ABSTRACT
There is no, so far, a rational method of therapy based upon the etiology of autoimmune Graves' ophthalmopathy. As a malignant Graves' ophthalmopathy we defined the most severe eye changes leading to the sight loss or permanent disability of vision which are classified as exceeded class 3c according to the eye changes classification of the American Thyroid Association [27]. The aim of the study was to develop the most efficacious method of therapy for malignant Graves' ophthalmopathy. The material consisted of 206 patients treated according to the 3-stage method: 1-st--corticotherapy, 2-nd--radiotherapy, including linear accelerator, 3-rd--orbital decompression. Moreover, in four patients plasmapheresis was applied and in additional five cyclosporine was administered. In all 206 patients the estimation of the results of the treatment was based on the Donaldson ophthalmopathy index [4]. It has been proved that corticotherapy combined with linear accelerator radiotherapy has been the most efficacious method of treatment. It has also the least number of side effects. Orbital decompression as the 3-rd stage of treatment was employed in those cases in which the previous two stages of medical therapy were unsuccessful.
Subject(s)
Graves Disease/therapy , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Combined Modality Therapy , Cyclosporine/therapeutic use , Female , Humans , Male , Middle Aged , PlasmapheresisABSTRACT
A case of 55 years old woman with "hot" right lobe toxic thyroid nodule, presenting with paroxysmal atrial fibrillation, and therefore treated with 131I 666MBq (18 mCi) is described. After six years she became pyrexic and suffered of severe cough proxyisms. The fine needle biopsy of the above nodule showed the presence of anaplastic thyroid carcinoma. Strumectomy followed by local radiotherapy resulted in complete disappearence of all symptoms. The microscopic of the removed thyroid tissue confirmed the above diagnosis. After 22 months' observation the patient remained in good general condition. The possible reasons for the development of the thyroid carcinoma in this case are discussed.
Subject(s)
Carcinoma/etiology , Iodine Radioisotopes/adverse effects , Neoplasms, Radiation-Induced/etiology , Thyroid Neoplasms/etiology , Thyroid Nodule/radiotherapy , Carcinoma/therapy , Female , Humans , Middle Aged , Thyroid Neoplasms/therapySubject(s)
Hyperthyroidism/radiotherapy , Iodine Radioisotopes/administration & dosage , Adenoma/radiotherapy , Adult , Aged , Aged, 80 and over , Dose-Response Relationship, Radiation , Female , Goiter, Nodular/radiotherapy , Graves Disease/radiotherapy , Humans , Iodine Radioisotopes/therapeutic use , Male , Middle Aged , Thyroid Neoplasms/radiotherapyABSTRACT
Hydrodynamics of the eyes was evaluated in 29 patients in the period of one to one and a half years after completion of prednisone therapy. Open angle glaucoma was observed in 2 patients, in 3--only a raised intraocular pressure (21-25 mm Hg) in the period of exacerbation of the infiltrative changes in the tissues of the orbit.
Subject(s)
Exophthalmos/physiopathology , Graves Disease/physiopathology , Intraocular Pressure/physiology , Ocular Hypertension/etiology , Prednisone/administration & dosage , Adult , Aged , Dose-Response Relationship, Drug , Exophthalmos/complications , Exophthalmos/drug therapy , Female , Graves Disease/complications , Graves Disease/drug therapy , Humans , Intraocular Pressure/drug effects , Male , Middle Aged , Ocular Hypertension/chemically induced , Prednisone/adverse effectsABSTRACT
The increase of the IOP--5 to 30 mm Hg--was observed in patients in whom severe infiltrative changes in the motor muscles dominated the clinical picture. Characteristic for glaucoma changes of the visual field and optic papilla were not seen, the angle was open and the outflow coefficient was in normal limits. The normalization of the IOP was obtained after decompensation of the orbits when the exophthalmos and the infiltrative changes in the motor muscles of the eye receded.
Subject(s)
Exophthalmos/complications , Graves Disease/complications , Ocular Hypertension/etiology , Combined Modality Therapy , Exophthalmos/physiopathology , Exophthalmos/therapy , Female , Graves Disease/physiopathology , Graves Disease/therapy , Humans , Intraocular Pressure/drug effects , Intraocular Pressure/physiology , Middle Aged , Ocular Hypertension/therapy , Oculomotor Muscles/surgery , Prednisone/therapeutic useABSTRACT
The studies comparing the actions of dried thyroid gland (Thyroideum-Polfa) with L-thyroxine sodium (L-T4) were carried out in 20 female patients with hypothyroidism, including 19 patients with the primary hypothyroidism and 1 patient with hypothyroidism secondary to pituitary deficiency. Administration of the dried thyroid gland did not normalize blood serum T4 an TSH in any patient. Normal serum T4 or even slightly increased was achieved in all patients treated with L-T4. Serum TSH was normalized in 17 patients with the primary hypothyroidism. The following conclusions have been drawn: 1. Dried thyroid gland (Thyroideum-Polfa) is ineffective in the treatment of hypothyroidism. 2. Serum TSH remains elevated despite normal serum T3 in cases of the primary hypothyroidism with decreased serum T4 levels. 3. Sodium salt of L-thyroxine should be used for the treatment of hypothyroidism. 1-Triiodothyronine sodium may be used as an adjuvant therapy.
