OBJECTIVETo evaluate the results of treatment of infants with congenital hypothyroidism (CH) with a low initial dosage of levothyroxine.

METHODS138 newborns with primary CH detected by neonatal screening were divided into 3 groups according to levels of serum TSH, TT(3) and TT(4): sub-clinical CH (TSH >50 mU/L), mild CH (TT(4) <54 nmol/L), severe CH (TT(4)<54 nmol/L and TT(3)<1.2 nmol/L). The initial dose of levothyroxine was (3.5 +/-1.0) microg/(kg.d) for sub-clinical CH group, (4.3 +/-0.7)microg/(kg.d) for mild CH group and (4.7 +/- 0.6)microg/(kg.d) for severe CH group. Follow-up evaluation was carried out at 1, 2 and 3 months of age by measuring serum levels of TT(3), TT(4) and TSH. The time, when clinical signs and symptoms were eliminated and serum levels of TT(3), TT(4) and TSH normalized, was recorded. Development Quotient (DQ) testing was performed when CH cases were about 2 years old.

RESULTSThe mean initial dose of levothyroxine in 138 cases was (4.3 +/-0.9)microg/(kg.d). In one month the serum TT(3) and TT(4) levels returned to normal, while for TSH levels 67.4 % cases reached normal range in 2 months and 84.1 % in 3 months. Two months after therapy, the levels of TT(3) and TT(4) reached to the upper half of normal range and there were no signs or symptoms of hypothyroidism. The time for all cases in 3 groups to reach the normal clinical and biochemical indicators was similar (P=0.925). The dosage for cases with low circulating thyroxine before treatment was higher than that of the other groups (P<0.01). The average DQ score of 18 cases after treatment was 116.7 +/- 17.0.

CONCLUSIONhe levothyroxine dosage of (4.3 +/- 0.9)microg/(kg.d) is appropriate for the initial treatment of the majority of infants with CH. However it is better to individualize the dosage for each case.

Congenital Hypothyroidism ; Female ; Humans ; Hypothyroidism ; drug therapy ; Infant, Newborn ; Male ; Thyrotropin ; blood ; Thyroxine ; administration & dosage ; blood ; Triiodothyronine ; blood

Intra-abdominal infection complicated with hypothyroidism is very common. It mostly featured decreased T3, with or without decreased T4, and without elevated thyroid stimulating hormone(TSH). This particular type of hypothyroidism was called "low T3 syndrome" or "thyroid illness syndrome", and is called "non-thyroid illness syndrome" increasingly in recent years. Its pathogenesis has not been fully understood, and probably is associated with abnormality of hypothalamic-pituitary-thyroid axis, disorder of peripheral thyroid hormone metabolism, change in thyroid hormone binding protein, regulation of triiodothyronine receptors, effect of cytokines, and lack of trace element selenium. Intra-abdominal infection complicated with hypothyroidism should be differentiated from primary hypothyroidism, which may be one cause of mental depression, insufficient anabolism, and poor tissue healing. Therefore, the changes of T3 and T4 levels should be actively monitored in patients with severe or prolonged intra-abdominal infection. Whether treatment is needed for intra-abdominal infection complicated with hypothyroidism remains controversial. T3 replacement therapy may improve prognosis. When low T3 syndrome presents as a disease-mediated hypothyroidism, we recommend the use of levothyroxine(L-T4) or liothyronine (L-T3) treatment to improve the prognosis of critical patients. Enteral nutrition can improve hypothyroidism and has good efficacy for enterocutaneous fistula patients with intra-abdominal infection.
Humans ; Hypothyroidism ; complications ; drug therapy ; Intraabdominal Infections ; complications ; diagnosis ; therapy ; Thyroxine ; therapeutic use ; Triiodothyronine ; therapeutic use

Bipolar disorder is a major mental illness that is difficult to treat and has a high degree of recurrence. This article reports general anesthesia for oral surgery in a patient with bipolar disorder complicated with hypothyroidism. It also discusses the rational application of antipsychotic drugs and anesthetics with reference to the literature to improve the understanding of the disease and help patients with mental disorders complete the surgical treatment quietly and smoothly.
Humans ; Bipolar Disorder/drug therapy* ; Antipsychotic Agents/therapeutic use* ; Hypothyroidism/drug therapy* ; Oral Surgical Procedures ; Anesthesia

Adult ; Aged ; Female ; Heart Failure ; complications ; therapy ; Humans ; Hypothyroidism ; complications ; therapy ; Middle Aged

This report describes a case of severe hypernatremia with a serum sodium concentration of 188.1mmol/L caused by exogenous salt intake. A 26-year-old man diagnosed with Crohn's disease 5 years previously visited our clinic due to generalized edema and personality changes, with aggressive behavior. He had compulsively consumed salts, ingesting approximately 154 g of salt over the last 4 days. Despite careful fluid management that included not only hypotonic fluid therapy for 8 hours but also hypertonic saline administration, his serum sodium level decreased sharply at 40.6 mmol/L; however, it returned to normal within 72-hour of treatment without any neurological deficits. Primary hypothyroidism was also diagnosed. He was discharged after 9 days from admission, with a stable serum sodium level. We have described the possibility of successful treatment in a patient with hypernatremia caused by acute salt intoxication without sustained hypotonic fluid therapy.
Adult ; Crohn Disease ; Edema ; Fluid Therapy ; Humans ; Hypernatremia* ; Hypothyroidism* ; Salts ; Sodium

Female ; Humans ; Hypothyroidism ; drug therapy ; Infant, Newborn ; Thyroxine ; poisoning ; therapeutic use

Hypothyroidism has various cardiovascular manifestation and exhibits electrocardiographic change. The QT dispersion on surface ECG reflects regional variations in myocardial repolarization. The effect of L-thyroxine treatment on ECG parameters, such as QT dispersion, in patients with primary hypothyroidism were investigated. This study involved 18 patients (3 men, 15 women, ages: 48+/-18 yr) with primary hypothyroidism. All patients were checked with a standard 12-lead ECG before and after L-thyroxine treatment. Various ECG parameters were then measured twice. The mean L-thyroxine treatment duration was 22+/-2.7 months. The mean thyroid-stimulating hormone levels of patients before and after therapy were 40.2+/-29.8 microU/mL, 3.6+/-4.6 microU/mL (p<0.001) and free-T4 levels were 0.44+/-0.38 ng/dL, 1.51+/-0.39 ng/dL (p<0.001). After L-thyroxine treatment, QT interval (395+/-42 vs. 380+/-24 msec, p<0.05), QTc interval (434+/-32 vs. 417+/-23 msec, p<0.05), QT dispersion (45+/-23 vs. 30+/-13 msec, p=0.008), QTc dispersion (49+/-23 vs. 32+/-14 msec, p=0.005) significantly decreased. There were no significant changes in the PR and RR intervals, as well as the QRS duration. Our findings suggest that the thyroid hormone affects ventricular inhomogenicity, and that L-thyroxine replacement therapy may reduce malignant ventricular arrhythmia and sudden cardiac death in primary hypothyroidism.
Thyroxine/*therapeutic use ; Middle Aged ; Male ; Hypothyroidism/*drug therapy/physiopathology ; Humans ; Female ; Electrocardiography/*drug effects ; Adult

PURPOSE: Thyroxine is the hormone indispensible to the growth and development of infants. We made this study to confirm the influence of temporary depression of serum thyroxine levels on the development of intelligence. METHODS: I adopted as the study group 14 patients diagnosed with depression at the pediatrics department of Pusan National University Hospital from April of 1991 to October of 1997, and selected as the control group 24 infants born with normal functioning of thyroid glands in the same period. From August 18 to September 3 2003, a clinical psychologist carried out Korean Wechsler Intelligence Scale for Children on the patient group and the control group. According to the guidelines, they conducted 12 small tests, gave them marks and expressed the intelligent quotients by the conversion grade in seven articles. RESULTS:The patient group had meaningfully lower grades than the control group in three(similarity, vocabulary, digit scan) out of six articles of the small test of verbal scales, and the former had meaningfully lower grades in two(picture completion, object assembly) out of six articles of the small test of performance scales by K-WISC-III. The I.Q. shows the group of patients was meaningfully depressed in six(verbal IQ, performance IQ, global IQ, verbal comprehension, perceptional organization, working memory) out of seven articles; out of the six articles, the working memory was most depressed. CONCLUSION: Transient hypothyroidism can bring the mental retardation of children, so we think that there should be further studies for appropriate thyroid hormone replacement therapy on these patients.
Busan ; Child ; Comprehension ; Congenital Hypothyroidism* ; Depression ; Growth and Development ; Hormone Replacement Therapy ; Humans ; Hypothyroidism ; Infant ; Intellectual Disability ; Intelligence ; Memory, Short-Term ; Pediatrics ; Psychology ; Thyroid Gland ; Thyroxine ; Vocabulary ; Weights and Measures

BACKGROUND: Ectopic thyroid gland is relatively rare condition and a developmental anomaly characterized by an aggregated of thyroid tissue in the midline anywhere from the base of the tongue to the mediastinum. The role of ectopic thyroid in the pathogenesis of non-goitrous sporadic cretinism and primary hypothyroidism has been emphasized. 19 cases of ectopic thyroid for 12 years was presented with Tc-pertechnetate or radioactive iodine, which were diagnosed by scintigraphy. METHODS: We wish to report these 19 cases and 12 cases of brief review of literatures on the incidence, etiology and development, symptomatology, diagnosis and treatment of ectopic thyroid gland was done. RESULTS: The most frequent incidental age was between the age 1 year and 29 years. And the frequency of ectopic thyroid was about 7 times more common in female(27 cases) than in male(4 cases). The location of ectopic thyroid were found to be lingual in 18 cases, sublingual in 9 cases, prelaryngeal in 1 case, and combine with lingual and sublingual in 3 cases. In chief complaints, palpable mass was most common and there were foreign body sensation on throat, dysphagia, dysphonia, and hoarseness. In 15 cases of hypothyroidism, l2 cases were taken thyroid hormone replacement therapy, 1 case was removed ectopic thyroid gland. In 2 of 10 cases of euthyroidism, replacement of thyroid hormone were done and 2 cases were removed ectopic thyroid gland, in 6 cases of unknown thyroid function, 1 case was removed ectopic thyroid gland and 131I therapy was done in 1 case, and others were observed with following up thyroid function test. CONCLUSION: These results suggest that the long terms thyroid function test, thyroglossal duct eyst and malignant change in ectopic thyroid tissue when finding the ectopic thyroid in thyroid scintigraphy were recommended highly.
Congenital Hypothyroidism ; Deglutition Disorders ; Diagnosis ; Dysphonia ; Foreign Bodies ; Hoarseness ; Hormone Replacement Therapy ; Hypothyroidism ; Incidence ; Iodine ; Mediastinum ; Pharynx ; Radionuclide Imaging ; Sensation ; Thyroid Dysgenesis* ; Thyroid Function Tests ; Thyroid Gland ; Tongue

OBJECTIVETo observe the clinical efficacy of Jiakangling Capsule (JC) combined with reduction of 1311 in treatment of Graves hyperthyroidism.

METHODSTotally 387 Graves hyperthyroidism patients were randomly assigned to the treatment group (200 cases) and the control group (187 cases). Patients in the treatment group took JC combined with reduction of 131I. The 131I dosage per gram of thyroid tissue was 50-80 microCi. They additionally took JC one week after taking 1311 for one consecutive month. Patients in the control group took 131 routinely as one disposable treatment. The 131I dosage per gram of thyroid tissue was 70-120 microCi, without using JC or other anti-thyroid drugs. All patients were reexamined after 24-month treatment. Whether hyperthyroidism was cured, incurred, or permanent was observed. Efficacies of thyroglobulin antibody (TGAb) and thyroid microsome antibody (TMAb) were compared between the two groups.

RESULTSCompared with the control group, the incurred ratio increased in the treatment group [3.2% (6/187) vs. 16.0% (32/200), P < 0.01], the incurred ratio of strong positive TGAb and TMAb patients increased [3.5% (2/57) vs. 27.1% (16/59), P < 0.01], the permanent hypothyroidism ratio decreased [21.1% (12/57) vs. 3.4% (2/59), P < 0.05 ].

CONCLUSIONJC combined with reduction of 1311 was superior in treating Graves hyperthyroidism induced permanent hypothyroidism than routine 1311 treatment, especially for strong positive TGAb and TMAb patients.

Autoantibodies ; Capsules ; Drugs, Chinese Herbal ; therapeutic use ; Graves Disease ; drug therapy ; Humans ; Hyperthyroidism ; drug therapy ; Hypothyroidism ; Iodine Radioisotopes