ABSTRACT
Thyroid dysfunction is associated with attention deficit and impairment of the motor system (muscle weakness and fatigue). This paper investigates possible motor function deficit in thyroid patients,compared to the controls. Functional MRI studies (fMRI)were carried out in five hypo and five hyperthyroid patients and six healthy volunteers. Whole brain imaging was performed using echo planar imaging (EPI)technique, on a 1.5T whole body MR system (Siemens Magnetom Vision). The task paradigm consisted of 8 cycles of active and reference phases of 6 measurements each, with right index finger tapping at a rate of 120 taps/min. Post-processing was performed using statistical parametric mapping on a voxel-by-voxel basis using SPM99. Clusters of activation were found in the contralateral hemisphere in primary somatomotor area (M1), supplementary motor area (SMA), somatosensory,auditory receptive and integration areas, inferior temporal lobe, thalamus and cerebellum. Increased clusters of activation were observed in M1 in thyroid subjects as compared to controls and with bilateral activation of the primary motor cortex in two hyperthyroid patients. The results are explained in terms of increased functional demands in thyroid patients compared to volunteers for the execution of the same task.
Subject(s)
Adult , Brain Mapping , Fingers/physiopathology , Humans , Hyperthyroidism/physiopathology , Hypothyroidism/physiopathology , Magnetic Resonance Imaging , Middle Aged , Motor Activity , Motor Cortex/physiopathologyABSTRACT
BACKGROUND: Radioactive iodine has gained widespread acceptance as the first-line therapy for Graves' hyperthyroidism and is the preferred treatment option in most situations. OBJECTIVE: A prospective study was conducted to look at the therapeutic practice of use of radioactive iodine in the treatment of Graves' hyperthyroidism, to determine whether the expected or desired therapeutic outcome is achieved. SETTINGS: A tertiary referral centre in north India, Delhi that caters to patients with thyroid disorders. METHODS: One hundred and seventy four consecutive subjects with Graves' hyperthyroidism, who were given radioactive iodine were followed up. RESULTS: There were 59 (33.9%) males and 115 (66.1%) females. The mean age was 41.8 +/- 9 years. The dose of radioactive iodine ranged from 2 mCi to 15 mCi and the mean dose administered was 5.2 +/- 1.9 mCi. After one year following radioactive iodine therapy, 29 (16.7%) subjects were euthyroid, 51 (29.3%) were hypothyroid and the remaining 94 (54%) had persisting hyperthyroidism. Those subjects with persisting hyperthyroidism at one year after radioactive iodine had received a significantly lower dose compared to the groups who had achieved cure (either euthyroidism or hypothyroidism). CONCLUSION: The study shows that the current practice of empirical low dose radioactive iodine therapy to avoid hypothyroidism results in majority of patients having persisting hyperthyroidism. There is a need to take a new look at the current practice to increase the cure rate.
Subject(s)
Adult , Dose-Response Relationship, Radiation , Female , Goiter, Nodular/drug therapy , Graves Disease/radiotherapy , Hospitals , Humans , Hyperthyroidism/pathology , India , Iodine Radioisotopes/administration & dosage , Male , Middle Aged , Prospective Studies , Radioimmunoassay , Radiotherapy Dosage , Thyroid Gland/drug effects , Thyroid Hormones/blood , Thyrotropin/blood , Treatment OutcomeABSTRACT
The autonomic status in female thyroid patients was compared with healthy, age matched normal females taken as controls. The patients (29 +/- 7 years) were categorised into two groups: hyperthyroid and hypothyroid. The valsalva manoeuvre, standing to lying ratio (S/L ratio) and immediate heart rate response to standing (30:15 ratio) to assess the parasympathetic status while the galvanic skin response (GSR) was recorded to assess the sympathetic status. Statistical analysis was done using Student's t-test for comparing between the different groups and regression analysis were performed between autonomic indices and thyroid hormone levels. Although the mean values were not significantly different in hypothyroid and hyperthyroid patients, yet the correlation between autonomic function and thyroid hormone levels indicates a statistically significant difference (P-value<0.05), with the S/L ratio. The correlation was negative for log [T3] and log [T4], while it was positive for log [TSH]. This indicates that there is decreased parasympathetic activity with increased T3 and T4, which is in agreement earlier reports. The GSR, which is one of the measures of sympathetic activity, was found to be unaffected.