A case of long-term hypothyroidism converted to hyperthyroidism secondary to an autoimmune trigger

Primary hypothyroidism is a common endocrine condition that is encountered. Graves disease and Hashimoto抯 thyroiditis are the most common autoimmune conditions in which conversion of hyperthyroidism to hypothyroidism is seen. Chances of conversion of hypothyroidism to hyperthyroidism is extremely rare. This case highlights that there should be a high index of suspicion for a possible conversion of hypothyroidism to hyperthyroidism. The etiology being an autoimmune switch by an external stimulus in genetically susceptible individuals. Hereby, presenting a case of 53-years female, who is a known case of type II diabetes mellitus, chronic kidney disease, nephrotic syndrome diagnosed with minimal change disease who presented with a hormonal profile showing hyperthyroidism. She had a history of hypothyroidism in the past for 12-years and was treated with levothyroxine and was off treatment for the past 2 years. Further evaluation showed presence of primary Sjogren抯 syndrome which has let to this conversion.

Study on Clinical and Laboratory Profile of Patients with Primary Hyperthyroidism

Introduction: Thyroid hormones regulate numerousmetabolic processes. Therefore, any alteration in theirsynthesis or function has important health implications. Aims:Study done on clinical and laboratory profile of patients withprimary hyperthyroidism.Material and methods: Descriptive and cross-sectionalStudy done amongst the in-patients with a proven PrimaryHyperthyroidism. 60 Patients with newly diagnosed PrimaryHyperthyroidism above the age of 18 years. Diagnostichormone levels i.e. increased SERUM T3,T4 levels withdecreased TSH levels.Results: out of 60 patients of Hyperthyroidism, 60% wereGrave’s disease, 28.3% were Toxic multinodular goiter and1.7% was toxic solitary nodule. Majority of TSH values wereless than 0.01. In all most all cases both T3 and T4 wereelevated (predominantly T4). There was no difference inT3, T4 and TSH values among the three common causes ofHyperthyroidism. Wayne’s clinical Diagnostic index had goodcorrelation with T3 (p value of 0.024), T4 and TSH. When theWayne’s index was high, T3 & T4 were also high and TSHwas low.Conclusion: Wayne’s clinical index correlate quite well withthe thyroid function tests particularly raised T3 and the scorecould be a useful tool for follow up of hyperthyroid patients

Clinical treatment of primary hyperthyroidism complicated with thyroid cancer / 中华内分泌外科杂志

Objective To investigate the clinical effects of different surgical methods for primary hyperthyroidism complicated with thyroid cancer.Methods The clinical data of patients with primary thyroid hyperthyroidism complicated with thyroid cancer who visited our hospital from Jan.2011 to Dec.2017 were collected,including preoperative preparation,operation mode and so on,to explore the clinical effect of different surgical methods.Results Thirty patients with single nodules preoperatively,no suspected lymph node metastasis and no intraoperative involvement of glandular extravasation were performed Ipsilateral thyroid + isthmectomy and contralateral thyroidectomy.Less than 1g of thyroid tissue was retained at the throat of the contralateral gland (less than 1 cm x 1 cm x 1 cm volume of glandular tissue).Double-sided total thyroidectomy was performed on 19 patients with preoperative ultrasound suspects cancer and multiple nodules,bilateral cancers,suspected lymph node metastases,and extraeapsular invasion.All patients who were followed did not show recurrence or metastasis of hyperthyroidism or thyroid cancer.Conclusions The treatment of hyperthyroidism combined with thyroid gland should be based on the principle of thyroid cancer cure and relapse prevention of hyperthyroidism and according to the tumor size,location,pathological type and risk of relapse stratified development of personalized surgery program.Conventional central lymph node dissection is necessary for patients with primary hyperthyroidism complicated with thyroid cancer,especially for those with young age,large tumor diameter,and invasion of the capsule and the surrounding tissue.

Clinical efficacy and ultrasonographic evaluation of anti-thyroid drugs in the treatment of primary hyperthyroidism / 中国生化药物杂志

Objective To investigate the clinical efficacy and ultrasonographic changes treated with anti-thyroid drugs ( ATD ) in patients with primary hyperthyroidism(PHT).Methods 83 cases of PHT patients admitted to the department of ultrasound from February 2013 to August 2015 in Zhuji People's Hospital of Zhejiang Province were selected, the patients were divided into two groups according to the results of ultrasonography, echo nonuniform group 41 cases and echo uniform group 42 cases.ATD therapy was administered to the both groups (were treated with methimazole).The thyroid related indexes and hemodynamics of thyroid right superior diagnosed by color doppler ultrasound, and the curative efficacies of the two groups were analyzed.Results After treatment, the systemic vascular resistance index(RI) of echo uniform group was (0.62 ±0.17), and the echo nonuniform group was (0.65 ±0.18), there was no significant difference between the two groups.The echo uniform group of thyroid artery diameter on the right lobe(D), the peak systolic velocity(Vmax), minimum diastolic blood flow velocity(Vmin), thyroid volume(V) and blood flow volume(Q) were significantly lower than the echo nonuniform group, the difference was statistically significant (P <0.05).The total effective rate of the echo nonuniform group (48.78%) was significantly lower than that in the echo uniform group (85.71%), the difference was statistically significant(P <0.05).Conclusion ATD has a good effect in treating PHT, and can significantly improve the thyroid hemodynamics in patients, it has a positive effect on the regulation of thyroid-related parameters in patients, the clinical treatment is effective, and the effect is better especially in patients with uniform echo.