1/10. Transient hyperthyroidism complicating hydatidiform mole.A 15-week pregnant patient with hydatidiform mole presented with overt features of hyperthyroidism. With evacuation of the uterus and subsequently hysterectomy, her thyroid state returned to normal. The transient nature of the syndrome makes definitive anti-thyroid treatment unnecessary.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. methimazole-induced hepatotoxicity.OBJECTIVE: To present the case of a patient with Graves' hyperthyroidism in whom treatment with methimazole led to severe cholestasis. methods: A detailed case report and an overview of previously published cases of methimazole- and carbimazole-induced hepatotoxicity, found in a medline search with use of methimazole, carbimazole, thionamides and antithyroid agents as subject headings, are provided. RESULTS: In a 36-year-old woman with severe hyperthyroidism, treatment with methimazole (20 mg twice daily) was initiated. Nineteen days later, pruritus, scleral icterus, dark urine, and abdominal discomfort prompted discontinuation of the therapy. Laboratory investigations and abdominal ultrasonography showed findings consistent with a cholestatic reaction to methimazole. Recovery was slow but complete. Of the 30 previously published cases of hepatotoxicity related to treatment with methimazole or carbimazole in which the nature of the hepatic injury was described, 19 were also cholestatic. CONCLUSION: physicians should be aware that thionamide drugs can be associated with hepatotoxicity. Analysis of the known cases suggests that older age of the patient and higher dose of the drug are risk factors for cholestatic injury.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/10. Macro- and microadenoma of thyrotropin secreting pituitary tumors--two clinical cases.Thyrotropin secreting adenoma, thyrotropinoma (TSH-oma), is a rare cause of hyperthyroidism--called secondary hyperthyroidism. The hormonal profile in pituitary hyperthyroidism is characterized by a nonsuppressed TSH in the presence of high levels of free thyroid hormones (fT4, fT3) reflecting an abnormal feedback. The diagnosis of TSH-oma is often made at the stage of macroadenoma because of the aggressive nature of the tumor and due to the fact that patients are mistakenly treated for more common primary hyperthyroidism for a long time. Two cases of TSH-secreting adenoma were detected in Chair and Department of endocrinology, Collegium Medicum of the Jagiellonian University in Krakow for the last twenty years. Case 1: 49 year old woman was admitted to the Clinic of endocrinology in 1999 with recurring hyperthyroidism treated with surgical thyroid ablation in 1992 and thyreostatics for the previous nine years. On admission to the Clinic her thyroid panel presented with elevated free hormone levels (mainly fT3-14.8 pmol/l) and not suppressed TSH-0.7 mIU/l suggesting central hyperthyroidism. MRI scan of the pituitary gland revealed microadenoma of 5 mm in diameter. She was qualified to transsphenoidal resection of the tumor. Histopathology revealed acidophilic adenoma with positive TSH staining. thyroid hormones 8 days after the operation suggested full effectiveness of the surgery. Case 2: 65 year old man treated for one year with L-Thyroxin because of elevated TSH (60 mIU/l) and then with thyreostatics for elevated fT3 and fT4 was admitted to the Clinic of endocrinology in 2000 with suspected thyrotropinoma. On admission to the Clinic thyroid panel suggested hyperthyroidism with fT4-40 pmol/l, FT3-11.2 pmol/l without suppression of TSH 2.2 mIU/l. MRI scan revealed a pituitary tumor 20 x 18 x 20 mm, compressing the optic chiasm. He was administered octreotide as a preparation for the operation. The patient underwent trans-sphenoidal resection of the adenoma (histopathologically a chromophobic adenoma). The example of presented patients suggests that clinical course of the pituitary tumor producing TSH and the rate of the tumor growth may differ significantly. Surgical resection of TSH producing adenoma is the most effective therapy. It should be proceeded by octreotide administration in patients with macroadenoma.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. Fine-needle aspiration of an unusual case of poorly differentiated insular carcinoma of the thyroid.Poorly differentiated insular carcinoma of the thyroid is a rare thyroid malignancy that is intermediary in biological behavior between well-differentiated and undifferentiated thyroid carcinoma. We used fine-needle aspiration (FNA) to diagnose a poorly differentiated insular carcinoma with unusual cytological features in a 53-yr-old woman with a history of goiter and hypothyroidism, who presented with a massively enlarged thyroid gland and a large liver metastasis. The hypercellular aspirates were comprised predominantly of individually dispersed tumor cells. The tumor cells were small, monotonous, round to oval, and often plasmacytoid with eccentric hyperchromatic nuclei and occasional binucleation; finely granular, ill-defined cytoplasm; and smooth nuclear contours, with hyperchromasia, and small to inconspicuous nucleoli. There were no identifiable microfollicles, necrosis, and mitotic figures. The differential diagnosis included poorly differentiated insular carcinoma, medullary carcinoma of the thyroid, and low-grade lymphoma. Immunocytochemical staining for thyroglobulin, calcitonin, and CD45 yielded negative findings. The insular pattern and scattered microfollicles were appreciated only focally in the specimen from the total thyroidectomy, which also showed other histological patterns including solid, trabecular, and papillary forms. In addition to small, uniform cells, Hurthloid, columnar, and clear cells were focally noted. thyroglobulin immunoreactivity was recognized only in areas with well-formed follicles. In view of the aggressive nature of insular carcinoma, preoperative recognition is important in planning appropriate therapy. Familiarity with the cytomorphological features, a high index of suspicion, and consideration of appropriate differential diagnoses can greatly aid in reaching a definitive preoperative diagnosis. The limitations of FNA in the sampling of a large tumor with heterogeneous patterns should be kept in mind when interpreting the cytomorphological and immunocytochemical results.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/10. An approach to mediastinal masses associated with hyperthyroidism.Benign thymic hyperplasia (BTH) is a known feature of hyperthyroidism, but is infrequently appreciated by clinicians. In most cases thymic enlargement is minimal; however, it may occasionally present as an appreciable anterior mediastinal mass. While surgical resection is a common approach to such a mass, recognition of the benign nature of BTH and its regression following treatment of hyperthyroidism would prevent a major surgical procedure. We present three cases of BTH associated with hyperthyroidism and describe our approach to this syndrome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. Relapse of Graves' disease 23 years after treatment with radioactive iodine (131I).The use of radioactive iodine (131I) in the treatment of Graves' disease results frequently in hypothyroidism requiring thyroid hormone supplementation. Relapse of Graves' disease months after inadequate treatment with 131I is well-recognized. However, late relapse of Graves' disease in a patient rendered hypothyroid by 131I years after therapy has not been reported. The authors discuss a patient who had a relapse of his Graves' disease 23 yr after treatment with 131I. Over the interval the patient had been on 1-thyroxine replacement for hypothyroidism and had persistently high levels of long acting thyroid stimulator or thyroid stimulating antibody. The authors speculate that the immune nature of Graves' disease may play a role in the observed clinical response to 131I.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/10. Resolution of thyroid-induced schizophreniform disorder following subtotal thyroidectomy: case report.Psychoses due to thyrotoxicosis are typically affective in nature. We report on a schizophreniform psychosis in a woman with Graves' disease whose symptoms abated following subtotal thyroidectomy. Surgical thyroidectomy should be considered in thyrotoxic patients who are unresponsive to medical therapy or who manifest unremitting or life-threatening psychotic behavior, especially if long-term compliance required for medical therapy appears unlikely.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. Transient thyrotoxicosis associated with acute hemorrhagic infarction of autonomously functioning thyroid nodules.Two patients with nontoxic autonomously functioning thyroid nodules had transient hyperthyroidism after acute hemorrhagic infarction. Previously solid "hot" nodules were converted to cystic "cold" nodules. Aspiration confirmed the hemorrhagic nature of the process. There was marked regression in nodule size, marked reduction of nodular autonomous secretory activity (indicated by a change from a blunted to a normal response to thyrotropin-releasing hormone), and spontaneous recovery of function in the previously suppressed extranodular thyroid tissue. confusion of this entity with a nontoxic autonomously functioning thyroid nodule that has progressed to the toxic stage may be avoided if the loss of nodular function is noted on imaging. The possibility of granulomatous thyroiditis may be excluded by blood aspiration.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. Clinical application of computed tomography to thyroid disease.CT examinations were carried out in 62 patients with various thyroid disorders, 42 patients with thyroid nodules, 12 with diffuse abnormality and 8 of others. Evaluation was made whether CT could provide more information compared with other techniques. Cystic thyroid nodules could be differentiated from solid nodules with a reasonably high degree of accuracy. Uncalcified thyroid carcinoma was noticed as an ill-defined nodule with irregular wall, grossly the same in density with the muscle in plain CT, and not opacified by contrast material. CT has the ability to define the nature of the thyroid nodules better than other nontraumatic diagnostic modalities.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. Case of propylthiouracil-induced vasculitis associated with anti-neutrophil cytoplasmic antibody (ANCA); review of literature.A 39-year-old Japanese woman had been receiving propylthiouracil for 5 years for hyperthyroidism when she developed myalgia, scleritis, proteinuria, fever, and inflammation of the nose. Examination of a renal biopsy specimen showed focal segmental necrotizing glomerulonephritis. Indirect immunofluorescent staining showed a highly positive perinuclear pattern of anti-neutrophil cytoplasmic antibody (ANCA) in her serum. enzyme-linked immunosorbent assay (ELISA) of the ANCA showed positivity for anti-proteinase 3, anti-myeloperoxidase, anti-leukocyte elastase, and anti-lactoferrin, but anti-cathepsin g and anti-lysozyme were negative. Because ELISA showed the titer of anti-leukocyte elastase antibody to be markedly elevated, we challenged this data by performing dot blot analysis. The patient's serum reacted with the native form, but not with denatured leukocyte elastase. propylthiouracil-induced vasculitis was suspected. Symptoms abated within 2 weeks and all values of ANCA were reduced after the drug was withdrawn. vasculitis is a rare side-effect of propylthiouracil therapy. Recently it was reported in association with ANCA. We present the findings of this patient and compare them with those described in 19 published cases of propylthiouracil-induced vasculitis associated with ANCA.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
| | Next -> |