propylthiouracil and Exophthalmos

Hyperthyroidism is rare in early childhood and most commonly caused by Graves' disease. We report 14 children (4 boys, 10 girls) aged 3.4-7.5 yr. At diagnosis, all patients had weight loss, hyperkinetic activity, tachycardia, difficulty sleeping, and poor concentration and 11 presented with proptosis. Four patients developed long-term neuropsychological problems. There was a family history in 7 cases. All patients had goiters, clinically assessed to be large and diffuse in 21%, medium-sized in 43%, and small in 36%. At diagnosis, height was increased with median (range) height; 1.25 standard deviation score (SDS) (-0.2-5.24) and body mass index (BMI) was decreased; -0.48 SDS (-1.65-1.26). Height and BMI SDS values were statistically different (p<0.032) Bone age was advanced in 4 of 5 children, who had assessments. Total or free T4 levels were elevated and TSH was undetectable. Ninety percent of patients (12/14) had positive thyroid peroxidase autoantibodies, mean level 680 IU/ml (range 50-1347). Initial treatment was with antithyroid medication using carbimazole; median dose 0.75 mg/kg/day (no.=13) or propylthiouracyl 15 mg/kg/day (no.=1). T4 was added in 6 patients. Normalisation of serum T4 occurred at 4 months (1- 9) and TSH at 7 months (3-24) after start of therapy. Treatment was discontinued after a minimum of 2 yr in 11 patients, relapse occurring in 9. Median duration of total therapy was 58 months (18-132). During adolescence, 4 patients had curative therapy by surgery (no.=2) or radioiodine (no.=2). In conclusion, disturbance of growth, behavioral difficulties and infrequent spontaneous remission are key features of Graves' disease in early childhood.

Topics: Age of Onset; Antithyroid Agents; Attention Deficit Disorder with Hyperactivity; Carbimazole; Child; Child, Preschool; Exophthalmos; Female; Graves Disease; Growth Disorders; Humans; Hyperkinesis; Iodide Peroxidase; Male; Propylthiouracil; Recurrence; Retrospective Studies; Sleep Wake Disorders; Tachycardia; Thyrotropin; Thyroxine; Weight Loss

To describe an episode of thyroid associated orbitopathy (TAO) following the initiation of thiazolidinedione (TZD).. We report a female patient with a history of Graves' disease and stabilised thyroid associated orbitopathy for 2.5 years, who experienced rapid progression of TAO after the initiation of thiazolidinedione for glycemic control. Following the discontinuation of TZD, the patient experienced subsequent stabilisation of disease and normalization of vision. The medical history, ophthalmic findings, and clinical course are discussed.. Thiazolidinediones may exacerbate TAO, and this should be taken into consideration when selecting treatment for diabetic patients with a history of autoimmune thyroid disorders.

Topics: Diplopia; Disease Progression; Drug Therapy, Combination; Exophthalmos; Female; Graves Ophthalmopathy; Humans; Hypoglycemic Agents; Magnetic Resonance Imaging; Metformin; Middle Aged; Propranolol; Propylthiouracil; Retreatment; Rosiglitazone; Thiazolidinediones

We report an 11-year-old girl with euthyroid Graves' disease. She was referred to our clinic because of left exophthalmos without other symptoms suggestive of hyperthyroidism. Her serum concentration of free thyroxine (FT4) and free triiodothyronine (FT3) were normal, but thyroid-stimulating hormone (TSH) was below normal and impaired TSH response to TSH releasing hormone (TRH) was found. Although the sera were positive for anti-TSH receptor antibody (TRAb) and thyroid-stimulating antibody (TSAb), both titers were not as high as usually observed in Graves' disease. Three months later, she developed hyperthyroidism and was treated with propylthiouracil. Within 2 weeks of the initiation of therapy, all symptoms except exophthalmos disappeared, and after 2 months of treatment TRAb was negative though TSAb remained positive. TSAb is therefore a good indicator to use in the diagnosis and follow-up of euthyroid Graves' disease and should be measured in patients with exophthalmos of unknown origin, even in children.

Topics: Antithyroid Agents; Autoantibodies; Child; Exophthalmos; Female; Graves Disease; Humans; Immunoglobulins, Thyroid-Stimulating; Magnetic Resonance Imaging; Propylthiouracil; Receptors, Thyrotropin; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine; Triiodothyronine

Propylthiouracil (PTU) is the most common antithyroid medication utilized in children for the treatment of hyperthyroidism. An adverse effect of PTU reported infrequently is hepatic injury. The child described here is the fifth reported case of severe hepatic injury in the pediatric age group and documents that clinical or biochemical evidence of hepatic injury requires immediate discontinuation of PTU.

Topics: Chemical and Drug Induced Liver Injury; Child; Exophthalmos; Female; Hepatic Encephalopathy; Humans; Hyperthyroidism; Propylthiouracil

Patients with both exophthalmos and hyperthyroidism were treated with different modes of therapy for their hyperthyroidism. Propylthiouracil followed by surgery, propylthiouracil followed by radioactive iodine, propylthiouracil alone, and radioactive iodine alone were used. Some of the patients became hypothyroid and were made euthyroid with levothyroxine sodium. Based on the mode of therapy and whether or not hypothyroidism occurred, each patient was assigned to one of seven groups and followed up for 18 months or longer. Careful exophthalmometry was performed at six-week intervals in all patients. Though progression of exophthalmos was noted in all groups, the group that received propylthiouracil demonstrated the greatest progression of exophthalmos. In the group receiving sodium iodide l 131 therapy and in the group treated surgically, the rate of progression of exophthalmos was lessened with the development of hypothyroidism. Since these hypothyroid patients were made euthyroid with supplemental levothyroxine, it appeared that loss of thyroid tissue, rather than the hypothyroidism per se, was responsible for the decrease in progression of the exophthalmos. The continued progression of exophthalmos in the propylthiouracil-treated group may be related to effects of propylthiouracil on the immune system.

Topics: Exophthalmos; Graves Disease; Humans; Hyperthyroidism; Hypothyroidism; Iodine Radioisotopes; Propylthiouracil; Thyroidectomy; Thyroxine; Time Factors

Although the extent of proptosis in exophthalmic Graves' disease has been measured directly and shown to correlate with serum content of a bioassayable exophthalmus-producing factor (EPS;1), a comparable relationship in an experimental model has not been reported. Progressive exophthalmos, measured from photographs and expressed as a ratio of intercorneal distance to intersupraorbital ridge distance, was produced in male guinea pigs when thyroid status was altered either by surgical thyroidectomy supplemented with 131-I treatment or by the administration of 6-propyl-2 thiouracil (0.1% in chow). In both groups, at time of sacrifice, serum content of EPF estimated by a modified goldfish bioassay using a known exophthalmogeric TSH preparation (Ambinon, Organon-Oss) as standard was positively correlated (r equals 0.804) with the terminal degree of exophthalmos. Daily replacement therapy with T4 (15mug/kg body wt) failed to alter significantly the exophthalmos which developed, even when replacement was initiated prior to the alterations of thyroid gland function; this observation tends to eliminate thyroid hormone deficiency per se as the causal event in exophthalmos. T4 treatment did, however, reverse or prevent the rises in serum TSH levels (McKenzie bioassay) thus dissociating TSH activity from EPF activity in the guinea pig. Treatment of guinea pigs with synthetic TRH (0.5, 1.0 OR 10 mug/kg body wt) for 21 days failed to produce demonstrable exophthalmos or assayable EPF levels although plasma TSH was significantly elevated.

Topics: Animals; Biological Assay; Body Weight; Exophthalmos; Goldfish; Guinea Pigs; Iodine; Iodine Radioisotopes; Male; Organ Size; Propylthiouracil; Thyroid Gland; Thyroidectomy; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine

Topics: Birth Weight; Body Weight; Digitalis Glycosides; Exophthalmos; Female; Humans; Hyperthyroidism; Infant, Newborn; Infant, Newborn, Diseases; Propylthiouracil; Tachycardia; Thyroid Function Tests

Topics: Adolescent; Cerebrospinal Fluid; Exophthalmos; Female; Fluoresceins; Fluoroscopy; Fundus Oculi; Humans; Hyperthyroidism; Ophthalmoscopy; Papilledema; Phenobarbital; Photography; Pressure; Propylthiouracil

Topics: Animals; Exophthalmos; Female; Propylthiouracil; Rats; Thymectomy; Thymus Gland; Thyroid Gland; Thyrotropin; Triiodothyronine

Topics: Antithyroid Agents; Exophthalmos; Humans; Hyperthyroidism; Iodides; Iodine; Iodine Isotopes; Methylthiouracil; Perchlorates; Propylthiouracil; Radioisotopes; Radionuclide Imaging; Thyroid Neoplasms; Toxicology

Topics: Child; Exophthalmos; Goiter; Graves Disease; Humans; Propylthiouracil

Topics: Animals; Exophthalmos; Propylthiouracil; Rats; Thiourea

Topics: Exophthalmos; Goiter; Graves Disease; Humans; Propylthiouracil; Thiourea