propylthiouracil and Adenoma

A 28 year-old woman in her first pregnancy was referred to the department of obstetrics and gynecology at 24 weeks of gestation because of pregnancy-induced hypertension.. Thyroid stimulating hormone (TSH), free T3 and free T4 were elevated. Antibody screening did not show antithyroid peroxidase (anti-TPO) antibodies and TSH receptor antibodies. Clinical findings were suspicious of TSH secreting pituitary tumour (TSH-om) or thyroid hormone resistance (RTH). In absence of clinical sings of elevated intracranial pressure magnetic resonance imaging (MR) was discussed but not carried out and planned after delivery. A visual-field defect was ruled out by orbital field evaluation.. Treatment with 3 × 50 mg propylthiouracil daily was initiated. However, normal fT3/fT4 titers could not be achieved. Serum levels were in the high normal ranges and TSH remained increased. The clinical situation of the patient improved resulting in a normal delivery at term. The healthy newborn was breast feed and MR imaging of the mother revealed a 5×8 mm tumor of the pituitary gland.. In pregnant women with pregnancy-induced hypertension thyroid diseases have to be ruled out. Rare causes of hyperthyreoidism are TSH secreting pituitary tumors or thyroid hormone resistance (RTH). Treatment of choice for hyperthyreoidism in pregnancy is propylthiouracil. Normal vaginal delivery and breast feeding are possible. Following delivery it is mandatory to determine an individual treatment strategy.

Topics: Adenoma; Antithyroid Agents; Female; Humans; Hyperpituitarism; Hyperthyroidism; Infant, Newborn; Magnetic Resonance Imaging; Pituitary Gland; Pituitary Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Trimester, Second; Propylthiouracil; Rare Diseases; Thyroid Function Tests; Thyrotropin

Hyperthyroidism is mainly caused by Graves' disease and toxic adenoma or multinodular goiter. In Europe, treatment of both disorders is usually started with antithyroidal drugs such as methimazole. Complications include agranulocytosis and the risk is dose-dependent. The starting dose of methimazole should not exceed 15-20 mg/d. Propylthiouracil can cause severe liver failure, leading to liver transplantation or death. Propylthiouracil, therefore, should not be used as first line agent and is only recommended when an antithyroid drug is to be started during the first trimester of pregnancy or in individuals who have experienced adverse responses to methimazole. Toxic adenoma is finally treated with radioioidine. To reduce the risk of treatment failure, antithyroidal drugs should be stopped at least one week prior to radioiodine. For Graves' disease, remission is unlikely if antibodies against the TSH-receptor remain above 10 mU/l after 6 months of antithyroidal treatment and radioiodine or thyroidectomy can be recommended. Thyroidectomy should be performed as (near) total thyreoidectomy.

Topics: Adenoma; Agranulocytosis; Antithyroid Agents; Female; Goiter, Nodular; Graves Disease; Humans; Hyperthyroidism; Methimazole; Pregnancy; Pregnancy Complications; Propylthiouracil; Thyroid Neoplasms; Thyroidectomy

We described a 39-yr-old asian female who was initially diagnosed with prolactinoma and presented with increase nervousness and weight loss. Laboratory evaluation revealed an inappropriately normal TSH level with elevated free T4, total T3, alpha-subunit and prolactin level. The alpha-subunit/TSH molar ratio was 4. MRI showed a macroadenoma extending to the suprasellar cistern. Treatment was begun with propylthiouracil and bromocriptine. After 5 months of therapy, she became pregnant. At 27 weeks of gestation, she developed headache and decreased visual acuity in her left eye. MRI showed a slightly increase in tumor size compressing the optic chaiasm. Transphenoid macroadenectomy was performed with immediate relief of the visual field abnormality. At 39 weeks gestation a baby with no malformations was delivered. This is the second case report of TSH secreting pituitary adenoma which was exarcerbated during pregnancy. In contrast to the first case, our case was managed with both surgical and medical approach. The judicious use of both medical and surgical therapy can result in a successful outcome to mother and fetus in a patient with TSH secreting pituitary adenoma.

Topics: Adenoma; Adult; Antithyroid Agents; Combined Modality Therapy; Female; Humans; Infant, Newborn; Magnetic Resonance Imaging; Pituitary Hormones; Pituitary Neoplasms; Pregnancy; Propylthiouracil; Thyrotropin

Reports of the coexistence of hyperparathyroidism and thyroid disease have raised the issue of a possible etiologic relationship. The present study tests the hypothesis that chronic elevation of thyroid-stimulating hormone (TSH) is related to the development of hyperparathyroidism. Four groups of 60 female rats were treated as follows: group 1, control; group 2, propylthiouracil (PTU) 0.0025%; group 3, PTU 0.0025% plus thyroxine, 5 microg two times per week; and group 4, only thyroxine. The animals' serum calcium, phosphorus, TSH, thyroxine, and parathyroid hormone (PTH) levels were evaluated at 0, 6, 12, and 18 months. Significant elevation of TSH was sustained throughout the 18 months in groups 2 and 3. The PTH levels were also significantly elevated in both group 2 and group 3 animals (P = 0.02). The histopathologic features of the parathyroids were evaluated at 18 months. In the group 2 (PTU only) animals, which had profound hypothyroid, 44% developed parathyroid adenomas. In the group 3 (PTU plus thyroxine) animals, who had mildly elevated TSH levels, 53% developed parathyroid adenomas. These findings are consistent with the hypothesis that prolonged TSH stimulation may lead to hyperparathyroidism in the rat model.

Topics: Adenoma; Animals; Antithyroid Agents; Calcium; Chronic Disease; Disease Models, Animal; Female; Hyperparathyroidism; Hyperplasia; Hypothyroidism; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Phosphorus; Propylthiouracil; Rats; Rats, Sprague-Dawley; Survival Rate; Thyroid Gland; Thyrotropin; Thyroxine

Topics: Adenoma; Female; Goiter, Nodular; Graves Disease; Humans; Hyperthyroidism; Iodine Radioisotopes; Methimazole; Pregnancy; Pregnancy Complications; Propylthiouracil; Thyroid Neoplasms

Estrogen receptor (ER) levels were evaluated in thyroid tumors induced by N-methyl-N-nitrosourea (MNU) and low iodine diet (LID) or propylthiouracil (PTU) in intact and estrogen (E2) loaded Long-Evans (LE) rats. MNU at 40 mg/kg body wt was injected in 50 day-old LE rats of both sexes. The animals were killed 17-22 weeks later and the thyroid tissues were subjected to ER assay. In LID-treated groups, cytosolic ER (cER) levels were 6.7 +/- 5.8 (fmol/mg protein, mean +/- SE) in females and 0.7 +/- 1.4 in males, E2 increased the ER levels. In E2-loaded LID groups, cER levels were 12.9 +/- 3.7 in females and 1.7 +/- 1.7 in males. PTU treatment produced almost comparable ER levels as LID treatment. PTU treatment as well as LID treatment increased the serum TSH levels with E2 treatment producing additional elevation. In evaluating ER levels by histological type of thyroid tumors, the level in cER plus nER showed the lowest value of 6 +/- 6.4 (fmol/mg DNA, mean +/- SE) in hyperplasia, followed by 129 +/- 52.3 in adenoma and 289 +/- 51.7 in carcinoma. The rates of BrdU incorporation in thyroid follicles indicated higher proliferation activity in the area of adenoma and carcinoma rather than in the hyperplastic area. These data suggested that E2 treatment increases the ER levels in MNU and LID/PTU-induced thyroid tumors. The level of ER was correlated to the histological type of thyroid tumors.

Topics: Adenoma; Animals; Carcinoma; Estrogens; Female; Hyperplasia; Iodine; Male; Methylnitrosourea; Organ Size; Pituitary Gland; Propylthiouracil; Rats; Rats, Inbred Strains; Receptors, Estrogen; Thyroid Gland; Thyroid Neoplasms; Thyrotropin

The clinical management of the hyperthyroid patient is controversial, because there is no perfect treatment. Factors that influence the choice of therapy include the patient's age, sex, and type of hyperthyroidism, as well as patient and physician preference.

Topics: Adenoma; Adolescent; Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Child; Female; Goiter, Nodular; Graves Disease; Humans; Hyperthyroidism; Iodine; Iodine Radioisotopes; Male; Pregnancy; Pregnancy Complications; Propylthiouracil; Thyroid Neoplasms; Thyroxine; Triiodothyronine

Thyroid surgery in the pediatric age patient accounts for a small minority of all thyroid surgery. Batsakis and Nishiyama reported only 136 patients under the age of 18 who underwent thyroid surgery in 27 years at the University of Michigan. In most series involving the pediatric age group, the majority of thyroid procedures are performed on adolescents. Thyroid surgery in the young child requires special precautions in addition to those routinely associated with thyroidectomy in the adult. The techniques and perioperative management of the pediatric thyroidectomy employed at our institution has evolved as experience is gained. Our experience with five such patients with adequate follow-up will be presented.

Topics: Adenoma; Adolescent; Age Factors; Child; Child, Preschool; Drainage; Female; Follow-Up Studies; Graves Disease; Humans; Hypothyroidism; Iodine; Male; Postoperative Care; Postoperative Complications; Preoperative Care; Propylthiouracil; Thyroid Hormones; Thyroid Neoplasms; Thyroidectomy

The effect of 0.15% propylthiouracil (PTU) on thyroid tumorigenesis was studied in male Wistar rats given a single i.p. injection of 280 mg of N-bis(-2-hydroxypropyl)nitrosamine (DHPN) per 100 g body weight. The mean weights of the thyroid of rats treated with DHPN followed by PTU and with PTU alone were significantly higher than those of rats treated with DHPN only and control rats. The incidences of follicular adenoma at the end of week 20 of the experiment were 100% (21/21) in rats treated with DHPN followed by PTU, and 19% (4/21) in rats given DHPN alone. Papillary adenoma was observed in one rat treated with DHPN followed by PTU. The incidence of follicular carcinomas with invasive growth into the capsule, adipose tissues or blood vessels was 52% (11/21) in rats given DHPN and then PTU. No papillary carcinomas or solid tumors were found in any rats. Rats given PTU alone and untreated rats had no thyroid tumors. The serum concentration of T4 in rats treated with PTU alone was significantly lower than that in the control group. The serum concentration of T4 in rats treated with DHPN followed by PTU was slightly, but not significantly, lower than that in control rats. The serum concentrations of T3 in rats treated with DHPN followed by PTU, DHPN alone and PTU alone were also slightly, but not significantly, lower than that in controls.

Topics: Adenoma; Animals; Carcinogens; Cystadenoma; Drug Synergism; Male; Nitrosamines; Propylthiouracil; Rats; Rats, Inbred Strains; Thyroid Neoplasms

Topics: Adenoma; Antithyroid Agents; Carbimazole; Humans; Hyperthyroidism; Iodides; Methimazole; Propylthiouracil; Sulfur Isotopes; Thyroid Gland; Thyroid Neoplasms

Topics: Adenoma; Antithyroid Agents; Buffers; Centrifugation; Chromatography, Paper; Evaluation Studies as Topic; Goiter; Humans; Hydrolysis; Imidazoles; Iodine; Iodine Radioisotopes; Methods; Pronase; Propylthiouracil; Thyroid Function Tests; Thyroid Gland; Thyroid Hormones; Thyroid Neoplasms; Thyroxine

Topics: Adenoma; Animals; Cell Transformation, Neoplastic; Iodine Isotopes; Male; Mitosis; Neoplasms, Experimental; Neoplasms, Radiation-Induced; Propylthiouracil; Rats; Thyroid Neoplasms; Thyrotropin

Topics: Adenoma; Animals; Iodine Isotopes; Male; Neoplasms, Experimental; Propylthiouracil; Rats; Thyroid Neoplasms

Topics: Adenoma; Animals; Carcinogens; Carcinoma; Fluorenes; Methylthiouracil; Neoplasm Metastasis; Neoplasms, Experimental; Propylthiouracil; Rats; Thiouracil; Thyroid Neoplasms

Topics: Adenoma; Goiter; Hyperthyroidism; Pathology; Propylthiouracil; Rats; Research; Thyroid Neoplasms; Thyrotropin; Toxicology

Topics: Adenoma; Adenoma, Chromophobe; Child; Diagnostic Imaging; Drug Therapy; Hyperthyroidism; Intracranial Pressure; Pathology; Pituitary Neoplasms; Propylthiouracil; Radiography; Surgical Procedures, Operative; Visual Fields

Topics: Adenoma; Chromatography; Diiodotyrosine; Iodine Isotopes; Metabolism; Mice; Neoplasms, Experimental; Propylthiouracil; Research; Thyroid Neoplasms; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine; Triiodothyronine; Tyrosine

Topics: Adenoma; Animals; Joint Diseases; Mice; Pituitary Gland; Pituitary Gland, Anterior; Propylthiouracil; Thyroid Neoplasms