No abstract available.
Immunoglobulins, Thyroid-Stimulating* ; Phosphatidylinositols* ; Thyroid Gland*

We characterize the clinical and laboratory characteristics of 5 patients with Graves’ thyrotoxicosis whose serum free thyroxine (fT4) concentration decreased unexpectedly to low levels on conventional doses of carbimazole (CMZ) therapy. The initial fT4 mean was 40.0 pM, range 25-69 pM. Thyroid volume by ultrasound measured as mean 11 ml, range 9.0-15.6 ml. Initial TSI levels measured 1487% to >4444%. Serum fT4 fell to low-normal or hypothyroid levels within 3.6 to 9.3 weeks of initiating CMZ 5 to 15 mg daily, and subsequently modulated by fine dosage adjustments. In one patient, serum fT4 fluctuated in a “yo-yo” pattern. There also emerged a pattern of low normal/low serum fT4 levels associated with discordant low/mid normal serum TSH levels respectively, at normal serum fT3 levels. The long-term daily-averaged CMZ maintenance dose ranged from 0.7 mg to 3.2 mg. Patients with newly diagnosed Graves' hyperthyroidism who have small thyroid glands and markedly elevated TSI titres appear to be “ATD dose sensitive.” Their TFT on ATD therapy may display a “central hypothyroid” pattern. We suggest finer CMZ dose titration at closer follow-up intervals to achieve biochemical euthyroidism.
carbimazole ; Thyroid Stimulating Immunoglobulin ; Immunoglobulins, Thyroid-Stimulating ; Immunologic Tests ; Graves disease

This report concerns a 71-year-old female with long standing untreated toxic multinodular goiter (TMG) coexisting with anaplastic thyroid carcinoma who presented with progressive shortness of breath and easy fatigability. Thyroid function tests showed suppressed TSH and elevated FT4 and FT3. Anti-thyroid hormone drugs were started. Thyrotropin receptor antibody was negative. A thyroid scan revealed both hot and cold nodules and fine needle aspiration biopsy (FNAB) of the thyroid gland showed colloid nodule. Chest CT scan imaging revealed an enlarged thyroid gland with the right lobe compressing the trachea. Patient underwent total thyroidectomy, final histopathology showed Anaplastic thyroid carcinoma. Our case is interesting from a pathophysiologic perspective,since it suggests that TMG can potentially transform into an aggressive form of thyroid carcinoma. High index of suspicion in patients with TMG with other risk factors for malignancy requires careful evaluation to detect cancer.

Human ; Female ; Aged ; Goiter ; Immunoglobulins, Thyroid-stimulating ; Receptors, Thyrotropin ; Thyroid Carcinoma, Anaplastic ; Thyroid Hormones ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Hyperthyroidism

BACKGROUND: It is important to differentiate Graves' disease from that of painless thyroiditis in patients with thyrotoxicosis. In this study, we evaluated the usefulness of total T3 to free T4 ratio in making a differential diagnosis between Graves' disease and painless thyroiditis. METHODS: We reviewed medical records of thyrotoxic patients, who had been diagnosed with Graves' disease or painless thyroiditis, from October 2009 to July 2011. We assessed clinical characteristics, serum levels of total T3, free T4, thyroid stimulating hormone, thyrotropin-binding inhibitory immunoglobulin, and findings of 99mTechnetium thyroid scan. We analyzed the total T3/free T4 ratios between Graves' disease and painless thyroiditis patients. RESULTS: A total of 76 untreated thyrotoxic patients "49 Graves' disease and 27 painless thyroiditis" were examined. The total T3, free T4 levels and the total T3/free T4 ratios were significantly higher in patients with Graves' disease than in those with painless thyroiditis (P < 0.001). In the total T3/free T4 ratio > 73, the possibility of Graves' disease was significantly higher than in painless thyroiditis (sensitivity, 75.5%; specificity, 70.3%). The sensitivity and specificity of the total T3/free T4 ratio in patients with free T4 < 3.6 ng/dL have been increased (sensitivity, 100%; specificity, 71.4%). CONCLUSION: The total T3/free T4 ratios was useful for making a differential diagnosis between Graves' disease and painless thyroiditis.
Diagnosis, Differential ; Graves Disease ; Humans ; Immunoglobulins ; Immunoglobulins, Thyroid-Stimulating ; Medical Records ; Sensitivity and Specificity ; Thyroid Gland ; Thyroiditis ; Thyrotoxicosis ; Thyrotropin

BACKGROUND: Hyperthyroidism relapse in Graves disease after antithyroid drug (ATD) withdrawal is common; however, measuring the thyrotropin receptor antibody (TRAb) at ATD withdrawal in order to predict outcomes is controversial. This study compared measurement of thyroid stimulatory antibody (TSAb) and thyrotropin-binding inhibitory immunoglobulin (TBII) at ATD withdrawal to predict relapse. METHODS: This retrospective study enrolled patients with Graves disease who were treated with ATDs and whose serum thyroid-stimulating hormone levels were normal after receiving low-dose ATDs. ATD therapy was stopped irrespective of TRAb positivity after an additional 6 months of receiving the minimum dose of ATD therapy. Patients were followed using thyroid function tests and TSAb (TSAb group; n=35) or TBII (TBII group; n=39) every 3 to 6 months for 2 years after ATD withdrawal. RESULTS: Twenty-eight patients (38%) relapsed for a median follow-up of 21 months, and there were no differences in baseline clinical characteristics between groups. In the TSAb group, relapse was more common in patients with positive TSAb at ATD withdrawal (67%) than patients with negative TSAb (17%; P=0.007). Relapse-free survival was shorter in TSAb-positive patients. In the TBII group, there were no differences in the relapse rate and relapse-free survivals according to TBII positivity. For predicting Graves disease relapse, the sensitivity and specificity of TSAb were 63% and 83%, respectively, whereas those of TBII were 28% and 65%. CONCLUSION: TSAb at ATD withdrawal can predict the relapse of Graves hyperthyroidism, but TBII cannot. Measuring TSAb at ATD withdrawal can assist with clinical decisions making for patients with Graves disease.
Follow-Up Studies ; Graves Disease* ; Humans ; Hyperthyroidism ; Immunoglobulins ; Immunoglobulins, Thyroid-Stimulating* ; Prognosis ; Receptors, Thyrotropin ; Recurrence* ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Function Tests ; Thyroid Gland* ; Thyrotropin

Autoantibodies directed against the thyrotropin receptor have been well known to be an important pathogenesis of Graves' disease. However, the diagnosis and management of Graves' disease are still mainly dependent on thyroid function itself and clinical manifestation of thyrotoxic patients. That is mainly due to the low sensitivity of early generation of thyrotropin receptor assay methods. The development of sensitive thyrotropin receptor measuring tools through third generation immunometric assay made the diagnosis of Graves' disease with mild hyperthyroidism accurate and convenient for patients. Bioassay to detect thyroid stimulating immunoglobulin is also commercially available nowadays, which theoretically discriminate thyroid stimulating antibodies from thyrotropin receptor-blocking antibodies. Although the use of these serologic markers plays an informative role in accurately diagnosing Graves' disease and predicting the prognosis of disease, consideration of the heterogeneous nature of autoimmunity of Graves' disease and the limitation of indirect antibody assay is also required for proper management of Graves' disease patients. In this review, the clinical usefulness of thyrotropin receptor antibody in various clinical situations of Graves' disease was overviewed.
Antibodies ; Autoantibodies ; Autoimmunity ; Biological Assay ; Diagnosis ; Graves Disease ; Humans ; Hyperthyroidism ; Immunoglobulins, Thyroid-Stimulating ; Prognosis ; Receptors, Thyrotropin* ; Thyroid Gland ; Thyrotropin

PURPOSE: To determine the prevalence of thyroid-associated ophthalmopathy (TAO) and the correlation between TAO and the thyroid function state. METHODS: 40 patients with TAO were selected among 2,000 patients of thyroid disease between September 1, 1995 and December 31, 2000, and classified by the Van Dyk's ''NOSPECS and RELIEF'' classification. T3, T4, TSH and Thyroid stimulating antibody (TSAb) levels were examined before and after treatment of TAO and thyroid disease. Relationship between TAO and thyroid function state was evaluated by using paired t-test and logistic regression test. RESULTS: The prevalence of TAO was about 2% in thyroid disease patients. Clinical manifestations of TAO were eyelid retraction (75%), exophthalmos (62.5%), soft tissue periorbital swelling (42.5%), diplopia and extraocular muscle restriction (20%), keratopathy (2.5%) and optic neuropathy (2.5%). Thyroid function state decided by T3, T4 and TSH level had no correlation with the improvement of TAO (p<0.05). But, TSAb level in improved TAO group (n=8) significantly decreased after treatment of TAO and thyroid disease (p<0.05). CONCLUSIONS: Thyroid function restoration may not help to improve the course of TAO. But, low TSAb level can be thought as a significant marker in improvement of TAO.
Classification ; Diplopia ; Exophthalmos ; Eyelids ; Graves Ophthalmopathy* ; Humans ; Immunoglobulins, Thyroid-Stimulating ; Logistic Models ; Optic Nerve Diseases ; Prevalence ; Thyroid Diseases ; Thyroid Gland* ; Troleandomycin

Neonatal hyperthyroidism is a very rare disorder occurring typically in the offspring of patients with Graves' disease or chronic thyroiditis. It is caused by the transplacental passage of thyroid stimulating antibodies (TSAb) from the mother to the fetus. There has been few reports of neonatal hyperthyroidism associated with congenital anomalies. We experienced a case of neonatal hyperthyroidism with unilateral microtia and agenesis of external auditory canal in a female neonate born to a mother who had euthyroid but with a thyroid stimulating antibody. The patient was presented with unusual alertness, tachycardia, tachypnea, watery diarrhea, periorbital swelling and exophthalmos. Diagnosis was made by thyroid function tests and TSAb. She was treated with Lugol solution, PTU and propranolol. New she is 6 months old and in good condition with no symptoms of hyperthyroidism.
Diagnosis ; Diarrhea ; Ear Canal ; Ear* ; Exophthalmos ; Female ; Fetus ; Graves Disease ; Humans ; Hyperthyroidism* ; Immunoglobulins, Thyroid-Stimulating ; Infant ; Infant, Newborn ; Mothers ; Propranolol ; Tachycardia ; Tachypnea ; Thyroid Function Tests ; Thyroid Gland ; Thyroiditis

PURPOSE: We aimed to investigate the predictive factors for early response to methimazole (MMI) in pediatric patients with Graves disease (GD). METHODS: Our study included 44 pediatric patients who were diagnosed with GD between January 1, 1993, and December 31, 2013, and were available for follow-up, achieving a normalization of thyroid functions (TFs) at the Chonbuk National University Hospital Pediatric Department. We retrospectively analyzed TFs such as tri-iodothyronine (T3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), and thyroid antibody levels at diagnosis. We also examined their family history of thyroid disease, symptoms at presentation, and normalization time for TF after treatment. We divided our clinical series of patients into the following 4 age groups: <7 years old, 7-12 years old, 13-15 years old, and 16-18 years old. RESULTS: At diagnosis, the time of normalization of T3 was significantly shorter in the higher antimicrosomal antibody (AMA) group compared with the lower AMA group (2.53 months vs. 6.18 months) (P<0.05). However, the time of normalization of T3/fT4/TSH had no significant correlations with other variables such as age, sex, a family history of thyroid diseases, thyroglobulin, thyroid-stimulating immunoglobulin, or antithyroglobulin antibody (ATA). CONCLUSION: Higher serological titers of AMA at diagnosis may have prognostic value in the response to initial MMI treatment in pediatric hyperthyroid GD patients.
Adolescent* ; Child* ; Diagnosis ; Follow-Up Studies ; Graves Disease* ; Humans ; Immunoglobulins, Thyroid-Stimulating ; Jeollabuk-do ; Methimazole* ; Retrospective Studies ; Thyroglobulin ; Thyroid Diseases ; Thyroid Gland ; Thyrotropin ; Thyroxine ; Triiodothyronine

PURPOSE: We aimed to investigate the predictive factors for early response to methimazole (MMI) in pediatric patients with Graves disease (GD). METHODS: Our study included 44 pediatric patients who were diagnosed with GD between January 1, 1993, and December 31, 2013, and were available for follow-up, achieving a normalization of thyroid functions (TFs) at the Chonbuk National University Hospital Pediatric Department. We retrospectively analyzed TFs such as tri-iodothyronine (T3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), and thyroid antibody levels at diagnosis. We also examined their family history of thyroid disease, symptoms at presentation, and normalization time for TF after treatment. We divided our clinical series of patients into the following 4 age groups: <7 years old, 7-12 years old, 13-15 years old, and 16-18 years old. RESULTS: At diagnosis, the time of normalization of T3 was significantly shorter in the higher antimicrosomal antibody (AMA) group compared with the lower AMA group (2.53 months vs. 6.18 months) (P<0.05). However, the time of normalization of T3/fT4/TSH had no significant correlations with other variables such as age, sex, a family history of thyroid diseases, thyroglobulin, thyroid-stimulating immunoglobulin, or antithyroglobulin antibody (ATA). CONCLUSION: Higher serological titers of AMA at diagnosis may have prognostic value in the response to initial MMI treatment in pediatric hyperthyroid GD patients.
Adolescent* ; Child* ; Diagnosis ; Follow-Up Studies ; Graves Disease* ; Humans ; Immunoglobulins, Thyroid-Stimulating ; Jeollabuk-do ; Methimazole* ; Retrospective Studies ; Thyroglobulin ; Thyroid Diseases ; Thyroid Gland ; Thyrotropin ; Thyroxine ; Triiodothyronine