Management of hyperthyroidism due to Graves' disease: a retrospective analysis of 1,000 inpatient cards.

There are three different modalities to treat hyperthyroidism due to Grave's disease: anti-thyroid drugs (ATD), radioiodine and surgery, each of them having its own advantages and disadvantages. The option for one of the three therapeutical approaches has both subjective and objective components. In Europe, a screening on the therapeutical options in Graves' disease was performed at the European Thyroid Association (ETA) initiative, being based on a questionnaire. In the Thyroid Department of the Endocrinology Institute in Bucharest, w analysed the managements of hyperthyroidism due to Graves' disease on 1,000 cards of hyperthyroid patients admitted there during the last five years. In order to diagnose Graves' disease, in vivo tests radioiodine uptake (RIU) at 2 and 24 hrs, 93.39% scintigram (92.93%), thyroid ultrasonography (15%) and reflexogram (98.06%), were carried out. Out of the in vitro tests, PBI (protein bound iodine) was performed prioritarily, while T4, T3 (variable), TSH (13.91%) were performed according to the economic factors. For the patient with moderate hyperthyroidism, antithyroid therapy was alternative with the radioiodine one (51.61% and 48.35%, respectively). The age of the patient played a major role in the decision to take. The frequency of cases treated with radioiodine was considerably higher in the patients with recurrence and in the elderly. The initial dose of antithyroid treatment was high (50-60 mg), and was reduced according to the thyroid function. The therapy duration was not pre-determined. The ATD treatment was prolonged for a time-interval ranging between 2 and 5 years, depending of the clinical status (age, sex, goiter size, exophthalmic syndrome) and the social conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

A retrospective study on the treatment and evolution of Graves' ophthalmopathy.

Although Graves' ophthalmopathy (GO) seems to be unanimously considered as an autoimmune disease, its pathogenesis is still unknown. That is why the different therapeutical formulas led to ambiguous results. We think that a critical retrospective analysis on our therapeutical possibilities in GO will help us to become aware of our limits in treating this pathology. Our study performed on 123 patients with GO-stage III-IV who were admitted several times in the Thyroid Department of our Institute between 1975-1991; mean age 42 yrs (42 in men and 43 in women. One hundred and twelve patients presented GO associated with thyroid hyperfunction and 11 patients--with hypo- and euthyroidism. Thyroid status was evaluated through clinical examination and laboratory investigations (radioiodine uptake--RIU, 2h, 24 hrs, Achillean reflexogram--AR, T4, T3--radioimmunoassay-RIA). Three therapeutical formulas which were available to us were used in our subjects with GO: 1) general corticotherapy (C) was given in 77.6% of the cases; initial doses: 60-40 mg prednisone for 3 weeks followed by decreasing doses for 2 months (number of cures according to GO severity); 2) orbital radiotherapy (RT) alone was administered from the very beginning to the subjects in whom general C was not possible (7.4% of the cases); 3) general C associated with orbital RT were applied in the very severe cases of GO stage IV-VI (15% of the cases). The two available formulas acted particularly on oedematous symptoms (53% with C and 55.55% with RT alone). Muscular changes were improved by C in 30.83% and by RT only in 11.11% of the cases. It was noticed a mild positive effect on protrusion under C in only 11.66%, and under RT in 33% of the cases. The less favourable results in the cases under both C and RT can be explained by the fact that these groups included cases with stages IV-VI of GO with severe evolution. In 24% of the patients we noted an aggravation of the GO evolution regardless the therapy administered. The possible pathological relationship between the exophthalmic syndrome (ES) and hyperthyroidism (HT) is also supported by our data. The onset of ES together with HT occurred in 63% of the cases. On the other hand, we can notice that it was a more severe disease evolution when both ES and HT were associated. The treatment of hyperthyroidism led to GO aggravation (following 131I, thyroidectomy and antithyroid agents (ATD) in 43%, 52% and 29% of the cases, respectively).

The diagnostic and prognostic value of HLA B 35 antigen in viral subacute thyroiditis.

HLA B 35 antigen was assessed in 19 patients with viral subacute thyroiditis. The antigen was present in 68.43% of patients (no = 13). The relative risk (vs 500 health blood donors) is very high (12.27), with X2 = 33.4 and p less than 0.001. Despite the high relative risk, the presence/absence of HLA B 35 antigen showed no correlations with the main clinical features in our patients; no correlations can be made for: erythrocyte sedimentation rate, radioiodine uptake, thyromegaly, hyperthyroidism and evolution.

The serum osteocalcin levels in patients with thyroid diseases.

The mechanism of bone, calcium, phosphorus and proteins abnormalities observed in hyperthyroidism is rather complex and as yet not wholly understood. Increased serum osteocalcin was recently reported in hyperthyroid patients and its decrease after 4-8 months of treatment. Osteocalcin was measured by RIA in the sera of 211 women and 18 men with thyroid diseases. The patients were divided into 3 groups according to diagnosis: I. polynodular goitre and subacute thyroiditis (59 women, 5 men); II. Graves' disease (70 women, 3 men) and III. thyroid cancer, after treatment by surgery and 131I (82 women, 10 men). The osteocalcin levels in the sera of these patients were: 2.97 +/- 2.63 ng/ml (mean +/- SD) for the women and 3.56 +/- 2.10 ng/ml for the men in the 1st group; 16.31 +/- 11.34 ng/ml for the women and 12.75 +/- 6.09 ng/ml for the man in the IInd group and, 1.01 +/- 0.60 ng/ml for the women and 0.78 +/- 0.46 ng/ml for the men in the IIIrd group. No differences were found between the osteocalcin concentrations in the hyperthyroid female patients treated with antithyroid drugs (no = 58) and the non-treated hyperthyroid women (no = 12): 16.22 +/- 11.40 ng/ml vs 16.74 +/- +/- 11.53 ng/ml. These data suggest that bone resorption stimulated by endogenous thyroid-hormones is a rather resistant processus, persisting even after 6-8 mos of associated anti-thyroid therapy. Further are analyzed the possible causes of the subnormal osteocalcin levels observed in patients with thyroid cancer treated by surgery and radioisotope, whose suppression therapy was discontinued 2-3 weeks before blood sampling.(ABSTRACT TRUNCATED AT 250 WORDS)

Thyroglobulin autoantibodies in endocrine diseases.

A simple, rapid haemagglutination laboratory kit was developed for the measurement of the thyroglobulin autoantibodies (Tgl-AAb). The Tgl-AAb kit was applied to the measurement of the AAbs titres in the sera collected from 2861 endocrine patients either hospitalized in the Institute of Endocrinology (about 75%) or endocrine outpatients--the great part of patients (over 90%) being however diagnosed as thyroid disorders. The sex classification showed the F/M ratio 6.61/1 for the whole group and 7.4/1 for the positive cases. The prevalence of the Tgl-AAbs positive sera at low titre (under 1:200) is 11.6% about twofold higher than in a population of 700 blood donors (6.4%), previously reported. Among the significant Tgl-AAbs titres, chosen more or less arbitrarily over 1:200, 30.47% of the patients have titres in the range 1:200-1:5000. The Tgl-AAbs positive and negative sera are classified and analysed according to the endocrine pathology but especially thyroid disorders and the positive thyroid disease are grouped by low, high and very high Tgl-AAbs titres and by Tgl-precipitin positive. Our results are rather similar to those reported for endocrine collectivities in other countries. The technical and methodological sources of some discrepancies between the laboratory Tgl-AAbs results and the clinical symptoms and/or anatomo-pathologic results are commented as well as some of the future perspectives of the laboratory investigation of the thyroid autoimmune diseases. Concluding, a strategy schema for a possible immunogram is presented.

[Clinical and hormonal development of a case of malignant exophthalmus after hypophyseal myskiotomy]. / Evolution clinique et hormonale d'un cas d'exophtalmie maligne après myskiotomie hypophysaire.

A pituitary myskiotomy was performed in a 26-years old man with Graves' disease and progressive exophtalmus. At the onset of Graves' disease a high level of serum TSH, LATS and thyroid hormones was found. Following pituitary miskiotomy a stationary exophtalmus and other signs of Graves' disease have been recorded. The serum levels of LATS and thyroid hormones were high. The serum concentration of TSH decreased to a level undetectable even after the TRH stimulation test. It is discussed the pathogenesis of Graves' disease: its onset due to neuroendocrine disturbances (S. M. Milcu) and its evolution due to autoimmune mechanisms.