MyMedR

Optimization of nuclear medicine procedures for the diagnosis and management of thyroid disorders: report of a research coordination meeting held in Vienna, 15-17 December 1986 under the auspices of the International Atomic Energy Agency

Ganatra R, Gembicki M, Nofal M

Nucl Med Commun, 1988 Feb;9(2):131-9.

PMID: 3386976

The third and final meeting of a coordinated research programme on the diagnosis and management of thyroid disorders was held in Vienna from 15 to 17 December 1986. The participants were from Czechoslovakia, Egypt, Israel, Malaysia and Thailand. Each participant had studied between 500 and 1000 patients for thyroid function evaluation by performing T3, T4 and TSH radioimmunoassays. Each had also used the newly available supersensitive immunoradiometric (IRMA) assay in a group of patients to compare the efficiency of the new assay with that of the conventional assay. A microcomputer was provided to each participant for data analysis. Internal quality control was studied by establishing precision profiles and external quality control was on the basis of pooled standard sera in different ranges. Recommendation for the strategy suggested T4 RIA as the test of first choice in each category of thyroid function. IRMA TSH was suggested as a second test in borderline cases.

Matched MeSH terms: Hyperthyroidism/diagnosis

Fulltext Optic neuropathy in thyroid eye disease: A case series

Salleh NA, Wong HS, Mohd Isa HD

Korean J Fam Med, 2016 May;37(3):197-201.

PMID: 27274392 DOI: 10.4082/kjfm.2016.37.3.197

In patients with thyroid disease, ocular involvement or thyroid ophthalmopathy is common, irrespective of their thyroid status. A common feature of thyroid eye disease is eyelid retraction, which leads to a classical starry gaze (Kocher sign). Treatment with radioactive iodine (RAI) is a known therapy for hyperthyroidism. However, this treatment may lead to or worsen thyroid ophthalmopathy. We report a case series of two patients with thyrotoxicosis, who presented with an atypical and subtle occurrence of thyroid eye disease (TED) soon after RAI therapy. One of the patients was initially diagnosed and treated for dry eyes; however, over a period of time, the patient's vision progressively deteriorated. Clinical and radiological investigations confirmed thyroid ophthalmopathy with low serum thyroid hormone levels. Both patients recovered well after immediate intensive intravenous steroid treatment. These cases highlight the importance of recognizing partial ptosis as one of the presenting signs of active TED among general practitioners and physicians.

Matched MeSH terms: Hyperthyroidism*

Fulltext Occupational exposure and radiobiological risk from thyroid radioiodine therapy in Saudi Arabia

Al-Mohammed HI, Sulieman A, Mayhoub FH, Salah H, Lagarde C, Alkhorayef M, et al.

Sci Rep, 2021 Jul 15;11(1):14557.

PMID: 34267237 DOI: 10.1038/s41598-021-93342-1

Worldwide, thyroid cancer accounts for some 10% of total cancer incidence, most markedly for females. Thyroid cancer radiotherapy, typically using 131I (T1/2 8.02 days; β- max energy 606 keV, branching ratio 89.9%), is widely adopted as an adjunct to surgery or to treat inoperable cancer and hyperthyroidism. With staff potentially receiving significant doses during source preparation and administration, radiation protection and safety assessment are required in ensuring practice complies with international guidelines. The present study, concerning a total of 206 patient radioiodine therapies carried out at King Faisal Specialist Hospital and Research Center over a 6-month period, seeks to evaluate patient and occupational exposures during hospitalization, measuring ambient doses and estimating radiation risk. Using calibrated survey meters, patient exposure dose-rate estimates were obtained at a distance of 30-, 100- and 300 cm from the neck region of each patient. Occupational and ambient doses were measured using calibrated thermoluminescent dosimeters. The mean and range of administered activity (AA, in MBq) for the thyroid cancer and hyperthyroidism treatment groups were 4244 ± 2021 (1669-8066), 1507.9 ± 324.1 (977.9-1836.9), respectively. The mean annual occupational doses were 1.2 mSv, that for ambient doses outside of the isolation room corridors were found to be 0.2 mSv, while ambient doses at the nursing station were below the lower limit of detection. Exposures to staff from patients being treated for thyroid cancer were less compared to hyperthyroidism patients. With a well-defined protocol, also complying with international safety requirements, occupational exposures were found to be relatively high, greater than most reported in previous studies.

Matched MeSH terms: Hyperthyroidism/radiotherapy

Management strategies in Graves' hyperthyroidism

Tan CE, Tan KT, Khoo D, Wang KW

Family Physician, 1991;3:42-45.

Antithyroid drugs, radioiodine and surgery are lhe three modalities of treatment for Graves' hyperthyroidism. The treatment strategy depends on a clear understanding of the relative advantages and disadvantages of each mode of treatment as well as the individual patient's preference. Recent studies favour the use of high dose antithyroid drugs with thyroxine supplementation to induce a higher rate of remission. Radioiodine is likely to be favoured as the definitive form of treatment. Surgery still has a place particularly for young female patients with large goitres. Keywords: Antithyroid drugs, radioiodine, thyroidectomy.

Matched MeSH terms: Hyperthyroidism

Fulltext Lethargy in a patient with cirrhosis

Chuah SY, Wong NW, Goh KL

Postgrad Med J, 1997 Mar;73(857):177-9.

PMID: 9135840 DOI: 10.1136/pgmj.73.857.177

Matched MeSH terms: Hyperthyroidism/complications*

Fulltext Iodized salt supplementation and its effects on thyroid status amongst Orang Asli in Hulu Selangor, Malaysia

Lim KK, Wong M, Mohamud WN, Kamaruddin NA

Asia Pac J Clin Nutr, 2013;22(1):41-7.

PMID: 23353609 DOI: 10.6133/apjcn.2013.22.1.02

BACKGROUND: This research was performed to determine the prevalence of iodine deficiency disorder (IDD) and the effects of iodized salt supplementation on thyroid status amongst Orang Asli in Hulu Selangor, Malaysia.
METHODS: Study respondents were from three target groups, i.e. pre-school children (PSC), primary school-going children (SGC) and adult women. Each household was supplied with iodized salt fortified with iodate fortificant for a period of 12 months and the iodine levels in the salt ranged from 20 to 30 μg/L. Samples collected before and after 6 and 12 months of introduction to iodized salt were urine from all groups, as well as serum samples from adult women.
RESULTS: A total of 200 respondents were recruited; 58 (29.0%) PSC, 65 (32.5%) SGC and 77 (38.5%) adult women. The median urine-iodine concentration (mUIC) in all groups were of moderately low before the iodized salt intervention, but increased significantly in all study groups after 6 and 12 months of intervention. However, at the end of the study, there was an increase in severe iodine deficiency (mUIC <20 μg/L) from 7.5% to 12% and about 9% of PSC and SGC respondents had mUIC level of more than 300 μg/L while the adult women showed a significant increase in free triiodothyronine (fT3) levels.
CONCLUSION: The study demonstrated that iodized salt supplementation was able to show an improvement in iodine level amongst Orang Asli. However, an increase in severe iodine deficiency and iodine excess indicated that the iodized salt programme needs to be carefully monitored.

Matched MeSH terms: Hyperthyroidism/drug therapy; Hyperthyroidism/epidemiology*; Hyperthyroidism/physiopathology

Insulin-like growth factor-binding protein-3 (IGFBP-3) but not insulin-like growth factor-I (IGF-I) remains elevated in euthyroid TSH-suppressed Graves' disease

Wan Nazaimoon WM, Khalid BA

Horm. Metab. Res., 1998 Apr;30(4):213-6.

PMID: 9623636 DOI: 10.1055/s-2007-978868

Thyroid hormones have been shown to be involved in the regulation of insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) expression. This is a cross-sectional study to look at the effects of thyroid hormone status on the circulating levels of IGF-I and IGFBP-3 in a group of 127 patients, aged 20-80 years, who were hyperthyroid, hypothyroid, rendered euthyroid and clinically euthyroid with normal free thyroxine (fT4), but suppressed thyroid stimulating hormone (TSH) levels. TSH was measured by the IMx (Abbott) ultrasensitive assay, while radioimmunoassays for total T3 and T4 were performed using kits from ICN, USA; fT4 and fT3 using kits from DPC USA; IGF-I and IGFBP-3 using kits from Nichols Institute Diagnostics B.V., Netherlands. Differences in the levels of IGF-I between the 4 groups of patients were significant only in the patients aged 20-40. Mean (+/-SEM) IGF-I levels of hypothyroid patients (169+/-19ng/ml) was significantly lower than hyperthyroid (315+/-26 ng/ml, p=0.003), euthyroid patients (241+/-19 ng/ml, p=0.002) and patients with suppressed TSH (308+/-29 ng/ml, p=0.02). The IGF-I levels of the hyperthyroid and suppressed TSH patients were, however, comparable to age-matched normal subjects (281+/-86 ng/ml). Although there was no difference in mean IGFBP-3 levels between the 4 groups of patients, the levels in the patients aged 20-40 with hyperthyroidism (3.7+/-0.9 microg/ml) and suppressed TSH (3.9+/-1.2 microg/ml) were significantly higher (p=0.02) than age-matched normal subjects (3.1+/-0.8 microg/ml). The IGF-I levels of the thyroid patients aged 20-40 showed significant negative correlation to TSH and positive correlations to the thyroid hormones. Hence, whilst low IGF-I is associated with hypothyroidism, high IGFBP-3 is associated with hyperthyroidism. Our finding that IGFBP-3 remained significantly elevated in patients with suppressed TSH but normalised fT4 and fT3 is important as it suggests a prolonged tissue effect of thyroid hormones on IFGBP-3. As such patients have been shown to have higher risk for atrial fibrillation, the significance and possible role of IGFBP-3 in these conditions should be further elucidated in future studies.

Matched MeSH terms: Hyperthyroidism/physiopathology*

Fulltext Hypothyroidism and its associated factors after radioactive iodine therapy among patients with hyperthyroidism in the Northeast Coast State of Malaysia

Wan Mohamed WMI, Sayuti SC, Draman N

J Taibah Univ Med Sci, 2018 Oct;13(5):432-437.

PMID: 31435358 DOI: 10.1016/j.jtumed.2018.06.004

Objectives: The aim of this study was to determine the incidence of hypothyroidism and its associated factors within one-year post radioactive iodine (RAI) therapy.

Methods: A retrospective study was conducted among patients with hyperthyroidism who received RAI therapy at Nuclear Medicine Clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan. Data regarding patients' demographics, gender, aetiology of hyperthyroidism, presence of autoantibodies, dose of RAI used and usage of antithyroid drug post RAI therapy were included in the analysis.

Results: Of a total of 167 screened patients, 137 subjects were eligible for this study. The incidence of hypothyroidism within one year of RAI therapy was 32.9%. Women were found to be less likely to develop hypothyroidism post RAI therapy (adjusted odds ratio, 0.406; 95% confidence interval: 0.181-0.908; p = 0.028). The usage of antithyroid drug post RAI was significantly associated with a lower incidence of hypothyroidism post RAI therapy (adjusted odds ratio, 0.188; 95% confidence interval: 0.081-0.438; p<0.001).

Conclusion: This study showed a high incidence of hypothyroidism within one-year post RAI therapy. Gender and usage of antithyroid drug post RAI therapy are significantly associated with the development of hypothyroidism.

Matched MeSH terms: Hyperthyroidism

Fulltext Hyperthyroidism with gynaecomastia, galactorrhoea and periodic paralysis

Muthusamy E

Singapore Med J, 1991 Oct;32(5):371-2.

PMID: 1788590

A 32 year old male thyrotoxic presenting with gynaecomastia, galactorrhoea and later complicated with hypokalaemic periodic paralysis is presented. The gynaecomastia and galactorrhoea resolved with treatment. To the best of the author's knowledge this combination of association in one patient has not been reported previously.

Matched MeSH terms: Hyperthyroidism/complications*; Hyperthyroidism/therapy

Hyperthyroidism in systemic lupus erythematosus

Cheah JS, Chia BL, Tay HH, Tan BY

Med J Aust, 1970 Nov 28;2(22):1029-30.

PMID: 5494951

Matched MeSH terms: Hyperthyroidism/complications*

Hyperthyroidism in pregnancy

Zainurrashid Z, Shaker AaRH

Family Physician, 2005;13:2-4.

Thyroid diseases are common in women, including at the time of pregnancies. Many typical features of hyperthyroidism are common in normal pregnancies and this may delay or mask the diagnosis. Uncontrolled thyrotoxicosis increases the rate of miscarriage, intrauterine growth restriction (IUGR), premature labour and perinatal mortality. Multi-disciplinary efforts are required to achieve optimal control of thyrotoxicosis. Anti-thyroid drugs are safe and should be used with the lowest possible doses. Radioiodine treatment is contraindicated during pregnancy and lactation. Indications of surgery include: compression symptoms, thyroid malignancy, non-compliance to medications or when the patient develop drugs side effects. Keywords: Hyperthyroidism, pregnancy

Matched MeSH terms: Hyperthyroidism

Hyperthyroidism in pregnancy

Zainuddin Z, Shaker AAH

Family Physician, 2005;13(3):2-4.

MyJurnal

Thyroid diseases are common in women, including at the time of pregnancies. Many typical features of hyperthyroidism are common in normal pregnancies and this may delay or mask the diagnosis. Uncontrolled thyrotoxicosis increases the rate of miscarriage, intrauterine growth restriction (IUGR), premature labour and perinatal mortality. Multi-disciplinary efforts are required to achieve optimal control of thyrotoxicosis. Anti-thyroid drugs are safe and should be used with the lowest possible doses. Radioiodine treatment is contraindicated during pregnancy and lactation. Indications of surgery include: compression symptoms, thyroid malignancy, non-compliance to medications or when the patient develop drugs side effects

Matched MeSH terms: Hyperthyroidism

Fulltext Hyperthyroidism following hypothyroidism--a case report

Kang BH

Med J Malaysia, 1991 Sep;46(3):287-9.

PMID: 1839927

A 25 year old female presented with hypothyroidism which was followed by the development of hyperthyroidism about 1 1/2 years later. This uncommon phenomenon is postulated to result from changes in the relative amounts of stimulatory and inhibitory TSH receptor antibodies. This case illustrates the possible continuum between Graves' disease and Hashimoto's thyroiditis within the broad spectrum of autoimmune thyroid disease.
Study site: Primary care clinic. University Malaya Medical Cengtre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Hyperthyroidism/complications*

Hyperthyroidism and autoimmune hemolytic anemia--a case report

Chee YC, Gill DS, Poh SC

Med J Malaysia, 1978 Dec;33(2):154-5.

PMID: 755168

Matched MeSH terms: Hyperthyroidism/complications*

Hyperthyroidism

Ng TS

Family Practitioner, 1988;11:12-15.

Matched MeSH terms: Hyperthyroidism

Fulltext Hyperthyroid psychosis

Kua EH

Med J Malaysia, 1982 Mar;37(1):60-1.

PMID: 7121348

Thyrotoxic psychosis is an uncommon phenomenon and the presentation is usually of the affective disorders. Three cases manifesting psychotic symptoms akin to schizophrenia are described. The neurobiocheinistry and treatment are discussed.

Matched MeSH terms: Hyperthyroidism/complications*

Fulltext High prevalence of thyroid antibodies in urban population of Peninsular Malaysia

MA, Shahar, Ahmad Marzuki Omar, N, AB Wahab, N, Sukor, NA, Kamaruddin

IIUM Medical Journal Malaysia, 2020;19(2):3-12.

MyJurnal

INTRODUCTION: Thyroid antibodies are closely related to autoimmune thyroid disorders. To date, there
are no data on the prevalence of these antibodies among the Malaysian population. This study aimed to
determine the prevalence of thyroid antibodies; and the factors associated with thyroid antibodies in the
Malaysian adult population. MATERIALS AND METHODS: A cross-sectional study was performed in 5 preassigned regions in Peninsular Malaysia. Participants’ sociodemographic profile and medical history were
recorded. Physical examinations were done looking for abnormalities of the thyroid gland and signs of thyroid
dysfunctions. Fifteen mils of blood were withdrawn and analysed for thyroid function, anti-thyroperoxidase
(anti-TPO) and anti-thyroglobulin (anti-TG) antibodies at a central laboratory. RESULTS: Among the total of
2190 respondents, the overall prevalence of positive anti-TPO and anti-TG antibodies were 12.2% and 12.1%,
respectively; mainly found in urban and coastal areas. Only 7% to 9% of those with positive anti-TPO or antiTG antibodies had either hypo- or hyperthyroidism. The predictors for positive anti-TPO antibody were
female [adjusted OR 1.7 (95%CI: 1.2–2.4); p=0.001], Indian [adjusted OR 1.9 (95%CI: 1.1–3.1); p=0.020], and
having a goitre [adjusted OR 1.8 (95%CI: 1.2–2.8), p=0.004]. The predictors of positive anti-TG antibody was
female [adjusted OR 2.3 (95%CI: 1.6–3.3); p

Matched MeSH terms: Hyperthyroidism

Fulltext Generalised pruritus as a presentation of Grave's disease

Tan CE, Loh KY

Malays Fam Physician, 2013;8(1):20-3.

PMID: 25606263 MyJurnal

Pruritus is a lesser known symptom of hyperthyroidism, particularly in autoimmune thyroid disorders. This is a case report of a 27-year-old woman who presented with generalised pruritus at a primary care clinic. Incidental findings of tachycardia and a goiter led to the investigations of her thyroid status. The thyroid function test revealed elevated serum free T4 and suppressed thyroid stimulating hormone levels. The anti-thyroid antibodies were positive. She was diagnosed with Graves' disease and treated with carbimazole until her symptoms subsided. Graves' disease should be considered as an underlying cause for patients presenting with pruritus. A thorough history and complete physical examination are crucial in making an accurate diagnosis. Underlying causes must be determined before treating the symptoms.

Matched MeSH terms: Hyperthyroidism*

Fulltext Frontal mucocele masked as upper lid abcess- a case report

Ng, WL, Umi Kalthum MN, Jemaima CH, Norshamsiah MD

Journal of Surgical Academia, 2016;6(1):43-45.

MyJurnal

Frontal mucocele is not commonly masked as upper lid abscess.A 72-year-old Chinese man with underlying hyperthyroidism complained of left upper eyelid swelling of 6 months duration. The swelling had persisted and worsen when intravenous antibiotic was changed oral type. Visual acuity on presentation was hand motion and reverse relative afferent pupillary defect was present. Because the swelling was large and resulted in mechanical ptosis and ophthalmoplegia, a CT imaging was performed, which showed huge left frontal mucocele eroding the supereromedial orbital rim. The left globe was displaced inferolaterally but there was no extension into brain parenchyma. Fundus examination showed pale optic disc with dull macula. Old laser marks were seen at peripheral fundus. Referral to ortholaryngologist was made and endoscopic sinus surgery and evacuation of mucopyocoele was done. Culture and sensitivity of the fluid showed no organism. He recovered well postoperatively with additional two weeks of antibiotics. We highlight the necessity of surgical drainage of mucocele, following a course of antibiotic.

Matched MeSH terms: Hyperthyroidism

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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