The serum concentrations of thyrotropin (TSH) were measured by means of radioimmunoassay, in 98 cases of normal controls, 51 cases of hyperthyroidism, 80 cases of primary hypothyroidism and 4 cases of secondary hypothyroidism to evaluate the diagnostic significance in various functional states of the thyroid. The obtained data were analyzed in correlation with other thyroid function test values in various phases of the functional thyroid diseases. The results were as follows: 1) The serum TSH concentration in normal control group was $<1.3{\sim}8.0{\mu}U/ml$. 2) The measurement of serum TSH was more significant in diagnostic accuracy compared with that of serum $T_4(75.0{\pm}12.2%)$. Free $T_4$ Index ($64.2{\pm}15.2%$), serum $T_3(41.0{\pm}21.0%)\;or\;T_3$ resin uptake ($41.1{\pm}15.8%$) in evaluation of primary hypothyroidism. 3) In case of overt hypothyroidism, the serum TSH and $T_4$ were both abnormal, compatible with the clinical diagnosis, while in case of preclinical or mild hypothyroidism, the serum $T_4(41.2{\pm}23.8%)\;or\;50.0{\pm}25.0%)$ was much less reliable than serum TSH. 4) In the treatment of primary hypothyroidism with desiccated thyroid, the administration of 1 grain of the hormone per day was sufficient to suppress the serum concentration of TSH to normal range. It showed that the measurement of serum TSH concentration was a significant criteria in evaluating the efficiency of the treatment of hypothyroidism. 5) The measurement of serum TSH concentration is a very significant method in the early detection of hypothyroidism induced during or after the treatment of the hyperthyroidism with antithyroid drugs or radioactive Iodine ($^{131}I$).
Park, Keun-Jo;Park, Sun-Yang;Park, Jung-Sik;Lee, Myung-Chul;Koh, Chang-Soon;Lee, Mun-Ho
The Korean Journal of Nuclear Medicine
/
v.10
no.1
/
pp.47-54
/
1976
A clinical study was made on 263 patients of hypothyroidism among the 5,970 patients of various thyroid diseases diagnosed and treated at the Radioisotope Clinic and Laboratory, Seoul National University Hospital from May, 1960 to Aug., 1975. The results obtained with this study are as follows: 1) The etiological classification of hypothyroidism revealed 244 cases (93%) of primary hypothyroidism and 19 cases (7%) of secondary hypothyroidism. 2) The most frequent cause of the thyroprivic primary hypothyroidism was post radioiodine therapy with 109 cases (41.4%). 3) There were 37 cases (14%) of male and 226 cases (86%) of female, showing a ratio of 1:6. 4) The majority of patients were between the ages of 30 and 60 with the peak incidence (87 cases, 33%) in their fourth decades of lives. 5) The major symtoms and signs were weakness (97%), edema of face and extremities (92%); Decreased Achilles tendon reflex (87%), cold intolerance (82%), gain in weight (76%), constipation (58%) and cold skin (51%). 6) The cumulative incidence of hypothyroidism in patient treated with $^{131}I(3{\sim}8mci)$ was 7.2% at first year, 33.3% at tenth year and the 50% at fourteenth year and the annual increment was 2.9%. 7) The incidence of hypothyroidism related to thenumbers of $^{131}I$ the rapy was not linear. 8) The diagnostic compatibilities of the various tests to hypothyroidism were TSH (100%), $T_4$ (93.8%), 24-hour-RNIU (91.5%), ATR (86.7%), $T_3RU$ (66.1%) and BMR (64.9%).
Hypothyroidism is not uncommon complication of therapy for head and neck cancer. A series of 52 patients treated with either radiotherapy alone or combined with surgery was retrospectively studied. Diagnostic procedure included total T3, T4 and TSH measured by radioimmunoassay. The rate of hypothyroidism was 25% (subclinical 15.4%, clinical 9.6%). The incidence of hypothyroidism increased to 40% when radiotherapy was combined with surgery. Risk factors influenced a high incidence of hypothyroidism were : tumor stage, primary tumor site, combination of radiotherapy and surgery (especially combined with laryngectomy). We advocate routine monitoring of head md neck cancer patients for hypothyroidism after treatment and recommend levothyroxine replacement therapy for subclinical hypothyroidism.
Sleep Apnea Syndrome is characterized by hypersomnolence, snoring, and sleep apnea. The symptoms of hypothyroidism include apathy, somnolence, lethargy, personality change, and intellectual deterioration and may be related to hypothyroid-related sleep disorders. Central, obstructive, and mixed patterns of sleep apnea may be observed in hypothyroidism. A 60-yr-old man was admitted due to hypersomnolence, snoring and generalized edema. Polysomnogram showed obstructive pattern of sleep apnea syndrome. Neck CT scan revealed narrowing of upper airway which is consistent with obstructive sleep apnea syndrome. Physical examination and hormonal study also disclosed the evidence of hypothyroidism. We report a case of sleep apnea syndrome due to primary hypothyroidism with review of literatures.
The hallmarks of sleep apnea syndrome include daytime hypersomnolence, snoring, obesity, disturbed nocturnal sleep, and apneic episodes. Thyroid deficiency states are now a well recognized cause of sleep apnea. Central, obstructive, and mixed patterns of sleep apnea may be observed in hypothyroidism. A-33-yr-old man was admitted complaining of daytime hypersomnolence, snoring, sleep apnea and obesity. A polysomnogram showed obstructive pattern of sleep apnea syndrome. Physical examination and hormonal study revealed a narrowing of the upper airway and primary hypothyroidism. Dilated cardiomyopathy was diagnosed by echocardiogram. The poctients was treated for obstructive sleep apnea syndrome with nasal continuous positive airway pressure(CPAP) for 2 months and the underlying hypothyroidism with thyroid hormone therapy. This successfully controlled the snoring, sleep apnea, and other apnea-related symptoms. Here, we describe our experience of nasal CP AP and thyroid hormone therapy in a patient with primary hypothyroidism associated with obstructive sleep apnea syndrome and dilated cardiomyopathy with review of the relevant literature.
Purpose : Radiation therapy in combination with surgery has an important role in the therapy of the head and neck cancer We conducted a prospective study for patients with head and neck cancer treated with surgery and radiation to evaluate the effect of therapies on the thyroid gland, and to identify the factors that might influence the development of hypothyroidism. Materials and Methods : From September 1986 through December 1994, 71 patients with head and cancer treated with surgery and radiation were included in this prospective study. Patients' age ranged from 32 to 73 years with a median age of 58 years. There were 12 women and 59 men. The primary tumor sites were larynx in 34 patients, hypopharynx in 13 patients, oral cavity in 12 patients, unknown primary of the neck in 6 patients, salivary gland in 3 patients, maxillary sinus in 2 patients, and oropharynx in 1 patient. Total laryngectomy with neck dissection was carried out in 45 patients and neck dissection alone in 26 patients. All patients were serially monitored for thyroid function (T3, T4, free T4, TSH, antithyroglobulin antibody and antimicrosomal antibody) before and after radiation therapy. Radiation dose to the thyroid gland ranged from 40.6Gy to 60Gy with a median dose of 50Gy The follow-up duration was 3 to 80 months. Results :The overall incidence of hypothyroidism was 56.3\%$);7 out of 71 patients $(9.9\%)$ developed clinical hypothyroidism and 33 patients $(46.4\%)$ developed subclinical hypothyroidism. No thyroid nodules, thyroid cancers, or hyperthyroidism was detected. Hypothyroidism developed earlier in patients who underwent total laryngectomy with neck dissection than in patients with neck dissection alone (P<0.05). The risk factor that significantly influenced the incidence of hypothyroidism was a combination of surgery (total laryngectomy with neck dissection) and radiation therapy (P=0.0000), Four of 26 patients $(15.4\%)$ with neck dissection alone developed hypothyroidism while 36 of 45 patients $(80\%)$ with laryngectomy and neck dissection developed hypothyroidism. Conclusion : The hypothyroidism following surgery and radiation therapy was a relatively common complication. The factor that significantly influenced theincidence of hypothyroidism was combination of surgery and radiation therapy. Evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests is recommended for an early detection of hypothyroidism and thyroid hormone replacement therapy is recommended whenever hypothyroidism develops.
Clinical measurement of thyroid autoantibodies in sera of some thyroid disorders have been widely applied since about twenty years ago. We investigated the incidence and titers of both anti microsomal and antithyroglobulin antibodies in forty eight cases with controls and one hundred and thirty three patients with some form of thyroid disorders. The results were as follows; 1) In controls, antimicrosomal antibodies were positive in 2% but anti thyroglobulin antibodies were all negative. 2) In a series of one hundred and thirty three patients with thyroid disease, anti microsomal antibodies were positive in 44% but antithyroglobulin antibodies were positive in only 15%. 3) The rate disclosing the positive results of antimicrosomal antibodies were 71 % in Hashmoto's disease, 60% in Graves' disease, and 38% in primary hypothroidism, respectively. On the other hand, the positive results of antithyroglobulin antibodies showed 21 % in Graves' disease, 19% in primary hypothyroidism, and 18% in Hashmoto's disease, respectively. Though there were relatively high rate of both antimicrosomal and anti thyroglobulin antibodies in patients with nodular goiter, they were only seven cases in our series. 4) The rate with the extremely high titers of antimicrosomal and antithyroglobulin antibodies$(>1:160^2)$ was 83% and 67% in Hashmoto's disease, 50% and 67% in primary hypothyroidism, and 41% and 18% in Graves' disease. Accordingly, the thyroid autoantibodies were commonly found higher positive rate in patients with Hashmoto's disease, primary hypothyroidism, and Graves' disease. Among these disorders, the extremely high positive rate of the thyroid autoantibodies was found in patients with Hashmoto's disease.
A four-year-old female Jindo dog was admitted to the hospital because of bilaterally symmetrical alopecia and inappentence. Systemic abnomalities detected on physical examination were obesity, bradycardia, exercise intolerance, mental dullness and hypothermia. Dermatologically symmetrical alopecia on the back, trunk and dorsal tail, and ventral hyperpigmentation were observed. Also face was very tragic. The level of basal $T_4$ was 0.01ug/dl. In TSH stimulation test $fT_4$ value was 0.08ng/dl. After treatment was initiated with L-thyroxine the dog's general condition was improved at 4 weeks.
Hypogonadism is a clinical syndrome that results in hormone deficiency and can be classified as 1) primary caused by the gonadal failure and 2) secondary by the hypothalamus-pituitary gland dysfunction and/or cardiometabolic complications. Recently the presence of thyroid hormone receptors in different testicular cell types was demonstrated, and thus thyroid dysfunctions would be another cause of secondary hypogonadism. Thus, we investigated the effects of perinatal hypothyroidism on hypogonadism in male Sprague-Dawley rats. Perinatal hypothyroidism was induced by daily administration of 0.05% 6-propyl-2-thiouracil (PTU) by tap water from gestation day 15, which were compared with negative control (PTU (-)) group. At postnatal day 28, hypothyroid pups were divided into 2 groups: PTU (+) group - continued PTU treatment and PTU (+/-) group - stopped PTU until postnatal day 49. Body weights, dehydrotesosterone (DHT), and testosterone levels were checked 2 and 3 weeks after grouping. Body weights were significantly decreased in PTU(+) and PTU(+/-) groups compared with PTU (-) group at postnatal day 28. 3 weeks later, PTU (+/-) group significantly gained weight compared with PTU (+) group. DHT and testosterone levels significantly decreased with PTU treatment, but increased 3 weeks after stopping PTU administration. Perinatal PTU-induced hypothyroid hypogonadism was sustained for 2 weeks after stopping PTU administration, but restored gonadal hormone levels 3 weeks after stopping PTU. These results suggest that researchers should design an experiment on hypothyroid hypogonadism based on the estimated period.
Objective: The aim of this study was to assess thyroid function in breast cancer patients exposed to therapeutic external beam radiation. The focus was on possible progressive changes and any relationships between the incidence of primary hypothyroidism, the time required to become hypothyroid, and factors such as chemotherapy, hormonotherapy and immunotherapy. Materials and Methods: Seventy females undergoing 3D conformal and IMRT radiation therapy for breast cancers were enrolled in a non-randomized prospective study. The patients was divided into two groups: those after mastectomy or breast conserving surgery (BCS) were irradiated to a scar of the chest wall/breast and the ipsilateral supraclavicular and the axillary areas (supraclavicular radiotherapy group - SC-RT group - 32 patients) and the control group receiving adjuvant chest wall/breast RT only (BCT group - 38 patients).The total doses were 50.0 to 70 Gy in 5 to 7 weeks. The median follow-up term was 24 months (range, 1-40 months). Thyroid function was evaluated by measuring thyroid stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels. The minimum, maximum and mean thyroid gland doses for 20 Gy (V20) were calculated for all patients. Results: Statistically significant results were obtained for the SC-RT group. Two yearsa fter the end of RT the chance of an event was increased in 6% of the population (p=0.009) in the SC-RT group. In the BCT group no significance was noted. No statistically significant differences were found for V20, chemio-, immunotherapy and hormonotherapy or Ki67 values (p=0.12). No significant results were obtained for development of hypothyroidism and clinical factors (age, thyroid volume, treatment modalities). Conclusion: Radiotherapy is associated with a higher incidence of thyroid toxicity in breast cancer patients. Routine thyroid function monitoring should be recommended in such cases.
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