Características clínico-oftalmológicas y evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social, Paraguay / Clinical-ophthalmological characteristics and evolution of patients with moderately severe active thyroid ophthalmopathy treated with methylprednisolone boluses who attended the Central Hospital of the Instituto de Previsión Social, Paraguay

Introducción: La oftalmopatía tiroidea (OT) es un trastorno debilitante en pacientes con enfermedad tiroidea autoinmune, principalmente enfermedad de Graves, que se desarrolla entre el 30 a 50% de los casos. Objetivos: Describir las características clínico-oftalmológicas y la evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social en el tiempo comprendido entre enero de 2018 y setiembre de 2021. Materiales y métodos: Investigación de diseño observacional, con estudio descriptivo, retrospectivo. Resultados: Se revisaron fichas de 34 pacientes con OT activa moderada severa que recibieron bolos de metilprednisolona basado en las guías EUGOGO 2016, de los cuáles se excluyeron 3 pacientes por tener fichas incompletas y otros 3 pacientes ya que requirieron tratamiento de segunda línea previo al término del esquema de 12 sesiones. De los 28 pacientes estudiados, la edad promedio fue de 43,6 ±13,1 años, el 89% de sexo femenino y el 28,5%, fumadores. En cuanto a la función tiroidea de la población previo al tratamiento, se constató hipertiroidismo en el 82%, hipotiroidismo en el 11% y eutiroidismo en el 7%; y posterior al tratamiento, se constató hipertiroidismo en el 78,6% (subclínico), eutiroidismo en el 17,9% e hipotiroidismo en el 3,5%. La mayoría (92.6%) contaba con anticuerpos contra el receptor de TSH positivo, con un promedio de 18 ± 9,9 mIU/Ml. Respecto a la actividad de la oftalmopatía según la escala CAS, se constató un promedio de 4,1 ±1,0 previo al tratamiento y posterior 1,2 ±1,4; de ellos el 46,4% presentó un estado leve según escala de gravedad, 39% sin criterios de gravedad y 14 % persistió en moderada -severa. Se constató mejoría de la agudeza visual tras el tratamiento (57,1%), el promedio de exoftalmía previo al tratamiento fue 22,2 mm y posterior 21,1 mm; se presentó diplopía en el 7,1% previo al tratamiento y en el 3,6% posterior al tratamiento. Conclusión: El tratamiento con glucocorticoides endovenosos en la oftalmopatía de Graves moderada-severa (esquema EUGOGO 2016) fue muy efectivo, revirtiendo la actividad y consecuentemente ayudando a disminuir la gravedad, en la gran mayoría de nuestros pacientes. Esto podría explicarse porque la oftalmopatía era incipiente y por el alto grado de adherencia de los pacientes en el contexto de un manejo multidisciplinar bien protocolizado.

Introduction: Graves' orbitopathy (GO) is a debilitating disorder in patients with autoimmune thyroid disease, mainly Graves' disease, which develops in 30 to 50% of cases. Objectives: To describe the clinical-ophthalmological characteristics and evolution of patients with moderate-to- severe active GO treated with methylprednisolone boluses who attended the Central Hospital of the Institute of Social Security between January 2018 and September 2021. Materials and methods: Observational design research, descriptive, retrospective study. Results: Records of 34 patients with active moderate-to-severe GO who received boluses of methylprednisolone based on the EUGOGO 2016 guidelines, were reviewed, of which 3 patients were excluded due to having incomplete records and another 3 patients since they required second-line treatment prior to end the 12-session scheme. Of the 28 patients studied, the average age was 43.6 ±13.1 years, 89% were female and 28.5% were smokers. Regarding the thyroid function of the population prior to treatment, hyperthyroidism was found in 82%, hypothyroidism in 11% and euthyroidism in 7%; and after treatment, hyperthyroidism was found in 78.6% (subclinical), euthyroidism in 17.9% and hypothyroidism in 3.5%. The majority (92.6%) had positive thyrotropin receptor antibodies, with an average of 18 ± 9.9 mIU/Ml. Regarding the activity of orbitopathy according to the CAS scale, an average of 4.1 ±1.0 was found before treatment and 1.2 ±1.4 after; Of them, 46.4% presented a mild condition according to the severity scale, 39% without severity criteria and 14% persisted in moderate-severe. Improvement in visual acuity was noted after treatment (57.1%), the average exophthalmia before treatment was 22.2 mm and after 21.1 mm; Diplopia occurred in 7.1% before treatment and in 3.6% after treatment. Conclusion: Treatment with intravenous glucocorticoids in moderate-severe Graves' orbitopathy (EUGOGO 2016 scheme) was very effective, reversing the activity and consequently helping to reduce the severity, in the vast majority of our patients. This could be explained because the orbitopathy was incipient and by the high degree of patient adherence in the context of well-protocolized multidisciplinary management.

Caractéristiques épidémio-cliniques et évolutives des dysthyroïdies autoimmunes au centre national hospitalier universitaire Hubert Koudougou Maga (CNHU-HKM) de Cotonou / Epidemiological, clinical and evolutionary characteristics of autoimmune dysthyroidism in the National University Center Hubert Koutoukou Maga (CNHU-HKM) Of Cotonou

Objectif : Etudier les caractéristiques épidémio cliniques et évolutives des dysthyroïdies auto immunes dans le service d'endocrinologie diabétologie du CNHU-HKM. Matériel et méthode d'étude : Il s'agit d'une étude transversale descriptive et analytique ayant porté sur les patients reçus en consultation pour une pathologie thyroïdienne dans le service d'endocrinologie diabétologie sur une période de 10 ans. Ont été inclus les patients ayant au moins une TSH anormale et les anticorps anti thyroïdiens positifs. Résultats : Sur la période d'étude, nous avons enregistré 2883 consultants, 347 avaient une pathologie thyroïdienne, dont 69 cas de dysthyroïdie auto-immune répartis en 54 cas de maladie de Basedow et 15 cas de maladie de Hashimoto. Les dysthyroïdies auto immunes représentaient donc 2,39 % des consultations et 19,89% des thyroïdopathies. Les fréquences de la maladie de Basedow et de la maladie de Hashimoto étaient respectivement de 1,87% (54 cas) et 0,52% (15 cas) parmi les consultations. Les dysthyroïdies auto immunes étaient plus fréquentes dans les tranches d'âge de 30 à 40 et 40 à 50 ans. Les manifestations les plus fréquentes de la maladie de Basedow étaient l'asthénie (94,4%), l'amaigrissement (87,0%) et la tachycardie (85,2%) . Quant à la maladie de Hashimoto les principales manifestations étaient représentées par une asthénie (86,66%), un goitre (66,6%) et une prise de poids (60%). Le titre initial élevé des anticorps anti R-TSH, l'hypothyroïdie iatrogène ont été retrouvés comme des facteurs associés au suivi prolongé de la maladie de Basedow au-delà de 18 mois. Conclusion : Les dysthyroïdies auto-immunes sont des affections fréquentes dominées par la maladie de Basedow. Leur évolution sous traitement est influencée par des facteurs cliniques, biologiques et échographiques.

Objective: To study the epidemiological, clinical and evolutionary characteristics of autoimmune dysthyroidism in the endocrinology-diabetes department of the CNHU-HKM. Material and method: This was a descriptive and analytical cross-sectional study of patients seen for thyroid pathology in the endocrinology diabetology department over a 10-year period. Patients with at least one abnormal TSH and positive anti-thyroid antibodies were included. Results: Over the study period, we recorded 2883 consultants, 347 of them having thyroid diseases, including 69 cases of autoimmune dysthyroidism divided into 54 cases of Graves' disease and 15 cases of Hashimoto's disease. Autoimmune dysthyroidism represented 2.39% of consultations and 19.89% of thyroid disorders. Graves' disease and Hashimoto's disease accounted for 1.87% (54 cases) and 0.52% (15 cases) of consultations respectively. Autoimmune dysthyroidism was more frequent in the 30-40 and 40-50 age groups. The most frequent symptoms of Graves' disease were asthenia (94.4%), weight loss (87.0%) and tachycardia (85.2%). In Hashimoto's disease, the main symptoms were asthenia (86.66%), goiter (66.6%) and weight gain (60%). High initial R-TSH antibody levels and iatrogenic hypothyroidism were found to be factors associated with extended follow-up of Graves' disease beyond 18 months. Conclusion: Autoimmune dysthyroidism is a frequent condition, with Graves' disease predominating. Their evolution under therapy is influenced by clinical, biological and ultrasonographic factors.

El tratamiento paciente específico del hipertiroidismo con radioyodo: una oportunidad a la mejora / Radioiodine treatment of hyperthyroidism with patient-specific techniques: an improvement opportunity

Introducción: La aplicación de actividades fijas en el tratamiento del hipertiroidismo con I131 (yoduro de sodio, conocido también como radioyodo), es el método más usado en nuestro país, a pesar de la individualidad morfo-funcional que caracteriza esta afección. Sin embargo, no existe aún, un consenso internacional sobre la dosis más conveniente para cada caso, y por ende, los resultados no siempre son los deseados. Objetivo: Evaluar la aplicabilidad de varios métodos de cálculo de dosis paciente-específica para el tratamiento de hipertiroidismo con yoduro de sodio. Métodos: Se realizó un análisis de los resultados de varios métodos de cálculo de dosis recomendados internacionalmente a partir de la actividad fija prescrita en 10 pacientes, con el empleo de tecnologías y herramientas ya desarrolladas y disponibles en el país. Se evaluó la variabilidad inter-especialista y su impacto en la dosis planificada para el tratamiento. Resultados: El uso de la información incompleta de la biodistribución y farmacocinética del paciente produjo diferencias entre -42 por ciento y 37 por ciento de las dosis para el mismo paciente. El resultado de la comparación del método de cálculo recomendado por la Sociedad Europea de Medicina Nuclear, manejando la masa por gammagrafía-2D / 3D y por ultrasonido, arrojó diferencias no significativas entre sí. La variabilidad inter-especialista de las actividades prescrita mostró diferencias significativas, que arrojan sobre el mismo paciente, discrepancias entre 44Gy y 243Gy de las dosis terapéuticas a recibir, situación que puede comprometer el éxito del tratamiento y producir efectos secundarios no deseados. Conclusiones: Las técnicas dosimétricas paciente-específicas se pueden implementar satisfactoriamente en nuestro país. Las diferencias numéricas encontradas, especialmente la variabilidad inter-especialista, demuestran la no estandarización terapéutica, lo que apoya el uso de la farmacocinética paciente-específica pre terapéutica y la masa por gammagrafía-3D para planificar el tratamiento siempre que sean posible(AU)

Introduction: Despite of its typical morpho-functional individuality, fixed activities remain as the most used method in Cuba for hyperthyroidism treatment with I (sodium iodide, also known as radioiodine). However, there is not yet an international consensus on the most convenient doses for each case, so, the results are not always the desired ones. Objective: To evaluate the applicability of various patient-specific dose calculation methods for the treatment of hyperthyroidism with sodium iodide. Methods: It was carried out an analysis in 10 patients of the results of some methods for dose calculation from the prescribed fixed activity recommended internationally, with the use of technologies and tools already developed and available in the country. The inter-specialist variability and its impact in the planned dose for the treatment were assessed. Results: The use of uncompleted biodistribution and pharmacokinetics information of the patient showed differences between -42 percent and 37 percent in the doses for the same patient. The outcome of the comparison of the calculation method recommended by the European Society of Nuclear Medicine managing the mass by 3D/2D gammagraphy and ultrasound, presented no significant discrepancies among them. The inter-specialist variability of prescribed activity was statistically significant, and it can produce in the same patient differences between 44Gy and 243Gy of the therapeutic doses, which could affect the treatment success and lead to unnecessary side effects. Conclusions: The patient´s personalized calculation methods can be satisfactorily applied in Cuba. The numeric differences found, especially inter-specialist variability, show the lack of therapeutic standardization, which supports the use of pre-therapeutic patient-specific pharmacokinetics and the mass by 3D-gammagraphy to plan the treatment when possible(AU)

Resultados de la tiroidectomía total en el tratamiento del hipertiroidismo / Results of total thyroidectomy in the treatment of hyperthyroidism

INTRODUCCIÓN: En el tratamiento del hipertiroidismo se recurre a la cirugía en casos de bocio grande, fracaso del tratamiento médico o indicación social de tratamiento definitivo. OBJETIVO: Analizar los resultados en cuanto a función tiroidea del tratamiento del hipertiroidismo mediante tiroidectomía total (TT). MATERIAL Y MÉTODO: Estudio retrospectivo de 26 pacientes con hipertiroidismo, intervenidos en el Hospital de la Plana durante 2015-2018, con seguimiento de 36 meses. Tras estudio estadístico descriptivo e inferencial, se analizó la probabilidad de recidiva del hipertiroidismo mediante el método de Kaplan-Meier, y se utilizó el modelo de Cox para ajustar los efectos sobre la recidiva de las diferentes variables. RESULTADOS: El 73,1% tenían normofunción tiroidea; el 19,2%, hiperfunción, y en otro 7,7% existía hipofunción. El tiempo medio de supervivencia (normofunción) fue de 25,87 meses (IC: 17,52-34,21). En el estudio de supervivencia con el log-rank en función de la variable anatomía patológica y complicaciones, no hay diferencias estadísticamente significativas en la supervivencia de ambos grupos. DISCUSIÓN: Coincide con otros trabajos publicados. CONCLUSIÓN: La TT es un método efectivo de tratamiento para el hipertiroidismo, con baja incidencia de complicaciones. Sin embargo, no hemos encontrado ninguna variable que nos permita predecir el resultado.

INTRODUCTION: Surgery is used in the management of hyperthyroidism in cases of large goiter, failure of medical treatment or social indication of definitive treatment. AIM: To analyze the results of the treatment of hyperthyroidism by total thyroidectomy (TT) regarding to thyroid function. MATERIAL AND METHODS: Retrospective study of 26 patients with hyperthyroidism, operated on the Hospital de la Plana during 2015-2018, with a follow-up of 36 months. After a descriptive and inferential statistical study, the probability of recurrence of hyperthyroidism was analyzed using the Kaplan-Meier method, and the Cox model was used to adjust the effects on recurrence of the different variables. RESULTS: 73.1% had thyroid normofunction; in 19.2% there was hyperfunction, and in another 7.7% there was hypofunction. The average survival time (normofunction) was 25,87 months (CI: 17,52-34,21). In the study of survival with the log-rank depending on the pathological results and complications, there are no statistically significant differences in the survival of both groups. DISCUSSION: This coincides with other published works. CONCLUSION: TT is an effective method of treatment for hyperthyroidism, with a low incidence of complications. However, we have not found any variable that allows us to predict the result.

Enfermedad de Graves-Basedow e hiperplasia tímica: una asociación que no nos debe extrañar / raves-Basedow disease and thymic hyperplasia: an association that must not surprise us

RESUMEN El aumento del tamaño del timo asociado a hiperplasia tímica (HT) es frecuente en los pacientes con enfermedad de Graves-Basedow (EGB), si bien es poco habitual detectarla en la práctica clínica diaria. Presentamos el caso de una mujer de 38 años con EGB, a quien se le detectó de manera incidental un aumento del timo. La paciente no tenía síntomas compresivos locales y la tomografía computarizada demostró engrosamiento homogéneo de mediastino anterior sugestivo de HT. Durante la evolución, se evidenció reducción del tamaño tras el control de la función tiroidea con fármacos antitiroideos. La presencia de algunas características radiológicas como aumento difuso y homogéneo de la glándula, ausencia de invasión de estructuras vecinas, calcificaciones o imágenes quísticas, sugiere la presencia de una HT. En estos casos, el tratamiento del hipertiroidismo y un control expectante son actitudes razonables. Conocer esta evolución puede evitar intervenciones diagnósticas o terapéuticas innecesarias.

ABSTRACT Thymic enlargement associated with thymic hyperplasia (TH), in patients with Graves-Basedow disease (GBD) is common, although it remains largely unrecognized in routine clinical practice. We present the case of a 38 year-old woman with GBD, to whom an incidental thymic enlargement was detected. The patient did not have local compressive symptoms and the computerized tomography showed homogenous thickening of the anterior mediastinum suggestive of TH. During evolution, a reduction in size was observed after thyroid function was controlled by anti-thyroid drugs. The presence of some radiological features such as diffuse and homogeneous gland enlargement, absence of invasion of neighboring structures, calcifications or cystic images suggests the presence of TH. In these cases treatment of hyperthyroidism and expectant management are reasonable responses. Recognizing this evolution can avoid unnecessary diagnostic or therapeutic interventions.

Hipertiroidismo autoinmune y homeopatía / Autoimmune hyperthyroidism and homeopathy

El artículo presente rescata la evolución de un total de seis pacientes con hipertiroidismo autoinmune (enfermedad de Graves-Basedow) con una evolución de más de siete años. La autora menciona que el tratamiento alopático contra este trastorno ocasiona efectos adversos y solamente alcanza un 30 por ciento de remisión. De modo contrario, la medición homeopática que propone la experimentadora tuvo 80 por ciento de éxito sin ningún efecto colateral indeseable.

Experiencia en la cirugía del bocio tóxico / Experience in surgery of toxic goiter

Introducción: se hace recuento del hipertiroidismo y sus dos causas principales donde prima la enfermedad de Graves Basedow. Se mencionan su diagnóstico y tratamiento. Objetivo: determinar el comportamiento de la cirugía en el bocio tóxico en un grupo de trabajo del servicio de cirugía del Hospital Universitario Amalia Simoni de Camagüey. Métodos: se realizó un estudio retrospectivo transversal sobre bocio tóxico en 12 años con una muestra conformada por 57 pacientes operados en un grupo de trabajo. Se tuvieron en cuenta, aspectos clínicos, de diagnóstico y terapéuticos. Resultados: predominó el sexo femenino en un rango de edades de 21 a 40 años, así como la positividad de los complementarios realizados. Se expuso la preparación preoperatoria más utilizada, la técnica quirúrgica realizada y las complicaciones en el orden del 29,81 porciento. Conclusiones: la mayoría fueron mujeres, con edad media de 35 años, se subutilizaron algunos medios diagnósticos, la preparación preoperatoria más usada fue propiltiuracilo, propanolol y lugol. El proceder más realizado fue la tiroidectomía subtotal y las complicaciones no fueron ni elevadas ni graves(AU)

Introduction: a recount of hyperthyroidism and its two principal causes in which Graves-Basedow disease takes priority is made. Its diagnosis and treatment are also mentioned. Objective: to determine the surgical behavior of toxic goiter in a work group of the Surgery Service at Amalia Simony University Hospital in Camaguey. Methods: a transversal retrospective study about toxic goiter was conducted during 12 years. The sample was composed of 57 patients who were operated on by a work group. Clinical, diagnostic and therapeutic aspects were considered. Results: the female sex predominated between the ages of 21 and 40 years, as well as the positive results of the complementary tests performed. The most used preoperative preparation, the surgical technique applied and the complications were shown in the order of 29.81 percent. Conclusions: most of the patients were women, with a mean age of 35 years; some diagnostic methods were sub-utilized; the most used preoperative preparations were propylthiouracil, propranolol and lugol. The most preformed procedure was the subtotal thyroidectomy and the complications were neither high nor serious(AU)

Osteoma de la órbita en una anciana con enfermedad de Graves-Basedow / Osteoma of the orbit in an elderly woman with Graves - Basedow disease

Se describe el caso clínico de una paciente de 60 años con enfermedad de Graves-Basedow, asociada a osteoma de la órbita. Se muestran los hallazgos clínicos, radiográficos y anatomopatológicos que permitieron establecer el diagnóstico de la enfermedad.

The clinical case of a 60 year-old patient with Graves-Basedow disease, associated to osteoma of the orbit is described. The clinical, radiographic and pathological findings that allowed to establish the diagnosis of the disease are shown.

Hipertensión pulmonar asociada a enfermedad de graves basedow / Pumonary hyperteensión associated with graves basedow issease

La asociación entre hipertensión pulmonar e hipertiroidismo es conocida desde hace mucho tiempo. Sin embargo no es reconocida en nuestro medio como causa de descompensación hemodinámica en pacientes con enfermedad de Graves Basedow. Presentamos el caso de una paciente de 33 años, internada en el Hospital de Clínicas de La Paz, cuyo motivo de consulta fue disnea progresiva, asociada a cansancio, perdida de peso y sensación creciente de debilidad. Dentro del examen clínico se evidenciaron signos de hiperfunción tiroidea corroborados por exámenes complementarios. Llamó la atención la gran signología cardiaca que presentaba, evidenciándose por clínica y exámenes de gabinete hipertensión arterial pulmonar muy severa. Instaurado el tratamiento de la patología de base, es decir el hipertiroidismo, se evidenció en poco tiempo una gran mejoría del cuadro cardiológico asociado a la compensación del cuadro de hiperfunción tiroidea.

The association between lung hypertension and hyperthyroidism is known for a lot of time. However it is not recognized in our means as cause of hemodynamic failure in patient with Graves-Basedow. We present the case of a 33 year-old patient, hospitalized in the Hospital de Clinicas de La Paz, whose consultation reason was progressive dysnea, associated to fatigue, lost of weight and growing sensation of weakness. Inside the clinical exam signs of thyroid hyperfunction were evidenced corroborated by complementary exams. I call the attention the cardiac clinical signology that presented, being evidenced by clinic and complementary test a very severe pulmonary hypertension . Established the treatment of the base pathology, that is to say the hyperthyroidism, is evidenty in short time a great improvement of the cardiac clinic, associated to the improvement of the square of thyroid hyperfunctión.

Evaluación del tratamiento de pacientes con enfermedad de Graves Basedow y su relación con indicadores de necesidades básicas insatisfechas / Medical treatment evaluation in patients with Graves Basedow disease in relation to indicators of unsatisfied basic needs

El objetivo del presente trabajo fue, evaluar el cumplimiento del tratamiento médico de pacientes con diagnóstico de enfermedad de Graves Basedow y la evolución de la misma (remisión o recidiva) en relación a indicadores de necesidades básicas insatisfechas (NBI). Se practicó la revisión retrospectiva de 156 pacientes con diagnóstico de enfermedad de Graves Basedow, los cuales tuvieron un seguimiento entre 3 y 36 años (: 9.6 años), evaluándose en cada caso los diferentes tratamientos de inicio instituidos (metimazol-MMI-, yodo radiactivo o cirugía). De los pacientes que iniciaron y continuaron el tratamiento médico con metimazol (n=140), se revisó el cumplimiento y la eficacia del mismo, relacionándolo con los indicadores de privación (NBI). De los 156 pacientes estudiados, (137 mujeres Y 19 hombres), con una edad : 42.3 años, el tratamiento de inicio fue: con metimazol en 144, con radio yodo en 6 y con cirugía en 6 pacientes. De los 144 casos que comenzaron el tratamiento con MMI, 140 lo continuaron; de los cuales el 42,86% (n=60), presentaron indicadores de necesidades básicas insatisfechas mientras que el 57.14% (n=80) no presentaron indicadores de NBI. De los 140 pacientes que continuaron el tratamiento médico, el 24,28% (n=34), presentaron remisión de la enfermedad. El 90% de los casos que presentaron algún indicador/es de NBI no cumplieron con el tratamiento vs. el 17.5% de los pacientes NO NBI. La enfermedad remitió con tratamiento con metimazol en el 3.3% de los casos con NBI y en el 40% de los casos NO NBI. Teniendo en cuenta los resultados obtenidos, creemos que podría ser de utilidad, evaluar en los casos de pacientes con enfermedad de Graves Basedow la presencia de indicadores de privación, antes de instituir el tratamiento antitiroideo apropiado.

The objective of the present paper was to evaluate the compliance of medical treatment in patients with Graves Basedow disease diagnosis and the disease evolution (remission or relapse) in relation to indicators of unsatisfied basic needs. A retrospective review of 156 patients with Graves Basedow diagnosis was performed. They were followed up between 3 and 36 years (: 9.6 years), in each case, evaluating the different initial treatments implemented (methimazole-MMI, radioactive iodine or surgery). In those patients who started and followed medical treatment with methimazole (n= 140), compliance and efficacy were reviewed in relation to deprivation indicators. Out of the 156 patients studied (137 women and 19 men), with a mean age of : 42.3 years old, the initial treatment was: 144 patients with methimazole, 6 patients with radioiodine and 6 patients submitted to surgery. Out of the 144 cases who started treatment with MMI, 140 continued with it, of which 42.86% (n=60) showed unsatisfied basic needs indicators whereas 57.14% (n= 80) did not present indicators of unsatisfied basic needs. Out of the 140 patients who continued the medical treatment, 24.28 (n= 34) showed disease remission. Concerning the cases that showed some indicators of unsatisfied basic needs, 90% did not comply with the treatment versus 17.5% which did not present unsatisfied basic needs. The disease showed remission with methimazole treatment in 3.3% of the cases with unsatisfied basic needs and in 40% of the cases which did not present unsatisfied basic needs. Taking into account the results obtained, we believe that in the cases of patients with Graves Basedow disease, it might be useful to evaluate the presence of deprivation indicators before implementing the appropriate antithyroid treatment.

The determination of thyroid gland volume and imaging diagnosis of basedow disease by ultrasound

Background/Introduction: While manual clinical and imaging diagnosis methods expose their shortcomings such as errors, ultrasound becomes an appropriate technique for the measurement of the thyroid volume. \r\n', u'Objectives: We determine the thyroid in patient with Basedow disease by ultrasonography before radioiodine, diameter, measurement of thyroid volume, and the lesion echogenicity.\r\n', u'Subjects and method: The study groups consist of 264 patients, in which there are 53 men (20.07%) and 211 women (79.92%), in Bach Mai Hospital. The youngest is 16 years old and the oldest is 73. With a medium age of (42.97 \uf0b1 12.06) years (range from 16 to 73). The most common group ranging from 40 to 50 years of age, equivalent to a number of 80 patients (30.30%). Surveyed participants include 1845 people with normal thyroid. All of them underwent ultrasound scans with a 7.5 MHZ transducer. This is a prospective study. \r\n', u'Results/Outcomes: The average volume of thyroid is (37.03 \uf0b1 19.77) ml compared to the group with approximate thyroid volumes (p > 0.05 based on the ANOVA). Basedow patients\u2019 thyroid volumes tends to be bigger at the adult age, and were bigger than those of normal people (p = 0.0001 t test). 138 (52.27%) surveyed patients had diffuse injuries. 126 patients (47.73%) have thyroid glands which contained multiple nodules. 197 (96.57%) of them had nodules that were \r\n', u'solid echodense and echomix, and 35 (16.36%) had calcifications.\r\n', u'Conclusion: Ultrasonography (US) has become an important asset in thedetermination of thyroid volume at referred for 131I treatment and the evaluation of thyroid nodules of patients with Basedows\u2019 disease associated with nodules. These data suggest the value of surgery in Basedows\u2019 disease associated with nodules, to eliminate the risk of malignancy.\r\n', u'

Applying of radioactive immune quantitative method in evaluation result of treatment I-131 in patients with Basedow’s disease

175 Basedow’s disease patients (45 males and 170 females; mean age: 44.48 ± 8.89) were treated by I-131 at Bach Mai hospital and Military Hospital 103. Total T3 level in serum was 6.45 ± 2.81 nmol/l (n=146) and total T4 level was 243.58 ± 72.34 nmol/l (n=143). Before treatment T3 and T4 level increased abnormaly comparing with healthy people. By 4 months of treatment, T3 level was 2.15 ± 0.78 nmol/l and T4 level was 120.35 ± 36.81nmol/l, FT4 level was 15.67 ± 6.51pmol/l. With average dose of 6.52 ± 1.64 mCi I-131, most of patients had normalized total T3, T4 level

The variation of blood biochemical indices before and after treating Basedow’s disease using propyl thiouracyl

After a 4 weeks of treatment by propyl thyouracil, the biochemical indices of Basedow disease had changed obviously: triiodothyronin (T3) high level (7.95 ± 1.58 nmol/l before treatment) had increased dramatically (1.98 ± 0.54 nmol/l), total thyroxin (T4) high level (257.56 ± 47.45 nmol/l before treatment) had decreased dramatically (1278.04 ± 10.82 nmol/l). FT4 serum level high level had decreased after treatment. TSF low level before treatment had increased. But after treatment glucose level had increased unsignificantly versus that before. In severe condition blood cholesterol had increased, but in moderate and mild condition, there was no change.

Study on clinical characteristics of basedow in combined with Hashimoto disease

125 patients with Basedow disease associated with Hashimoto disease were investigated (in comparative with 88 patients subfering from single Basedow disease) at Military Hospital No 103 from January 1996 to June 2002. Results showed no difference between two groups in terms of the age of disease developing thyroid tumor of 3nd grade was occurred usually in both 2 groups, while the tumor of 4th grade occurred usually in the group of Basedow associated with Hashimoto disease. The tumor of Basedow associated with Hashimoto disease used to get high intensity, harderning in the grey and rose color while in the patient with simple Basedow disease, the tumor had low intensity, soft consistency and purple color.

Some paraclinical characteristic of intocicative diffuse thyroid disease (basedow) combining with Hashimoto auto immune thyroiditis

At the Hospital N0103, the characteristics of basedow symptoms were studied in 125 patients with basedow in combining with Hashimoto disease in comparing with 88 patients of simple basedow. Results showed no obvious difference between simple basedow patients and basedow associated with Hashimoto in terms of age of developing disease, of peripheral white blood cells, of basal metabolism, electro heart rate, T3, T4, FT4 level and Thyrotropin. 100% of patients who were diagnosed pathoanatomically as basedow in combining with Hashimoto, were diagnosed clinically as simple basedow. 98.8% of patients of basedow in combining with Hashimoto who underwent a biopsy of cell aspiration had got confirmed diagnosis

Evaluation of evolution in therapeutics of Basedow’s disease in Endocrinology Centre of Hoa Binh province

Studied on 360 patients Basedow in Endocrinology Centre of Hoa Binh province from 1/10/1998-1/10/2000. Results of the study were used by biological statistic with the software SPSS 10.0. Results showed that: Among all samples, 78.89% of patients were effectively treated. All the symptoms (except proptosis) and basic metabolic data were improved. ECG and thyroid ultrasound examination results were also significantly improved. However, the rate of compliance was relatively low. Only 26.11% of patients completed all 3 stages of the clinical trial

A proposal of a case of Basedow disease typical in clinical symtoms but normal in FT4 and TSH examinations

20 years old female patients with completed clinical symptoms, such as fatigue, weight loss, palpitation, tachycardia, hot feeling, tremor, hyperdefecation … However, FT4 and TSH tests gave normal results, therefore basal metabolism measurement and I131 concentration examination had been done to confirm the diagnosis.

Some changes of morphology and function of the heart of Basedow disease patients observed in TM and 2D ultrasonic image

The study was carried out on 35 subjects diagnosed definitely as Basedow by clinical symptoms and T3, T4, TSH reactions. The controlled group composes of 15 healthy persons. Results showed that the rate of females is more than males. Some functional indicators of the left ventricle, Co, EF% were higher than those of control, the volume of systolic blow decreased (p<0.05) due to the intoxication by thyroid hormone level and the volume of left ventrical and the negative correlation between the duration of disease and the blood expelling power of the left ventricle

Pituitary-thyroid axis hormone level and the concentration of TSH receptor autoantibodies (TRAB) in Basedow’s patients

The concentration of TSH receptor autoantibodies (TRAB) was determined by a Radioreceptor assay kit (RRA) in human serum of normal subjects and Basedow’s patients before and after treatment with antihydroid druf (ATD). The results were as following: Mean TRAB level in Basedow’s patients is higher than that in normal subjects (323.75+/-171.27u/l vs. 1.36+/-0.57u/l). There was not significant difference in the concentration between men and women in both groups. After treatment, the TRAB level was decreased to 10.63+/-11.16u/l.

Research for exophthalmic level in Basedow patients by Hertel ruler

Exophthalmus is an important symptom of Basedow’s disease. CT Scan, MRI or more simply by Hertel ruler can measure the exophthalmic level. The exophthalmic level was studied in association with age of diagnosis, disease duration and gender. The exophthalmus symptom has major diagnostic value in Basedow-related ophthalmic problems. The incidence of exophthalmus in Basedow patients is 60.9%, the longer the duration of disease, and the higher the incidence of exophthalmus.