No abstract available.
Chimerism ; Thyroid Diseases ; Thyroid Gland

Thyroid dysfunction during pregnancy can result in serious complications for both the mother and infant; however, these complications can be prevented by optimal treatment of maternal overt thyroid dysfunction. Although several studies have demonstrated that maternal subclinical hypothyroidism is associated with obstetric complications and neurocognitive impairments in offspring, there is limited evidence that levothyroxine treatment can improve these complications. Therefore, most professional societies do not recommend universal screening for thyroid dysfunction during pregnancy, and instead recommend a case-finding approach in which only high-risk women are tested. However, recent studies have estimated that targeted thyroid function testing misses approximately 30% to 55% of hypothyroidism cases in pregnant women, and some associations and researchers have recommended universal screening of pregnant women to facilitate the early detection and treatment of overt hypothyroidism. This review summarizes recent data on thyroid function test changes, thyroid functional disorder management, and thyroid screening during pregnancy.
Female ; Humans ; Hyperthyroidism ; Hypothyroidism ; Infant ; Mass Screening ; Mothers ; Pregnancy* ; Pregnant Women ; Thyroid Diseases* ; Thyroid Function Tests ; Thyroid Gland* ; Thyroxine

The treatment of choice for Cushing's disease is surgical removal of tumor, the source of ACTH overproduction. In occasional patients in whom a surgical approach including total adrenalectomy is not feasible or surgical removal of tumor is not complete, medical treatment may be necessary because pituitary irradiation requires a long 1ag time to remission. Although ketoconazole, an imidazole derivative with inhibitory activity on adrenal steroidogenesis has been reported to be effective in the treatment of Cushing's disease, the limited effectiveness in lowering very high level of cortisol and occasional hepatotoxicity restrains its wide use. In this report, we describe a woman with Cushing's disease due to pituitary microadenoma. Transsphenoidal pituitary adenomeetomy followed by ketoconzole treatment had been unsuccessful in achieving remission of the disease, but combined treatment with ketoconazole and octreotide accomplished successful reduction in cortisol production.
Adrenalectomy ; Adrenocorticotropic Hormone ; Female ; Humans ; Hydrocortisone ; Ketoconazole* ; Octreotide* ; Pituitary Irradiation

Thyroid dysfunction during pregnancy can result in serious complications for both the mother and infant. However, these complications can be prevented by the optimal treatment of overt maternal thyroid dysfunction. The serum thyroid-stimulating hormone (TSH) concentration is the most reliable measure of thyroid function during pregnancy. Due to the physiologic changes in TSH levels during pregnancy, the correct interpretation of thyroid function requires knowledge of the gestational week and the appropriate population-based reference interval. In addition to a TSH test, the measurement of thyroid peroxidase antibody helps determine whether to treat subclinical hypothyroidism during pregnancy. Since the use of antithyroid drugs during pregnancy is associated with birth defects, it is recommended to discontinue the medication and to perform repeated thyroid function testing during the first trimester. If therapy is needed during the first trimester, propylthiouracil is preferred over methimazole.
Antithyroid Agents ; Congenital Abnormalities ; Female ; Humans ; Hyperthyroidism ; Hypothyroidism ; Infant ; Iodide Peroxidase ; Methimazole ; Mothers ; Pregnancy Trimester, First ; Pregnancy ; Propylthiouracil ; Thyroid Function Tests ; Thyroid Gland ; Thyrotropin

No abstract available.

No abstract available.
Mandibular Condyle

Thyroid dysfunction during pregnancy can result in serious complications for both the mother and infant. However, these complications can be prevented by the optimal treatment of overt maternal thyroid dysfunction. The serum thyroid-stimulating hormone (TSH) concentration is the most reliable measure of thyroid function during pregnancy. Due to the physiologic changes in TSH levels during pregnancy, the correct interpretation of thyroid function requires knowledge of the gestational week and the appropriate population-based reference interval. In addition to a TSH test, the measurement of thyroid peroxidase antibody helps determine whether to treat subclinical hypothyroidism during pregnancy. Since the use of antithyroid drugs during pregnancy is associated with birth defects, it is recommended to discontinue the medication and to perform repeated thyroid function testing during the first trimester. If therapy is needed during the first trimester, propylthiouracil is preferred over methimazole.

The most common thyroid dysfunctions that occur after delivery are postpartum thyroiditis (PPT) and Graves' disease (GD). PPT is more likely to occur among patients who had a history of PPT or GD. For that reason, it is possible to assume that both PPT and GD occur concomitantly after delivery. Here we report two cases of atypical postpartum thyroid dysfunctions presenting the simultaneous occurrence of PPT and GD. A 31-year-old woman with history of PPT had thyrotoxicosis and hypothyroidism of PPT followed by GD with mild symptoms. The patient recovered quickly afterwards. In the second case, a 28-year-old woman with a history of GD presented with thyrotoxicosis of PPT followed by severe GD. The patient required long-term antithyroid treatment.
Female ; Graves Disease ; Humans ; Hypothyroidism ; Postpartum Period ; Postpartum Thyroiditis ; Thyroid Gland ; Thyrotoxicosis

BACKGROUND: Graves' disease and primary myxedema are thought to be caused by the action of TSH receptor autoantibodies(thyroid stimulating antibody; TSAb & thyroid stimulation blocking antibody; TSBAb). Thus, detection of these antibodies is crucial in diagnosis and in follow up of those patients. Recently, a sensitive method using human TSH receptor transfected Chinese Hamster Ovary(CHO) cells has been developed. However, the complexity of IgG purification procedure is considered as a limitation for its clinical application as a routine test. The aim of this study is to determine whether polyethylene glycol(PEG)-precipitated immunogiobuIin fraction could substitute for purified IgG. METHODS: We developed optimal conditions for TSAb and TSBAb assays using crude, PEG precipitated immunoglobulin fraction; and evaluated the correlation of TSAb and TSBAb activities between thase measured using crude immunoglobulin fraction and purified IgG to clarify the usefulness of PEG-precipitated immunoglobulin fraction. TSH receptor expressing wild type CHO cells were used in TSAb and CHO cells expressing chimeric TSH receptor(Mc2; 90-165 amino acid residues were substituted by those of rat LH/CG receptar) were used in TSBAb assay to minimize the possible disturbing effects of TSAb in serum. RESULTS: The optimal serum amount for TSAb and TSBAb assay using PEG-precipitated immunoglobulin fraction were 250mL serum equivalent/well and 50mL serum equivalent/well, respectively. The optimal incubation time for both assays were 2 homs, and aptimal ccrncentration of bTSH for TSBAb assay was 0.1U/L. TSAb activities measured with PEG-precipitated immunoglobulin were significantly correlated with those measured with purified IgG in 26 patients with Graves diseases(r=0.93, p<0.001). Although TSBAb activities measured using PEG-precipitated imrnunoglobulin were conelated with those measured using purified IgG in 20 patients with primary myxedema(r=0.86, p<0.001), the positive rate in TSBAb assay using PEG-precipitated immunoglobulin was lower than that of usmg purified IgG(20% v.s. 65%) because of negative conversion of TSBAb activities in samples with weakly positive TSBAb activities measured using purified IgG. CONCLUSION: PEG-precipitated immunoglobulin fraction could be used instead of purified IgG in TSAb assay using hTSHR-tranasfected wild type CHO cells with equal sensitivity and specificity. This simple and practical TSAb assay using PEG-precipitated immunoglobulin in hTSHR-transfected CHO cells would be useful in clinica1 practiee.
Animals ; Antibodies* ; Asian Continental Ancestry Group* ; CHO Cells ; Cricetinae ; Cricetulus* ; Diagnosis ; Graves Disease ; Humans ; Humans* ; Immunoglobulin G ; Immunoglobulins* ; Myxedema ; Polyethylene Glycols* ; Polyethylene* ; Rats ; Receptors, Thyrotropin* ; Sensitivity and Specificity ; Thyroid Gland

BACKGROUND AND OBJECTIVES: The purpose of this study was to figure out the correlation of hypertension and atherogenic dyslipidemia in postmenopausal women. MATERIALS AND METHODS: The study population consisted of consecutive 380 postmenopausal women (age> or =50, FSH>40IU/L and triglyceride[TG]<400 mg/dl) visiting health promotion center at Samsung Cheil Hospital from March 1997 to July 1998. We measured blood pressure by automatic sphygmomanometer (A & Dco.LTD.TM-2654) and divided them into four groups by blood pressure (Group I:systolic blood pressure[SBP]< 120 mmHg and diastolic blood pressure[DBP]<80 mmHg, n=87. Group II:SBP 120-139 mmHg or DBP 80-89 mmHg, n=109. Group III: SBP 140-159 mmHg or DBP 90-99 mmHg, n=127. Group IV: SBP> or =160 mmHg or DBP> or =100 mmHg, n=57). We measured thier body mass index (BMI) and waist-hip ratio (WHR). We also measured their levels of glucose, total cholesterol and TG by automatic biochemical analyzer (Hitachi 7150) and HDL cholesterol by direct method using AutoDAIICHI reagent. We calculated LDL cholesterol levels by Friedewald formula. RESULTS: MI, WHR and glucose level of group IV were significantly higher than those of group I. But there were no significant differences among the groups in the levels of total cholesterol, LDL cholesterol and apolipoprotein B. HDL cholesterol level of group I was statistically higher than that of group IV. TG level and LDL cholesterol/apo B ratio of group IV were significantly higher and lower than those of other groups respectively. CONCLUSION: Postmenopausal women who had moderate or severe hypertension show the trend toward abdominal obesity and atherogenic dyslipidemia. We might have to pay attention to these metabolic abnormalities in postmenopausal women with hypertension.
Apolipoproteins ; Blood Pressure ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Dyslipidemias* ; Female ; Glucose ; Health Promotion ; Humans ; Hypertension* ; Menopause ; Obesity, Abdominal ; Sphygmomanometers ; Waist-Hip Ratio