1/678. Membranous glomerulonephritis associated with Graves' disease.Renal involvement in thyroid diseases is an unusual event. Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis has been reported in propylthiouracil-treated patients. Membranous glomerulonephritis has been reported in association with both antithyroglobulin and thyroid antimicrosomal antibodies. The development of membranous glomerulonephritis may be associated with administration of 131I. We present a patient who developed membranous glomerulonephritis after administration of 131I. The clinical and pathological features of renal involvement in thyroid diseases are reviewed.- - - - - - - - - - ranking = 1keywords = thyroid (Clic here for more details about this article) |
2/678. Monocular involuntary eyelid closure.OBJECTIVES: Monocular blepharospasm (MBLS) is precipitated by ipsilateral ocular pathology and becomes bilateral over time. Two patients are reported with monocular visual disturbance exhibiting monocular involuntary eyelid closure (MIEC), resembling MBLS. MATERIAL AND methods: A 31-year-old female with hyperthyroidism developed monocular polyopia with left eye vision on binocular fixation followed by ipsilateral visual extinction. Monocular vision was otherwise normal. A 57-year-old male with renal failure developed monocular blindness secondary to retinal hemorrhage. RESULTS: The first patient had anisocoria and proptosis. brain magnetic resonance (MR) was normal. The second patient had involuntary movements of the left eye. head computerized tomography (CT) was normal. Both patients exhibited MIEC of the eye with visual impairment that could be overcome voluntarily, but reappeared upon distraction. Neither of the two developed BLS in long-term follow-up. CONCLUSION: MIEC represents a complication of ipsilateral ocular pathology in the absence of other involuntary movements, apraxia of eyelid opening, or blepharospasm (BLS). MIEC needs to be distinguished from MBLS, since not all MBLS becomes bilateral.- - - - - - - - - - ranking = 0.33333333333333keywords = thyroid (Clic here for more details about this article) |
3/678. Systemic adverse effect of antithyroid drugs.Antithyroid drugs adverse effects are varied and rare. Autoimmune disorders (vasculitis, lupus erythematosus, polyarthritis...) are unusual and serious complications of antithyroid drugs. Since 1945, fewer than 100 cases of systemic manifestations related to antithyroid drugs have been reported in the literature, most frequently with propylthiouracil. The outcome is usually good after drug discontinuation, but some fatal cases have been reported. Because possible cross-sensitivity with other antithyroid drugs, the appropriate treatment for hyperthyroidism relapse if a patient has had an antithyroid drug adverse reaction, should be 131I-iodine or surgery. We report four new cases of systemic manifestations during propylthiouracil therapy.- - - - - - - - - - ranking = 3.3333333333333keywords = thyroid (Clic here for more details about this article) |
4/678. Development of primary hypothyroidism with the appearance of blocking-type antibody to thyrotropin receptor in Graves' disease in late pregnancy.Spontaneous remission of Graves' disease with a decrease of thyroid stimulating antibody (TSAb) activity is commonly observed in pregnancy. In this article, however, a Graves' patient who developed primary hypothyroidism with an appearance of thyroid stimulation-blocking antibody (TSBAb) activity in late pregnancy is reported. A 25-year-old woman presented with clinical and biochemical hyperthyroidism with an elevation of 99mTcO4- thyroid uptake (4.7%; normal range, 0.7%-3.0%) and mildly elevated activity of thyrotropin-binding inhibitory immunoglobulin (TBII; 30.4%). She was euthyroid with normal TBII (8.0%) and TSAb (126%) before pregnancy, when the patient was taking a 5-mg daily dose of methimazole (MMI). MMI was stopped by the patient when she became pregnant. Subsequently, the patient progressed into primary hypothyroidism with a marked elevation of TBII activity (78.4%) in the third trimester of the pregnancy (at that time, TSAb activity was not detected). TSBAb measured 2 weeks later was detected at the activity of 85.0%. Replacement therapy was initiated with levothyroxine (LT4) (0.05-0.1 mg/day), which was discontinued on the 55th day postpartum because of the onset of mild thyrotoxicosis followed by short-term euthyroid state despite high TSBAb activity. Subsequently, because the patient developed primary hypothyroidism 5 months after delivery, replacement therapy with LT4 (0.1-0.125 mg/day) was readministered. Thus, it is suggested that the development of hypothyroidism with the appearance of TSBAb in Graves' patients can occur even in late pregnancy.- - - - - - - - - - ranking = 4.6666666666667keywords = thyroid (Clic here for more details about this article) |
5/678. Development of Graves' hyperthyroidism from primary hypothyroidism in a case of thyroid hemiagenesis.We report a 42-year-old female with right thyroid hemiagenesis who initially presented with hypothyroidism and then developed hyperthyroidism. The serum titer of thyroid-stimulating antibody was weakly positive in the initial hypothyroid state, and then markedly increased along with the development of hyperthyroidism, while thyroid stimulation-blocking antibody was continuously negative throughout the observation period. Thyroid histology of biopsied specimens during the hypothyroid state demonstrated diffuse thyroiditis with mononuclear cell infiltrations; however, the histology during the hyperthyroid state showed hyperplasia in follicular epithelial cells accompanied by partial lymphocyte infiltration. This is the first case of thyroid hemiagenesis associated with a conversion from primary hypothyroidism due to Hashimoto's thyroiditis to hyperthyroidism due to Graves' disease.- - - - - - - - - - ranking = 8.6666666666667keywords = thyroid (Clic here for more details about this article) |
6/678. Parasitic nodule of the thyroid in a patient with Graves' disease.We report a case of a parasitic nodule of the thyroid in a patient with Graves' disease, which mimicked a lymph node metastasis from a primary occult thyroid carcinoma. The patient was a 67-year-old Japanese woman with a past history of subtotal thyroidectomy for Graves' disease, who was referred to our hospital because of a right cervical mass. A lymph node-like lesion measuring 1.5 cm in diameter was palpable, distinct from the remnant of the right thyroid lobe. Thyroid scintigraphy using 123I-Na revealed a hot lesion at the upper lateral portion of the right thyroid lobe, and this was resected. Microscopically, the mass showed thyroid follicles with lymphocytic infiltration and lymphoid follicles. Clear ground glass nuclei, nuclear grooving and intranuclear inclusions were not observed. No morphological evidence of the lymph node was found in the mass by reticulin staining. Parasitic nodules of the thyroid in patients with Graves' disease may mimic a metastatic carcinoma of the thyroid.- - - - - - - - - - ranking = 4.0055037472266keywords = thyroid, nodule (Clic here for more details about this article) |
7/678. Appearance of anti TSH-receptor antibodies and clinical Graves' disease after radioiodine therapy for hyperfunctioning thyroid adenoma.Radioiodine treatment use is frequent in patients with benign hyperfunctioning thyroid diseases and the side-effects are rare. In this paper we described the appearance of TSH-receptor antibodies and the concomitant development of persistent hyperthyroidism in a patient with hyperfunctioning thyroid adenoma after 131I treatment. A 70-year-old man presented a hyperfunctioning thyroid adenoma with suppressed uptake in the adjacent normal gland. antibodies against the thyroglobulin (TgAb), thyroid peroxidase (TPOAb) and TSH-receptor (TRAb) were absent. One year after remission by radioiodine therapy the patient developed severe and persistent hyperthyroidism associated with diffuse 131I uptake in the gland. TgAb and TPOAb remained absent, but TRAb were present. Although spontaneous development of Graves' disease cannot be excluded, the time sequence and the negative familial and personal history for autoimmune diseases suggest a possible connection between the two phenomena. The release of TSH-receptor antigen from follicular cells damaged by 131I may have triggered the autoimmune response turning a toxic nodular goiter patient into a Graves' disease patient.- - - - - - - - - - ranking = 3.3333333333333keywords = thyroid (Clic here for more details about this article) |
8/678. Graves' disease following successful treatment of severe aplastic anaemia with antilymphocyte globulin.This case report is only the third report of thyroid dysfunction following the administration of anti-lymphocyte globulin for severe aplastic anaemia. It is the first report of the development of Grave's disease. We discuss a possible mechanism by which this may occur and highlight instances of other immune-mediated diseases occurring in ALG treated patients.- - - - - - - - - - ranking = 0.33333333333333keywords = thyroid (Clic here for more details about this article) |
9/678. hyperthyroidism of Graves' disease: evidence for only unilateral involvement of the thyroid gland in a 31-year-old female patient.hyperthyroidism of Graves' disease (Morbus Basedow) is known to involve the thyroid gland in toto, unlike Graves' ophthalmopathy which clinically may either be unilateral or bilateral. We report a 31-year-old Caucasian female patient who presented with unilateral goiter and clinical and laboratory evidence for hyperthyroidism. High-resolution ultrasonography of the thyroid gland revealed a morphology indicative of an autoimmune thyroid disease strictly limited only to the right lobe. 123I-scintiscanning showed a homogenous but several fold increased uptake of the radionuclide in the right lobe of the thyroid gland, whereas the uptake in the left lobe did not differ from the uptake in normal controls. Cytology of the fine needle aspirate of the right lobe revealed a remarkable inflammatory background mainly by presence of lymphocytes, a finding which was not seen in the cytology of the left lobe. Furthermore, both serum antibodies to TSH-receptors and thyroid peroxidase were significantly increased. Consequently, hyperthyroidism of Graves' disease with the involvement of only one lobe of the thyroid gland was diagnosed.- - - - - - - - - - ranking = 5.6666666666667keywords = thyroid (Clic here for more details about this article) |
10/678. Two Graves' disease patients who spontaneously developed hypothyroidism after antithyroid drug treatment: characteristics of epitopes for thyrotropin receptor antibodies.Few reports have identified blocking thyrotropin receptor antibodies (TSHRAbs) as a pathogenic mechanism explaining spontaneous hypothyroidism after antithyroid drug (ATD) treatment of Graves' disease. Here we report 2 Graves' patients who showed different courses of hypothyroidism after ATD treatment. The first patient had Graves' hyperthyroidism and was treated with ATD for 1 year. After a short period of euthyroidism, she developed permanent hypothyroidism with blocking TSHRAb. The second patient became euthyroid after 1 year of ATD treatment. After 3 years, however, she presented with hypothyroidism with blocking TSHRAb activity. Her hypothyroidism was transient, and restoration of euthyroidism was followed by disappearance of blocking TSHRAb. Blocking and stimulating TSHRAbs activities of these 2 patients were serially measured using Chinese hamster ovary (CHO) cells transfected with wild-type human TSHR (CHO-hTSHR) and 2 TSHR chimeras with residues 8-165 (Mc1 2) or 90-165 (Mc2) substituted by equivalent residues of the luteinizing hormone/chorionic gonadotropin receptor (LH/CGR). During their hypothyroid phases, blocking TSHRAbs activities were positive in all 3 kinds of assays and stimulating TSHRAbs activities were negative in CHO-hTSHR or in Mc 1 2 assay. Mc2 stimulating TSHRAb activity was detected in sera of hypothyroid phase of the second patient who had transient hypothyroidism but not in the first whose hypothyroidism was permanent. In these 2 cases, we demonstrate the causative role of blocking TSHRAb in the development of hypothyroidism after ATD treatment in Graves' patients. Interestingly, the difference in the course of blocking TSHRAb-induced hypothyroidism was associated with the difference in epitope reactivities of TRAb during hypothyroid phase that developed after ATD treatment of Graves' disease.- - - - - - - - - - ranking = 8.3333333333333keywords = thyroid (Clic here for more details about this article) |
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