase) that probably acts on iodothyronines in the fetal circulation to convert T4 to rT3 and T3 to 3,3'-T2. Since thyroid status and fasting have profound effects on iodothyronine deiodinases in other tissues, the present studies were performed to determine if these perturbations affected P5-Dase. Control and treated rats were mated and killed near term on the 20th day of gestation. P5-Dase was determined in placenta homogenates enriched with dithiothreitol by measuring the conversion of T4 to rT3. In four of five studies, P5-Dase was similar in dams that underwent thyroidectomy (Tx) on day 7 of gestation and sham Tx dams. P5-Dase was not altered in dams that were treated with methimazole (MMI) to induce maternal and fetal hypothyroidism. Treatment of dams with supraphysiological doses of T4, beginning on the seventh day of gestation, did not significantly affect P5-Dase. In three of four studies, P5-Dase was similar in fed dams to values in dams fasted for the last 5 days of pregnancy. Placenta iodothyronine 5'-deiodinase activity (P5'-Dase) was also measured in some studies. P5'-Dase was not decreased in Tx rats and was modestly decreased in MMI-treated rats. However, the effect of MMI was not reversed by the administration of supraphysiological doses of T4, Tx, MMI treatment, and fasting all decreased hepatic T4 5'-deiodinase activity in pregnant rats. These results strongly suggest that thyroid status and fasting do not alter P5-Dase activity.

Topics: Animals; Fasting; Female; Hypothyroidism; Iodide Peroxidase; Liver; Male; Methimazole; Placenta; Pregnancy; Rats; Rats, Inbred Strains; Thyroid Diseases; Thyroidectomy; Thyrotoxicosis; Thyroxine

Topics: Chemical and Drug Induced Liver Injury; Female; Humans; Methimazole; Middle Aged; Thyrotoxicosis

We present the case of a 21-year-old man who presented to the emergency department with an episode of profound weakness due to thyrotoxic periodic paralysis, a syndrome of muscular weakness occurring in patients with hyperthyroidism. Prior to the diagnosis, the patient was treated with a parenteral tranquilizer. When hypokalemia was discovered, potassium was administered, resulting in the development of hyperkalemia. Episodes of thyrotoxic periodic paralysis are usually self limited, and recovery of motor strength is complete. However, potassium is frequently administered to hasten recovery and prevent cardiac arrhythmias and respiratory arrest. Serum potassium must, therefore, be monitored carefully in these patients during treatment.

Topics: Adult; Humans; Hyperkalemia; Hypokalemia; Male; Methimazole; Paralyses, Familial Periodic; Potassium; Propranolol; Thyrotoxicosis

Amiodarone, a iodine-rich drug widely used in the treatment of tachyarrhythmias, represents one of the most common sources of iodine-induced thyrotoxicosis. The data concerning 58 patients with amiodarone-iodine-induced thyrotoxicosis (AIIT) were analyzed in the present study. Prevalence of AIIT was higher in males than in females (M/F = 1.23/l). Thyrotoxicosis occurred either during treatment with or at various intervals after withdrawal of amiodarone. AIIT developed not only in patients with underlying thyroid disorders, but also in subjects with apparently normal thyroid gland. Classical symptoms of thyrotoxicosis were often lacking, the main clinical feature being a worsening of cardiac disorders. Biochemical diagnosis of AIIT was established by the finding of elevated serum total and free triiodothyronine levels, since elevated serum total and free thyroxine could be found also in euthyroid amiodarone-treated subjects. Twenty-four-hour thyroid radioiodine uptake was very low or undetectable in AIIT patients with apparently normal thyroid glands, while it was inappropriately elevated in patients with underlying thyroid disorders, despite iodine contamination. The role of autoimmune phenomena in the pathogenesis of AIIT appeared to be limited, because circulating thyroid autoantibodies were undetectable in AIIT patients without underlying thyroid disorders or with nodular goiter. Conversely, humoral features of thyroid autoimmunity were mostly found in AIIT patients with diffuse goiter. Treatment of AIIT appeared to be a difficult challenge. Among the 11 patients given no treatment, thyrotoxicosis spontaneously subsided in the 5 patients with apparently normal thyroid gland, whereas the 6 patients with nodular or diffuse goiter were still hyperthyroid 6-9 months after discontinuation of the drug. The administration of high doses (40 mg/day) of methimazole alone proved to be ineffective in most (14/16) patients given this treatment. Twenty-seven patients were treated by methimazole combined with potassium perchlorate (1 g/day). With one exception, euthyroidism was restored within 15-90 days in all cases with underlying thyroid abnormalities, and within 6-55 days in subjects with apparently normal thyroid gland. Thus, the combined treatment appears to be the most effective one, but, due to the potential toxicity of potassium perchlorate, it should be reserved to patients with severe thyrotoxicosis and should be carefully monitored.

Topics: Adult; Aged; Amiodarone; Drug Therapy, Combination; Female; Humans; Immunoglobulin G; Immunoglobulins, Thyroid-Stimulating; Iodine; Iodine Radioisotopes; Male; Methimazole; Middle Aged; Tachycardia; Thyroid Hormones; Thyrotoxicosis

Topics: Adult; Humans; Hypokalemia; Male; Methimazole; Paralysis; Periodicity; Propranolol; Recurrence; Thyrotoxicosis

Amiodarone iodine induced thyrotoxicosis occurs frequently in patients residing in areas of mild iodine deficiency and in patients with preexisting goiter. Drug therapy of the hyperthyroidism is often unsuccessful. Twenty-three patients with amiodarone induced thyrotoxicosis were either not treated, treated with 40 mg methimazole daily or with methimazole and 1 gm potassium perchlorate daily for up to 40 days and then with methimazole alone. Thyrotoxicosis was more likely to spontaneously remit in patients without goiter. Therapy with methimazole alone was unsuccessful in inducing euthyroidism in 5 patients with goiter. However, combined therapy with methimazole and potassium perchlorate rapidly alleviated hyperthyroidism in almost all patients with goiter. This drug combination is successful because perchlorate inhibits the active transport of iodine into the thyroid and methimazole blocks the intrathyroidal synthesis of thyroid hormones.

Topics: Adult; Aged; Amiodarone; Drug Synergism; Drug Therapy, Combination; Female; Goiter; Humans; Male; Methimazole; Middle Aged; Perchlorates; Potassium; Potassium Compounds; Thyrotoxicosis

The incidence of juvenile thyrotoxicosis has not exceeded one case per 100,000 population per year in Hungary during the past decades. From more than 200 simultaneous determinations of serum thyroid hormones (T3, T4, FT4) it was concluded that increased FT4 concentrations are the most frequent findings in thyrotoxicosis, even when both or one of the other thyroid hormone concentrations (T3, T4) are normal. TSH and prolactin responses to TRH were studied in 18 patients; TSH remained always undetectable whereas prolactin increased in half of the patients. A significant negative relationship was found between the prolactin response and the level of circulating thyroid hormone. Although the pituitary lactotrophin is controlled by thyroid hormones, thyrotrophin is more sensitive to thyroid hormone levels in juvenile thyrotoxicosis. In 56 TRH tests during antithyroid drug therapy this test was not found to be useful in predicting the likelihood of long-term remission. The low maintenance dose of antithyroid treatment (2.5-5.0 mg/day) without thyroid hormone addition seems to be a favourable mode of therapy in juvenile thyrotoxicosis.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Hungary; Male; Methimazole; Thyroid Hormones; Thyrotoxicosis; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine; Triiodothyronine

The immune status was studied in patients with a familial nature of thyrotoxicosis and without complicated heredity. Disorders in the immune homeostasis, mostly expressed in thyrotoxicosis of familial nature, were revealed. Proceeding from the above the authors proposed a method of multimodality therapy of thyrotoxicosis with antithyroid drugs and immunomodulator levamisole causing a fast disappearance of the clinical signs of thyrotoxicosis, a decrease in thyroid activity and density and the reduction of the number of surgical interventions. The effect may be probably due to the normalization of the immune status.

Topics: Adjuvants, Immunologic; Diiodotyrosine; Drug Therapy, Combination; Humans; Levamisole; Methimazole; Thyrotoxicosis

Topics: Antithyroid Agents; Humans; Hyperthyroidism; Methimazole; Preoperative Care; Reserpine; Thyroidectomy; Thyrotoxicosis

Topics: Antithyroid Agents; Humans; Hyperthyroidism; Iodine; Iodine Isotopes; Methimazole; Thyroid Function Tests; Thyrotoxicosis

Topics: Antithyroid Agents; Hyperthyroidism; Iodine; Methimazole; Thyrotoxicosis

Topics: Antineoplastic Agents, Hormonal; Antithyroid Agents; Goiter; Goiter, Nodular; Hyperthyroidism; Methimazole; Thyrotoxicosis

Topics: Antineoplastic Agents, Hormonal; Antithyroid Agents; Hyperthyroidism; Methimazole; Thyrotoxicosis

Topics: Antithyroid Agents; Hyperthyroidism; Methimazole; Thyrotoxicosis

Topics: Antithyroid Agents; Hyperthyroidism; Methimazole; Thyrotoxicosis

Topics: Hyperthyroidism; Imidazoles; Methimazole; Thyrotoxicosis

Topics: Humans; Hyperthyroidism; Imidazoles; Methimazole; Thyrotoxicosis

Topics: Hyperthyroidism; Methimazole; Thyrotoxicosis