The effect of the combination therapy with antithyroid drug and thyroxine in Graves' disease / 대한내과학회지

OBJECTIVES: It was recently reported that the administration of T4 during antithyroid drug(ATD) therapy resulted in a significant decrease of antibodies to TSH receptors as well as the rate of recurrence of active Graves' disease following discontinuance of ATD treatment. But, there is still controversy whether combination therapy is efficient. Therefore, the present study was undertaken to evaluate the effect of T4 administration of patient with Graves' disease who were being treated with ATD. METHODS: We studied 56 patients received methimazole(MMI) alone(Group 1) and 48 patients received methimazole plus T4(Group 2), They are diagnosed active Graves' disease at department of internal medicine, Kwang ju Christian Hospital from January, 1994 to December, 1995. All the patients were treated initially with 30mg of methimazole daily for one month after then, in the Group 1(methimazole alone), the dose of methimazole was adjusted as necessary to achieve normal serum concentrations of T3, T4, and TSH. The patients of Group 2(methimazole plus T4) continue to receive the combination of T4 at a dose of 100 microgram daily. Simultaneously, we estimated the serum concentration of T3, T4, TSH and Thyroid-stimulating immunoglobulin(TSI) antibody at every three months. RESULTS: We obtained the following result. In the group 1, mean TSI values were 50.1%(first visit), 30.6%(6months), and 24.7%(1year). And, in the group 2 mean TSI values were 51.8%(first visit), 33.6%(6months), and 22.7% (1year). After 6 months of discontinuing of therapy, the recurrence rate was no significant difference in the two groups (the recurrence rate were 55.4%, 50.0%, respectively P>0.05). CONCLUSION: These results suggest that T4 administration in combination with MMI therapy have no significant effect in a decrease in levels of TSH receptors antibodies and recurrence rate within 6 months discontinuing MMI therapy as compared with MMI treatment alone.

The Evaluation and Treatment of the Obstructive Biliary Disease through the Percutaneous Transhepatic Choledocoscopy (PTCS ) / 대한소화기내시경학회지

BACKGROUND/AIMS: Obstructive jaundice is developed from the cholangiocarcinoma, biiliary tract stone, biliary benign stricture and pancreatic head cancer and is rapidly progress to cholangitis or sepsis. So early decompression, accurate diagnosis and treatment are very important. Percutaneous transhepatic choledocoscopy (PTCS) and endoscopic retrograde choledocoscopy (ERCS) have been used for evaluation of the obstructive jaundice. We performed, through the PTCS, electrohydraulic lithotripsy (EHL) for biliary tract stone rernoval, biopsy for diagnosis of biliary stric and self expandible metalic coil stent (EndocoilTM stent, Instent Co.) insertion on biliary stricture to evaluate the usefullness of PTCS in patients with obstructive jaundice. METHODS: Between Auguest 1994 and September 1995, PTCS was performed in 37 patients with obstructive jaundice. First, percutaneous transhepatic biliary drainage (PTBD) with 7Fr. drainage tube was done. Three days later, we exchainged the 7Fr. drainage tube with 16Fr.. Seven days later, through the PTCS, we performed EHL, biopsy and EndocoilTM stent insertion.

Suppressive Therapy with Levothyroxine in Benignn Solitary Thyroid Nodule / 대한내분비학회지

BACKGROUND: Clinically apparent thyroid nodule is a very common disease in adults. Patients are often treated with thyroxine in order to reduce the size of the nodule, but the efficacy of thyroxine-suppressive therapy with thyroxine remains uncertain. We investigated the efficacy of thyroxine-suppressive therapy and the hormonal characteristics during thyroxine therapy to find out whether such measurement could be used to determine the effectiveness of this therapy in patients with benign solitary thyroid nodule proved by aspiration biopsy. METHODS: In this study, 54 patients were randomly assigned to receive L-thyroxine (Group I, n=24) or placebo (GroupII, n=30) for 1 year. High resolution ultrasonography (10MHz) was used to measure the size of the nodules at six month intervals. Thyroid hormones and thyroglobulin assay and FNA (fine needle aspiration) was done at the same time. The dose of thyroxine was 200ug/day. Patients were followed at 6 month intervals. RESULTS: The results were as follows: 1) 13 (54.1%) out of 24 Group I patients after adequate TSH suppression had a statistically significant reduction of nodule size and before-to-after nodule volume ratios were significantly different between the Group I and Group II patients. 2) In the responders among Group I patients, the before-to-after therapy ratio of the nodule volume was not related to the pretreatment nodule size, thyroid hormones and thyroglobulin levels. CONCLUSION: Thus we concluded that an adequate suppressive dose of L-thyroxine significantly altered the volume of the benign solitary thyroid nodules 12 months later.