1/10. Thyroid carcinoma and Graves' disease.OBJECTIVE: To describe an unusual patient with thyroid carcinoma who had metastatic pulmonary nodules that regressed transiently during the active phase of Graves' disease. methods: The clinical, pathologic, and laboratory findings in a female patient with thyroid carcinoma, pulmonary lesions, and Graves' ophthalmopathy are presented. In addition, the patient's clinical course and results of serial studies are reviewed. RESULTS: A 62-year-old woman underwent excision of a follicular carcinoma of the thyroid and then total thyroidectomy in 1984. Two years later, chest radiography disclosed multiple pulmonary lesions; open-lung biopsy revealed follicular carcinoma. thyroglobulin determinations continued to increase, and computed tomography of the chest showed an increase in the size and number of pulmonary nodules. Clinically, the patient remained unchanged until 4 years postoperatively, when she noted rapid onset of diplopia, proptosis, and diminished visual acuity. During this time, a thyroid-stimulating immunoglobulin assay was strongly positive, thyroglobulin levels were decreased, and computed tomography and radiography of the chest showed evidence of tumor regression. Orbital decompression partially restored vision, and the inflammatory signs decreased gradually. Concurrently, the thyroid-stimulating immunoglobulin level declined, the thyroglobulin level increased, and the pulmonary lesions increased in size and number. The patient ultimately died of metastatic disease. CONCLUSION: The reduction in size of the pulmonary nodules and decrease in thyroglobulin levels when the thyroid-stimulating immunoglobulin level was high and the regrowth of lesions when it declined suggest a causal relationship. The hypothesis of an operative autoimmune factor cannot be substantiated without serologic evidence in this case but should prompt physicians to search for other such occurrences.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. Orbital lymphoma misdiagnosed as Graves' ophthalmopathy.OBJECTIVE: To describe a case of bilateral orbital lymphoma mistakenly diagnosed as Graves' ophthalmopathy. methods: We present a case report, with laboratory data and photographic documentation, and discuss the differential diagnosis in patients with orbital masses. RESULTS: A 65-year-old man with bilateral exophthalmos and substantial weight loss was referred to the Endocrine Clinic for evaluation of possible Graves' disease. A 6-cm mass was detected in the left axilla. biopsy of this mass revealed the histopathologic diagnosis of anaplastic B-cell lymphoma. Treatment with intrathecally administered methotrexate and orally administered dexamethasone promptly resulted in decreased proptosis. CONCLUSION: The most frequent cause of bilateral proptosis is Graves' ophthalmopathy, and when it is associated with weight loss in an elderly patient, the initial diagnostic consideration is thyrotoxic Graves' disease. This case should remind physicians that bilateral orbital lymphoma, although uncommon, may mimic Graves' ophthalmopathy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Minimal change nephropathy and graves' disease: report of a case and review of the literature.OBJECTIVE: To describe a possible association between Graves' disease and nephrotic syndrome attributable to minimal change nephropathy and to review the literature related to renal diseases in patients with Graves' disease. methods: The clinical, laboratory, and renal biopsy findings in a patient with Graves' disease and minimal change nephropathy are discussed. In addition, the pertinent English-language literature published from 1966 to 2001, determined by means of a medline search, is reviewed. RESULTS: A 29-year-old woman underwent assessment by her primary-care physician because of palpitations, sweating, and a 4.5-kg weight loss. physical examination revealed a diffuse goiter and tremors of the extremities but no ophthalmologic signs. Laboratory tests confirmed a diagnosis of thyrotoxicosis. Treatment was initiated with propylthiouracil and propranolol. Four weeks later, she presented to the University of Louisville Hospital with increasing swelling of her legs and periorbital puffiness. Examination revealed generalized edema, ascites, and pleural effusion. She continued to have features of thyrotoxicosis. Laboratory tests showed undetectable thyroid-stimulating hormone (<0.03 mIU/mL) and homogeneously increased 123I thyroid uptake and scan. A 24-hour urine collection revealed urinary protein excretion of 6.75 g. Antinuclear antibodies, serum complement levels, hepatitis, and human immunodeficiency virus (hiv) screen were normal. A kidney biopsy specimen revealed features consistent with minimal change disease on light, immunofluorescence, and electron microscopy. The patient had an excellent clinical and laboratory response to treatment with radioactive iodine and corticosteroids, and she was asymptomatic at 6-month follow-up. CONCLUSION: To the best of our knowledge, this is the first report of the concomitant occurrence of Graves' disease and minimal change disease in the absence of any other immunologic disorder known to be associated with minimal change nephropathy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. Deceptively high thyroid hormone levels in a neonate due to autoantibodies against thyroid hormones transferred from a mother with Graves' disease.At birth, a clinically euthyroid male neonate was found to have unexpectedly high levels of free T3 and T4 concurrent with a high TSH level. The mother was treated with propylthiouracil for Graves' disease during and after pregnancy. The neonate also had an extremely high titer of TSH receptor antibodies. He soon became clinically thyrotoxic as TSH levels were suppressed and thyroid hormone levels rose. After instituting antithyroid therapy, TSH levels became elevated again, while thyroid hormone levels decreased but were still above normal. Around 3 months after birth, both TSH receptor antibodies and discordance, between the levels of thyroid hormones and TSH, disappeared. Because of high maternal TSH levels in conjunction with an elevated free T3 level at 7 months postpartum, we suspected the presence of autoantibodies against thyroid hormones (AAb). Maternal and infant blood samples were then examined retrospectively for AAb and were detected in all the samples except those of the infant taken more than 3 months after birth. The authors, therefore, suggest that physicians be aware of the presence of AAb in pregnant women with Graves' disease, in order to avoid inappropriate treatment which could lead to fetal and neonatal hypothyroidism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. Hypocalcaemia following therapy of thyrotoxicosis in an infant.A 2-mo-old infant born to a mother with Graves' disease and having symptoms of thyrotoxicosis was started on antithyroid drugs. life-threatening hypocalcaemia requiring high-dose calcium infusions developed 1 mo after starting therapy. serum alkaline phosphatase and paratharmone levels were elevated. This communication may serve to alert treating physicians about this rare complication in infants with thyrotoxicosis after initiation of antithyroid therapy. Conclusion: Severe hypocalcaemia may follow initiation of antithyroid therapy in infants with thyrotoxicosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. hyperthyroidism in the geriatric population.Although the thyroid gland can become overactive at any age, the syndrome of hyperthyroidism changes considerably in elderly persons. The principal reason is comorbidity. The patient over age 65 is much more likely than a young adult of 20 or 25 to have one or more preexisting disorders when the thyroid becomes overactive. In the elderly, therefore, the classic picture of hyperthyroidism--the constellation of irritability, sweating, palpitations without heart disease, weight loss despite good appetite, goiter, and warm, fine skin, familiar to all physicians--may never develop. Well before it might have appeared, a milder degree of thyroid hyperfunction may become manifest because of worsening of an underlying disease. Accordingly, the recognition of the thyroid disorder is often delayed. The purpose of this article is not so much to review hyperthyroidism as to delineate the special features found in geriatric patients and to describe a simple but effective scheme of evaluation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. hypothyroidism with spontaneous progression to hyperthyroidism.Chronic lymphocytic thyroiditis (Hashimoto's disease) is usually regarded as a stable and irreversible condition. This report describes a patient with autoimmune hypothyroidism who subsequently developed hyperthyroid Graves' disease. patients with Hashimoto's thyroiditis should be followed regularly, and the development of clinical and/or biochemical hyperthyroidism should alert the physician to the possibility of another thyroid disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. multiple sclerosis, euthyroid restrictive Grave's ophthalmopathy, and myasthenia gravis. A case report.A 53-year-old physician with a 13-year history of multiple sclerosis presented with the subacute onset of an atypical, restrictive, euthyroid Grave's ophthalmopathy. The hypotropia and monocular upgaze restriction responded to a course of systemic and local steroids. Three months later, the patient developed ocular and systemic features of myasthenia gravis. This is the second reported case of coincident multiple sclerosis, myasthenia gravis, and thyroid-related disease complex.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. osteomalacia secondary to celiac disease, primary hyperparathyroidism, and Graves' disease.Primary hyperparathyroidism is seldom associated with other autoimmune disorders. The presence of normocalcemia in primary hyperparathyroidism should prompt the physician to look for vitamin d deficiency. This observation concerns a 34-year-old vegetarian woman with combined primary hyperparathyroidism, Graves' disease, and celiac disease. The patient presented with severe bone deformities; she was unable to walk, and had severe muscular weakness and weight loss. Biochemical findings revealed severe hyperparathyroidism with normocalcemia, hypophosphatemia, very low urinary calcium, and low 25-hydroxy vitamin D level. Thyroid tests showed hyperthyroidism with positive thyroid receptor antibodies, confirming the presence of Graves' disease. Positive antigliadin and antireticulin antibodies and complete villous atrophy on duodenal biopsy established the presence of celiac disease. The patient underwent a near-total thyroidectomy, with the removal of a parathyroid adenoma. To our knowledge, this observation is the first finding of an association between celiac disease, Graves' disease, and primary hyperparathyroidism. It emphasizes the need to rule out intestinal malabsorption in the case of normocalcemic hyperparathyroidism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. Hyperthyroid Graves' disease and primary hypothyroidism caused by TSH receptor antibodies in monozygotic twins: case reports.A 33-year-old woman with signs and symptoms of hypothyroidism, including increased thyroid stimulating blocking antibody (TSBAb) activity, was referred for treatment by her local physician. Her monozygote twin was treated for hyperthyroid Graves' disease 10 years earlier. This case of hyperthyroidism and hypothyroidism in identical twins suggests the involvement of environmental factors in the pathogenesis of autoimmune thyroid diseases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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