The study on arrhythmia in patient with basedow was carried out from which some method of treatment and prevention of complication of arrhythmia due to basedow was introduced. Subjects: 2758 patients in National Institute of endocrine during 9/1994 - 9/1996, in which: goiter: 923; basedow: 1838. Results: complications (66,8%) in which mild cardiac complication such as ventricular conductive disorder : 464 cases (25.2%). In 1838 patients female 93.3%, ages of 31 -50.
Graves Disease ; complications

Subtotal thyroidectomy under acupuncture anesthesia was successful for graves' disease. The complications in early postoperative period were only 8.77% and no mortality rate. A study on 456 patients who were performed subtotal thyroidectomy between 1993 and 1995 has shown the early complications were as follows: (1) Thyroid storm in early postoperative period were 6 patients (1.31%). (2) Post - thyroidectomy hemorrhage were 3 patients (0.65%). (3) Hypoparathyroidism: 12 patients (2.63%). (4) Postoperation Acute respiratory failure postoperative was 9 patients (1.97%). (5) Recurrent laryngeal nerve paralysis was 10 patients (2.18%).
Graves Disease ; surgery, Postoperative Complications ; surgery

Concurrent Graves' disease and primary hyperparathyroidism in the same patient is rare, probably accounts for hypercalcemia in no more than 1 percent of thyrotoxic patients. Hypercalcemia may be noted during the course of hyperthyroidism in as many as 22 percent of cases. The cause of hypercalcemia in a thyrotoxic patient might be due to the activation of osteoclastic bone resorption by the excess thyroid hormone, as the severity of hyperthyroidism correlates positively with osteoclastic activity in trabecular and cortical bone. In 1936, Noble JF et al reported the first case in the world. To our knowledge, only 49 such cases have been described in the literature until the year of 1989. No case has been reported again afterward. The occurrence of hypercalcemia in a patient with hyperthyroidism may present a challenging diagnostic problem. In this communication, we described the first case in mainland of China with hypercalcemia caused by concurrent hyperthyroidism and primary hyperparathyroidism, and the clinical and laboratory characteristics were studied before and after therapy with anti-thyroid medication.
Female ; Graves Disease ; complications ; pathology ; Humans ; Hyperparathyroidism ; complications ; pathology ; Middle Aged

Adolescent ; Cardiomyopathy, Dilated ; diagnosis ; etiology ; physiopathology ; Diagnosis, Differential ; Female ; Graves Disease ; complications ; diagnosis ; physiopathology ; Humans

Among 545 surgically treated Graves' disease patients, 17 were found to have coexisting thyroid neoplasms. Of these 17 patients, 11 turned out to have thyroid carcinomas. These patients could be divided into 2 groups; Group I with a diffusely enlarged gland with a clinically palpable nodule (n = 6) and Group II without a palpable nodule (n = 5). In Group I, 4 patients were diagnosed by preoperative fine needle aspiration cytology, and the remaining 2 by intraoperative frozen-section examination. In Group II, none of the patients were suspected of any concurrent thyroid carcinoma preoperatively, and only 2 were identified by intraoperative frozen-section examination. Thus, 8 of the 11 patients were diagnosed preoperatively or intraoperatively. These observations suggest that in all patients with Graves' disease and concurrent thyroid nodules, the suspicion of associated malignancy may be raised. And also, fine needle aspiration cytology in every case of Graves' disease with a palpable nodule and intraoperative frozen-section examination of the suspicious lobe in the cases of non-palpable nodules appear worthwhile in detecting a concurrent thyroid carcinoma.
Adult ; Aged ; Biopsy, Needle ; Female ; Frozen Sections ; Graves' Disease/*complications ; Human ; Intraoperative Period ; Male ; Middle Age ; Thyroid Neoplasms/*complications/*pathology

OBJECTIVETo investigate the association of Graves' disease and Graves' ophthalmopathy with the C/T transition polymorphism at position -318 of promoter and the A/G transition polymorphism at position 49 of exon 1 within cytotoxic T lymphocyte associated antigen-4 (CTLA-4) gene.

METHODSThirty-three patients with ophthalmopathy of Graves' disease, fifty-six Graves' patients without ophthalmopathy and sixty normal subjects as control were involved in the present case-control study. The polymorphisms were evaluated by polymerase chain reaction fragment length polymorphism (PCR-RFLP). Comparisons were made of gene frequencies and allele frequencies between the groups.

RESULTSThe gene frequencies of CT and allele frequencies of T were much higher in Graves' patients with ophthalmopathy than that in the group without ophthalmopathy (P=0.020, P=0.019). The gene frequencies of GG and allele frequencies of G in patients with Graves' disease were significantly increased as compared with control group (P=0.008, P=0.007). The data suggest that smokers with Graves' disease seemed to be more predisposed to ophthalmopathy than non-smokers (P=0.018).

CONCLUSIONOur results suggest that an allele of T at position -318 of promoter is associated with genetic susceptibility to Graves' ophthalmopathy while an allele of G at position 49 of exon 1 is associated with genetic susceptibility to Graves' disease instead. Smoking is believed to be a major risk factor for ophthalmopathy.

Adult ; Antigens, CD ; genetics ; Antigens, Differentiation ; genetics ; CTLA-4 Antigen ; Exons ; Female ; Genetic Predisposition to Disease ; Genotype ; Graves Disease ; complications ; genetics ; Graves Ophthalmopathy ; complications ; genetics ; Humans ; Male ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Sensitivity and Specificity

Klinefelter's syndrome is one of the most common forms of primary hypogonadism and infertility in males. It is characterized by small and firm testes, gynecomastia, azoospermia, and an elevated gonadotropin level. The frequencies of diabetes mellitus, breast cancer, and germ cell neoplasia increases in Klinefelter's syndrome. We report upon a 35 year-old male patient with Graves' disease in association with Klinefelter's syndrome; as confirmed by chromosome analysis. The patient is being treated with antithyroid medication for Graves' disease and by testosterone replacement for Klinefelter's syndrome.
Adult ; Graves' Disease/*etiology/radionuclide imaging ; Human ; Hypogonadism/*etiology/genetics/pathology ; Klinefelter Syndrome/*complications/genetics/pathology ; Male

PURPOSE: Subtotal thyroidectomy has been the standard operation for Graves' disease in achieving a favorable outcome in recovery of euthyroid state. However, the postoperative outcomes following subtotal thyroidectomy differ by surgeon and postoperative thyroid dysfunctions develop as time passes. Here, we have studied the validity of total thyroidectomy for Graves' disease patients, with a comparison to subtotal thyroidectomy. METHODS: A total of 299 patients with Graves' disease underwent thyroid operation consecutively in Asan Medical Center, Seoul, Korea from December 1995 to December 2005. Among them, 241 cases had subtotal thyroidectomy and 43 had total thyroidectomy. The subtotal thyroidectomy cases were divided into 3 groups according to estimated remnant thyroid; <4 g, 4< or =~<6 g and > or =6 g. Also, according to postoperative thyroid function, the patients were divided into euthyroid, hypothyroidism and hyperthyroidism groups. The postoperative changes of thyroid function, postoperative complications and hospital days were analyzed. RESULTS: In subtotal thyroidectomy, postoperative thyroid function showed euthyroid in 25 (10.4%), hypothyroidism 206 (85.5%) and hyperthyroidism 10 (4.1%). However, total thyroidectomy showed no persistent hyperthyroidism or recurrence. The postoperative thyroid function state changed in 24 patients out of 148 who had more than 2 years postoperative follow-up. Hyper-functional changes developed with higher rates (Hypo-6 vs. hyper-18). The postoperative complication rate was higher in subtotal thyroidectomy including bleeding, hoarseness and hypocalcemia. CONCLUSION: In our study, the patients showing normal thyroid function after subtotal thyroidectomy were very limited and thyroid dysfunction developed continuously with time lapse, especially towards hyperthyroid state. Therefore, we suggest that total thyroidectomy should be considered as a treatment option in Graves' disease.
Follow-Up Studies ; Graves Disease ; Hemorrhage ; Hoarseness ; Humans ; Hyperthyroidism ; Hypocalcemia ; Hypothyroidism ; Korea ; Postoperative Complications ; Recurrence ; Thyroid Gland ; Thyroidectomy

BACKGROUND: The optimal extent of thyroid resection in Graves' disease has not been clearly determined. A significant proportion of patients experience recurrence of the disease after subtotal thyroidectomy. Total thyroidectomy can eliminate the source of the disease. However, many surgeons are reluctant to conduct a total thyroidectomy because it has been known to be associated with increased postoperative morbidity. METHODS: Thirty-six patients underwent subtotal thyroidectomy (ST, n=19) or total/near total thyroidectomy (T/NT, n=17) for Graves' disease after treatment with antithyroid drugs. Relapse of the hyperthyroidism, surgical complications, and serum calcium levels were evaluated. RESULTS: Operation time was not prolonged by the extent of thyroidectomy (ST: 106+/-32.1 min., T/NT: 118+/-34.3 min.). Transient hypocalcemia was observed in 5 patients (29.4%) after a total or a near total thyroidectomy, whereas 3 patients (15.7%) experienced transient hypocalcemia after a subtotal thyroidectomy. All patients showed normal serum calcium level 1 month after the operation and had become free of hypocalcemic symptoms. No patient had injury to the recurrent laryngeal nerve, regardless of the extent of the surgery. Recurrence of the hyperthyroidism was observed in 3 patients who had undergone a subtotal thyroidectomy. CONCLUSIONS: Total thyroidectomy can be conducted safely in patients with Graves' disease without any increase in postoperative complications, such as hypoparathyroidism or injury to the recurrent laryngeal nerve. Therefore, total thyroidectomy appears to be an effective alternative treatment modality for Graves' disease.
Antithyroid Agents ; Calcium ; Graves Disease* ; Humans ; Hyperthyroidism ; Hypocalcemia ; Hypoparathyroidism ; Postoperative Complications ; Recurrence ; Recurrent Laryngeal Nerve ; Thyroid Gland ; Thyroidectomy*

Graves' ophthalmopathy (GO) is also called thyroid-related eye disease, infiltrative ophthalmopathy, which is related with the autoimmunity of thyroid, especially hyperthyroidism. Its morbidity ragnes from five percent to ten percent of hyperthyroidism, and the morbidity of male patients is higher than that of the female patients. The treatment of severe GO is a difficult task for doctors. The therapeutic effect is not always satisfactory. In order to solve this knotty problem, researchers have been devoting themselves to the development of new therapeutic methods. Here, the development of the therapies for GO is introduced, and the trends of treatments are prospected.
Combined Modality Therapy ; Exophthalmos ; etiology ; radiotherapy ; therapy ; Graves Disease ; complications ; radiotherapy ; therapy ; Humans ; Immunoglobulins ; therapeutic use ; Prednisolone ; therapeutic use