A Case of Thyrotoxicosis During Lithium Therapy / 대한내분비학회지

Lithium has been established as a drug useful for the treatment of manic depressive disorder. It is now well recognized that long-term administration of this drug is associated with various antithyroid effects such as goiter, and subclinical and overt hypothyroidism. However, it has been associated less commonly with thyrotoxicosis. Recently we experienced a case of thyroitoxicosis during lithium therapy. A 24-year-old man treated with lithium carbonate 900 mg-1,200 mg/day for manic-depressive illness for four weeks. He then complained of nervousness, palpitation, tremor, heat intolerance, and sweating. Neck pain was not noted. At that time the results of thyroid function test were consistent with hyperthyroidism: T3 568.8 ng/dL, TSH 0.01 mU/mL, FT4 6.0 ng/dL, but 24 hr radioiodine uptake was 0.3%. We suspected this case as lithium induced thyrotoxicosis and discontinued lithium administration. After discontinuation of lithium thyrotoxic symptoms were subsided. One month later, thyroid hormon levels became normalized: T 100.2 ng/dL, TSH 0.06 mU/mL, FT4 0.97 ng/dL and 24hr radioiodine uptake was 16%. We report this case with review of literatures.

Remodeling and Changes of Systolic and Diastolic Functions of Left Ventricle after Acute Myocardial Infarction: Comparison according to Killip Class at Admission

BACKGROUND: Infarct size determines left ventricular (LV) systolic and diastolic dysfunctions after acute myocardial infarction, and also may affect the recovery from functional impairment. We studied the differences of LV remodeling and changes of systolic and diastolic functions of LV during two weeks after acute myocardial infarction, according to Killip class at admission. METHODS: Echocardiographic examinations were performed within two days (23.9+/-2.3 hours), and two weeks after the attack in 27 patients with acute myocardial infarction, and the results were compared with those of 19 controls. Patients were divided into two groups according to Killip class at admission; 18 patients in Killip class I (group I) and 9 patients in Killip class II to IV (group II). Group II had larger infarct, reflected by higher levels of peak serum cardiac enzymes. RESULTS: LV systolic function was more depressed in group II. Regional wall motion score index decreased in group I after two weeks, but not in group II. LV systolic and diastolic volume indexes increased after two weeks in group II but not group I. E/A ratio of mitral inflow was less than 1, and isovolumic relaxation time was prolonged in group I immediately after the attack. Group II had E/A>1 and shorter deceleration time (DT) of mitral inflow, and higher peak reverse flow velocity associated with atrial contraction (AR) of pulmonary venous flow than those of controls immediately after the attack. In group II, E/A ratio was greater, DT was shorter, peak systolic/diastolic flow velocity ratio of pulmonary venous flow was less, and AR was higher than those of controls after two weeks. CONCLUSION: Infarct size affected remodeling and changes of systolic and diastolic functions of LV after acute myocardial infarction. In patients with large infarct, LV was dilated and regional wall motion was not improved during two weeks. Restrictive pattern of LV filling, which was more aggravated during two weeks, was noted immediately after the attack. In patients with small infarct, LV was not dilated and regional wall motion was improved during two weeks. LV filling pattern showed relaxation abnormality.

MR Imaging of the Combined Anterior and Posterior Cruciate Ligament Tears: Focussing on the Patterns of Injuries and Associated Findings

PURPOSE: To evaluate the patterns of injuries and frequency of associated findings on MR imaging in patients with both anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears; to compare the associated findings, as seen on MR imaging, in cases with both ACL and PCL tears with those with ACL or PCL tears. MATERIALS AND METHODS: Ten patients with combined ACL and PCL tears, 16 with ACL tears and 18 with PCL tears, all confirmed by arthroscopy or open surgery, were involved in this study. To identify the associated knee injuries, MR images were retrospectively evaluated. RESULTS: In ten patients with combined ACL and PCL tears, open surgery led to the identification of six complete ACL tears (60%), four partial ACL tears (40%), eight complete PCL tears (80%) and two partial PCL tears (20%). Injuries associated with these combined tears, and revealed by MR imaging, comprised six medial collateral ligament injuries (60%), six lateral collateral ligament injuries (60%), five medial meniscal injuries (50%), three lateral meniscal injuries (30%), nine bony injuries (90%), two posterior capsular injuries (20%), and three popliteus muscle injuries (30%). The frequency of popliteus muscle injury was significantly different (p<0.05, Fisher's exact test) between the group with both ACL and PCL tears and that with ACL or PCL tears. CONCLUSION: Associated findings in patients with combined ACL and PCL tears are more frequentthan in those with ACL or PCL tears. In cases involving combined ACL and PCL tears, associated findings-as seen on MR images-should thus be carefully examined.

Early Avascular Necrosis of the Femoral Head: Relationship of the Findings of Preoperative MRI and the Long-Term Results of Core Decompression

PURPOSE: To evaluate potential correlation between the extent and site of avascular necrosis (AVN), as determined by preoperative magnetic resonance (MR) imaging, and the development of femoral head collapse. MATERIALS AND METHODS: Using clinical, radiographic and MR imaging criteria, twenty hips in 15 patients were selected for core decompression. Preoperative MR results were classified into three categories: group A, less than 15% involvement of the weight-bearing portion of the femoral head; group B, 15%-30% involvement; group C, more than 30% involvement, according to ARCO staging. We also established three groups according to site of involvement of the femoral head, namely medial, middle and lateral. RESULTS: Of 20 cases, three were stage Ia; two, Ib; four, Ic; three, IIa; two, IIb; and 6, IIc. Ten cases of Ia, Ib, IIa or IIb showed no femoral head collapse during follow-up of at least 24 months, while ten cases of Ic or IIc showed femoral head collapse. CONCLUSION: The prognosis of core decompression in patients with early AVN is related to the area of lesion in the femoral head.