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  1. Fulltext A combined case of macroprolactinoma, growth hormone excess and Graves' disease
    Hussein Z, Tress B, Colman PG
    Med J Malaysia, 2005 Jun;60(2):232-6.
    PMID: 16114168
    Thyrotoxicosis due to Graves disease is a relatively common endocrine disorder. The occurrence of a prolactinoma with co-secretion of growth hormone (GH) is on the other hand, rare. We report the rare co-existence of Graves' disease in a patient with macroprolactinoma and GH hypersecretion and describe the successful response to medical therapy with dopamine agonist and antithyroid therapy. We hypothesize that hyperprolactinaemia played a role in promoting autoimmune thyroid disease in our patient and that treatment of hyperprolactinaemia may have been important in suppressing autoimmune disease activity in Graves' disease. This case also reflects on the close and complex interactions between thyroid hormones, prolactin (PRL), GH and testosterone (T).
    Matched MeSH terms: Hyperthyroidism*
  2. Fulltext A report of three cases of untreated Graves' disease associated with pancytopenia in Malaysia
    Rafhati AN, See CK, Hoo FK, Badrulnizam LB
    Electron Physician, 2014;6(3):877-82.
    PMID: 25763162 DOI: 10.14661/2014.877-882
    Generally, clinical presentations of Graves' disease range from asymptomatic disease to overt symptomatic hyperthyroidism with heat intolerance, tremor, palpitation, weight loss, and increased appetite. However, atypical presentation of Graves' disease with hematological system involvement, notably pancytopenia, is distinctly uncommon. Hereby, we present and discuss a series of three untreated cases of Graves' disease clinically presented with pancytopenia and the hematological abnormalities that responded well to anti-thyroid treatment. With resolution of the thyrotoxic state, the hematological parameters improved simultaneously. Thus, it is crucial that anti-thyroid treatment be considered in patients with Graves' disease and pancytopenia after a thorough hematological evaluation.
    Matched MeSH terms: Hyperthyroidism*
  3. Fulltext An association of myasthenia gravis with Hashimoto's thyroiditis in a patient with a multinodular goitre
    Mohamed N, Mohd Zin F, Mohd Yusoff SS
    Malays Fam Physician, 2017;12(2):29-31.
    PMID: 29423128
    Introduction: The association of myasthenia gravis (MG) with other autoimmune diseases including autoimmune thyroid disease (ATD) is well recognised, although rare. The occurrence of both diseases can occur in two ways: either disease preceding the other, or concurrently. The presentation of MG in association with ATD can range from ocular to generalised disease.

    Case Summary: A 26-year-old Malay female with persistent hyperthyroidism secondary to Hashimoto's thyroiditis in multinodular goitre was diagnosed with generalised MG after 2 years. She presented with right eye ptosis (ocular) and difficulty in swallowing and chewing (bulbar). The diagnosis of MG was confirmed by fatigability testing, electromyography and the presence of AChR antibodies. Her symptoms showed improvement with pyridostigmine (Mestinon) 60 mg 6-hourly. Her antithyroid drug was tapered down according to her thyroid function test. Throughout a year of follow-ups, her hyperthyroidism and fatigability symptoms improved with treatment. She was later counselled for total thyroidectomy and thymectomy.

    Conclusion: Myasthenia gravis and hyperthyroidism may present with similar symptoms such as dysphagia due to neuromuscular weakness or fatigue. When the diseases occur together, one of the diagnoses may be missed. Therefore, the occurrence of new symptoms in a patient with underlying ATD should should trigger the early identification of other autoimmune diseases by primary care doctors.
    Matched MeSH terms: Hyperthyroidism
  4. Fulltext Asymptomatic tachycardia and acute pulmonary embolism in a case of tuberculosis spondylodiscitis
    Ahmedy F, Ahmad Fauzi A, Engkasan JP
    Spinal Cord Ser Cases, 2018;4:43.
    PMID: 29844926 DOI: 10.1038/s41394-018-0074-7
    Introduction: Tachycardia, or elevated heart rate is one of the important clinical parameters considered when diagnosing pulmonary embolism (PE) based on Wells' criteria. However, tachycardia is not highly specific and commonly presents in many other conditions.

    Case presentation: A 29-year-old female with incomplete paraplegia secondary to tuberculosis (TB) spondylodiscitis presented with asymptomatic sinus tachycardia. The related medical conditions, including anaemia, acute coronary syndrome, hyperthyroidism and other infective causes had been ruled out. Deep venous thrombosis was not on the list of differentials as she showed improvements in neurological and mobility functions with no clinical signs of calf pain or swelling. She had moderate risk of acute PE based on Wells' criteria with positive D-dimer testing and computed tomography pulmonary angiography (CTPA) showing thrombus formation in the left-ascending pulmonary artery.

    Discussion: Acute PE may present solely with asymptomatic sinus tachycardia in TB spondylodiscitis. This caveat should provide a high index of suspicion to prevent delay in diagnosis and prevention of more sinister complications. Early stratification based on Wells' criteria for a possible diagnosis of acute PE is proven to be a useful approach in conjunction with clinical features.

    Matched MeSH terms: Hyperthyroidism
  5. Fulltext Autoimmune thyroid disease in a cohort of Malaysian SLE patients: frequency, clinical and immunological associations
    Ong SG, Choy CH
    Lupus, 2016 Jan;25(1):67-74.
    PMID: 26113361 DOI: 10.1177/0961203315593164
    Autoimmune thyroid disease (ATD) has been associated with other systemic autoimmune diseases. To date, there is limited data on thyroid disorders and autoimmune thyroid disease in Malaysia. The frequency of ATD among 189 systemic lupus erythematosus (SLE) patients was 6.3%, with 2.6% in the hyperthyroid group and 3.7% in the hypothyroid group. Hypothyroidism developed at a much younger mean age (24.3 years), suggesting that SLE might be a predisposing factor for the development of Hashimoto's thyroiditis. There was a higher rate of thyroid peroxidase antibody (TPO) positivity compared with anti-thyroglobulin antibody (Tg) in the hyperthyroid subgroup. This study also demonstrated a greater proportion of ATD patients who demonstrated high titres (≥ 1:6400) of TPO compared with high titres of Tg. Although there was an association between ATD and the presence of anti-Ro/SSA and/or anti-La/SSB antibodies, the absence of sicca symptoms and negative Schirmer's tests suggest a lack of association with secondary Sjogren's syndrome. A novel association between ATD and antiphospholipid syndrome (APS) was detected in our cohort. Hence we propose that patients affected by APS be routinely screened for ATD.
    Matched MeSH terms: Hyperthyroidism
  6. Fulltext Biochemical derangement in twin pregnancy: complete hydatidiform mole and viable foetus
    Munirah, M., Khalidah, M.B., Dian Nasriana, N., Hanita, O.
    Medicine & Health, 2018;13(2):180-187.
    MyJurnal
    Case of co-existence of twin pregnancy of complete hydatidiform molar with viable intrauterine pregnancy is extremely rare with low incidence of 1 case for 20,000 – 100,000. It is associated with high risk of spontaneous abortion, preterm delivery, intrauterine death, bleeding, pre-eclampsia, and persistence trophoblastic disease (PTD). It may associate with biochemical derangement that may induce symptomatic manifestation to the mother. There are few cases reported in Asia population with significant clinical dilemma and management to the maternal and foetus. Here, we report a case of a young woman with previous bad obstetric history who presented with antepartum per-vaginal bleeding and was noted to have a twin pregnancy with complete hydatidiform molar and viable foetus. It was complicated with markedly elevated human chorionic gonadotropin (hCG) and hyperthyroidism. Postpartumly, her hCG level was persistently high and her condition progressed into gestational trophoblastic neoplasm.
    Matched MeSH terms: Hyperthyroidism
  7. Fulltext Carbimazole-induced aplastic anaemia - a case report
    Vijay AP, Lim SS, Tan ATB, Rokiah P, Chan SP
    JUMMEC, 2009;12(2):92-95.
    MyJurnal
    Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well, but some may develop rare life threatening side effects such as agranulocytosis and aplastic anaemia. Clinical experience with the latter condition is extremely limited. We report on a case of carbimazole-induced aplastic anaemia caused by hypocellular bone marrow and associated plasmacytosis in a thyrotoxic patient chronically treated with carbimazole. This resolved after substitution with propylthiouracil. The clinical course was complicated by neutropaenic septicaemia and atrial fibrillation.
    Study site: University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Hyperthyroidism
  8. Fulltext Carbimazole-related agranulocytosis in pregnancy – a case report
    Lim, S.S., Shireene, V., Vijay, A., Tan, T.B.A., Rokiah, P., Chan, S.P.
    JUMMEC, 2007;10(1):34-38.
    MyJurnal
    We report a 33-year-old Malay lady who presented with fever, tonsillitis and pharyngitis a month after initiation of antithyroid therapy (carbimazole 15 mg tds) for thyrotoxicosis by her general practitioner. She was still clinically and biochemically thyrotoxic but not in thyroid storm. At that time, she was also confirmed to be four weeks pregnant. Her full blood count revealed neutropaenia with an absolute neutrophil count of 0.036 × 109/L. Bone marrow aspirate and trephine were compatible with carbimazole-related agranulocytosis. Carbimazole was discontinued and she was given broad spectrum antibiotics and Granulocyte Colony Stimulating Factor (GCSF), to which she responded. Verapamil was used for symptomatic heart rate control instead of beta-blockers as she had a history of bronchial asthma. The patient subsequently opted for termination of pregnancy after which she was given radioactive iodine I131 (10 mCi) for definitive therapy of her thyrotoxicosis. In conclusion, carbimazole-related agranulocytosis is an important entity to recognise and treat early to prevent morbidity and mortality. Termination of pregnancy was carried out as the treatment given during the episode of agranulocytosis may have negative effects on foetal viability and growth.
    Matched MeSH terms: Hyperthyroidism*
  9. Fulltext Clinical Practice Guideline: Management of Thyroid Disorders
    Citation: Clinical Practice Guideline: Management of Thyroid Disorders. Putrajaya: Ministry of Health, Malaysia; 2019

    Quick reference: http://www.acadmed.org.my/view_file.cfm?fileid=968

    Keywords: CPG
    Matched MeSH terms: Hyperthyroidism
  10. Fulltext Clinical value of a rapid fully automated thyroid autoantibody assay in the diagnosis and management of graves disease
    Hanita, O., Azura, N.R., Faizal, M.M.Z.
    Medicine & Health, 2012;7(1):24-31.
    MyJurnal
    The most common cause of hyperthyroidism is Graves disease (GD) which is characterised by the presence of autoantibodies which binds to the TSH receptor (TRAb). Recently, a rapid, fully automated electrochemiluminescent immunoassay ElecsysAnti-TSHR for detection of autoantibodies to TSH receptor was made available for routine clinical use. The objective of this study is to evaluate this assay and to determine the sensitivity, specificity and cut-off value. Interassay and total imprecision (CV) were determined at 3.78-7.02 IU/L and 13.5-21.2 IU/L respectively. A total of 124 samples which comprised of 46 GD, seven Hashimoto thyroiditis (HD), 11 non autoimmune nodular goitre (NAG), 2 thyroid cancers (Ca) and 58 normal controls were retrospectively analysed to determine the sensitivity, specificity and cut-off value. Inter-assay CV’s were 2.4% at a concentration of 3.90 IU/L (range: 3.78-7.02 IU/l) and 0.8% at 20.80 IU/L (range:13.5-21.2 IU/l). Total imprecision was 3.8% at a concentration of 3.80 IU/L (range:13.5-21.2 IU/l) and 1.0% at 20.8 IU/L (range:13.5-21.2 IU/l). The ROC analysis of patients with GD, other thyroid disorders and normal controls revealed that the highest sensitivity (94%) and specificity (98%) were seen at cut-off value of 1.69 IU/L. Positive predictive value (PPV) and negative predictive value (NPV) was 95% and 94% respectively. At this derived cut-off value of 1.69 IU/L, we found that the sensitivity of TRAb positivity within the group of 29 newly diagnosed GD patients was 94%. Our results demonstrate that this fully automated assay with testing time of 27 minutes has high sensitivity in detecting GD and high specificity for discriminating other thyroid disease and represent major improvement in the diagnosis and management of patients with thyroid diseases.
    Matched MeSH terms: Hyperthyroidism
  11. Fulltext Comparison of the efficacy of single and multiple regimens of carbimazole in the treatment of thyrotoxicosis
    Mafauzy M, Wan Mohamad WB, Zahary MK, Mustafa BE
    Med J Malaysia, 1993 Mar;48(1):71-5.
    PMID: 8341175
    Carbimazole, in 3 divided daily doses, is commonly prescribed for the treatment of thyrotoxicosis. However, based on its long intra-thyroid half-life, the drug may be effective when used as a single or twice daily dose. This study was undertaken to determine the effect of once, twice or thrice daily doses of carbimazole on thyroid function in patients with thyrotoxicosis. Seventy previously untreated thyrotoxic patients were randomly allocated to receive carbimazole 30 mg once (group 1), 15 mg twice (group 2) and 10 mg thrice (group 3) daily. All patients were also prescribed propranolol 20 mg thrice daily for the first 4 weeks. Blood was taken for total T3, T4, TSH, blood counts and liver enzymes determinations at the beginning and at 6 weeks of treatment. Only 48 (68.6%) patients were included in the analysis, as the rest defaulted follow-up (20.0%) or blood samples were not available at review (11.4%). Of the 48 patients, 17 were in group 1, 16 in group 2 and 15 in group 3. Following 6 weeks of treatment, there was no significant difference in the mean serum levels of total T3 and T4 between the 3 groups. However, there was a significant decrease in the mean serum levels of total T3 and T4 as compared to the start of the treatment. Four patients (23.5%) in group 1, 4 patients (25%) in group 2 and 3 patients (20%) in group 3 were still thyrotoxic at 6 weeks of treatment, whilst 10 patients (58.8%) in group 1, 6 patients (37.5%) in group 2 and 3 (20%) in group 3 were biochemically hypothyroid.(ABSTRACT TRUNCATED AT 250 WORDS)
    Matched MeSH terms: Hyperthyroidism*
  12. Fulltext Congenital Hypothyroidism in Children - A Cross-Sectional Study in a Tertiary Centre in Malaysia
    Anuar Zaini A, Feng Tung Y, Ahmad Bahuri NF, Yazid Jalaludin M
    J ASEAN Fed Endocr Soc, 2020;35(1):62-67.
    PMID: 33790495 DOI: 10.15605/jafes.035.01.11
    Introduction: The causes of congenital hypothyroidism (CHT) are thyroid dysgenesis (TD), dyshormonogenesis (TDH) or transient hypothyroidism (TH).

    Methodology: This is a cross-sectional study looking at data over a period of 16 years (2000-2016). Confirmed cases had thyroid scan at the age of 3-years-old and repeated TFT (after 6 weeks off medications). Relevant data was collected retrospectively.

    Results: Forty (60% female) children with CHT were included in the study. Thirty (75%) children presented with high cord TSH. Nine (23%) presented after 2 weeks of life. Majority were diagnosed with TDH (42.5%) with TD and TH of 40% and 17.5% respectively. Median cord TSH of children with TD was significantly higher compared to TDH and TH (p=0.028 and p=0.001 respectively). L-thyroxine doses were not significantly different between TD, TDH and TH at diagnosis or at 3 years.

    Conclusions: TDH is highly prevalent in our population. TD may present after 2 weeks of life. One in five children treated for CHT had TH. Differentiating TD, TDH and TH before initiating treatment remains a challenge in Malaysia. This study provides clinicians practical information needed to understand the possible aetiologies from a patient's clinical presentation, biochemical markers and treatment regime. Reassessing TH cases may be warranted to prevent unnecessary treatment.

    Matched MeSH terms: Hyperthyroidism
  13. Cyclic adenosine 3',5'-monophosphate content and bronchial smooth muscle contractility of hyper- and hypothyroid lungs
    Nabishah BM, Morat PB, Alias AK, Kadir BA, Khalid BA
    Clin Exp Pharmacol Physiol, 1992 Dec;19(12):839-42.
    PMID: 1335381
    1. Male Sprague-Dawley rats were made either hyper- or hypothyroid with thyroxine or 4-methyl-2-thiouracil, respectively. Bronchial smooth muscle (BSM) contractility and lung cyclic adenosine 3',5'-monophosphate (cAMP) content were measured in both conditions. 2. Bronchial smooth muscle contractility was significantly weaker in hyperthyroid rats, while the BSM contractility of hypothyroid rats was the same as controls. 3. The cAMP content of hyperthyroid rat lungs was similar to controls but was decreased in hypothyroid rats. 4. These studies demonstrated that both the hyper- and hypothyroid states affect respiration, although the mechanisms involved with different for each condition.
    Matched MeSH terms: Hyperthyroidism/physiopathology*
  14. Fulltext Depression symptoms level among thyroid disorders patients at Central region of Peninsular Malaysia
    Siti Nur Illiani, J., Azlina, D., Sanisah, S., Ramli, M., Nik Noor Fatnoon, N.A.
    Malaysian Journal of Psychiatry, 2017;26(1):0-0.
    MyJurnal
    Background of Study: Patients with thyroid disorders were found to have
    continued to experience symptoms of depression despite the great of treatment has
    been given to the patient to balance the thyroid hormones. Objective: The aim of
    this study is to determine the level of depression symptoms among various types
    of thyroid disorders patients.

    Methods: A cross sectional study was carried out at
    one of the government hospital at central region of Peninsular Malaysia from
    August to October 2016. Patients were diagnosed as thyroid disorders, Malaysian
    citizen, above 18 years old and did not have any psychiatric disorders were
    included in this study.Depression Anxiety Stress Scale-42 (DASS-42) was
    selected to determine the severity of depression symptoms and interpreted as
    follow: less than 9-no depression, between 10 and 13-mild depression, between
    14-20-moderate depression, between 21 and 27- severe depression and more than
    28-extreme severe depression. Descriptive statistic was analysed by IBM
    Statistical Package for the Social Sciences (SPSS) version 21.0.

    Results: About
    15% (23) out of 153 thyroid patients had varies degree of depression symptoms
    from mild to severe extremely depression. Patients who had hyperthyroid were
    found to have more depressed, followed by hypothyroid and thyroid cancer group.

    Conclusion: These findings would suggest that the depression score was higher in
    the patients who have hyperthyroid. A more detail and thorough study is
    recommended to be done, in order to confirm these findings.
    Matched MeSH terms: Hyperthyroidism
  15. Fulltext Dual thyroid ectopia with graves' disease: a case report and a review of the literature
    Tan TH, Lee BN, Amir Hassan SZ, Ch'ng ES, Hussein Z
    Nucl Med Mol Imaging, 2012 Dec;46(4):300-3.
    PMID: 24900078 DOI: 10.1007/s13139-012-0160-x
    Ectopic thyroid or thyroid ectopia is a rare developmental anomaly with the prevalence of 1 per 100,000-300,000 population. Even rarer, such an anomaly manifests as dual thyroid ectopia. To our best knowledge, only one case has been reported on dual thyroid ectopia with Graves' disease in the English literature. We present here a case of dual thyroid ectopia complicated by Graves' disease, whereby the diagnosis was rendered through judicious use of various diagnostic modalities coupled with a close clinical follow-up. In this case, therapeutic consideration should be personalized with proper informed consent of the patient.
    Matched MeSH terms: Hyperthyroidism*
  16. Fulltext Dysphagia as a primary manifestation of thyrotoxicosis: a case report
    Ramanathan M
    Med J Malaysia, 1989 Mar;44(1):83-6.
    PMID: 2626117
    This report deals with a middle aged man in whom the presenting symptom of the disorder was dysphagia. The clinical approach to the final diagnosis of thyrotoxic myopathy causing dysphagia is outlined and the pathophysiology of dysphagia then discussed. The need to include thyrotoxicosis in the differential diagnosis of an otherwise unexplained case of dysphagia is stressed.
    Matched MeSH terms: Hyperthyroidism*
  17. Fulltext Endoscopic orbital decompression for Graves' ophthalmopathy
    Tang IP, Prepageran N, Shashinder S
    Med J Malaysia, 2008 Mar;63(1):67-8.
    PMID: 18935740
    We report a male patient of Graves' Disease with bilateral exophthalmos who had undergone bilateral transnasal endoscopic orbital decompression with subsequent improvement of 3 mm in orbital proptosis bilaterally without any complications. Transnasal endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques especially for purely cosmetic reasons.
    Matched MeSH terms: Hyperthyroidism*
  18. Fulltext Endoscopic orbital decompression for optic neuropathy in thyroid ophthalmopathy
    Tang IP, Prepageran N, Subrayan V, Tajunisah I
    Med J Malaysia, 2008 Oct;63(4):337-8.
    PMID: 19385499 MyJurnal
    Optic neuropathy, an uncommon manifestation occurs in 5% of patients with Graves' ophthalmopathy. Its outcome is good if early and proper treatment given. We reported a 49 years old male patient of Graves' disease with bilateral optic neuropathy. He underwent bilateral transnasal endoscopic orbital decompression with marked improvement of visual acuity bilaterally. The preoperative visual acuity was 6/36 in his right eye and 6/60 in his left eye. Two days after operation, his visual acuity was 6/12 in his right eye and 6/24 in his left eye. Transnasal endoscopic orbital decompression is a choice of treatment in optic neuropathy in thyroid ophthalmopathy after trial of corticosteroids.
    Matched MeSH terms: Hyperthyroidism*
  19. Fulltext Euthyroid hyperthyroxinemia: a case report
    Ramanathan M
    Med J Malaysia, 1987 Mar;42(1):65-7.
    PMID: 3431505
    This report deals with the problems of a young man who was clinically euthyroid but biochemically hyperthyroid. The possibility of peripheral resistance to thyroid hormones to explain this paradoxical state is discussed. The importance of recognising this condition to avoid the erroneous diagnosis of thyrotoxicosis and inappropriate therapy is stressed.
    Matched MeSH terms: Hyperthyroidism*
  20. Fulltext Follicular thyroid carcinoma in a patient with myasthenia gravis and thymoma: a rare association
    Ni H, Htet A
    Ecancermedicalscience, 2012;6:274.
    PMID: 23074376 DOI: 10.3332/ecancer.2012.274
    Myasthenia gravis (MG) is an autoantibody-mediated disorder affecting the neuromuscular junction causing characteristic fatigable muscle weakness. Though it can be associated with tumours of the thymus as well as thyroid disorders, it is rare for both to coexist. The exact prevalence of thyroid carcinoma in MG with thymoma is not known but only about a dozen cases have been reported in the literature. We report a case of a 38-year-old Myanmar lady who presented with weakness and breathlessness due to MG with neck swelling. On examination, she had fatigable proximal muscle weakness and thyroid enlargement with no obvious features of hyperthyroidism. Mediastinal widening and an enlarged thyroid gland were noted on her chest X-ray and chest CT. A subtotal thyroidectomy and thymectomy were done. The histology showed follicular carcinoma of the thyroid and benign thymoma. The majority of the reported cases of thyroid carcinoma in association with MG were papillary carcinoma. Follicular carcinoma thyroid associated with MG has not yet been reported in the literature.
    Matched MeSH terms: Hyperthyroidism
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