摘要:

OBJECTIVE A characteristic thyroid ultrasonographic picture with diffuse or scattered low echogenicity has been described in Graves' disease (GD). Thyroid hypoechogenicity in GD at onset has been considered a prognostic index of relapse after medical treatment; moreover, thyroid hypoechogenicity is regularly observed in GD at the onset, but not in patients with ‘burned‐out’ disease. The aim of this study was to evaluate the usefulness of thyroid hypoechogenicity changes in predicting GD relapse.DESIGN Longitudinal prospective study of previously untreated patients with GD.PATIENTS Thirty‐nine consecutive patients aged 10–72 years were treated with methimazole (MMI) for 12–24 months on a titration regimen. Evaluation of patients in remission or with relapse was done 12 and 24 months after MMI withdrawal.MEASUREMENTS Thyroid ultrasonography and TSH receptor antibodies (TRAb) were evaluated in basal conditions and then one month after MMI withdrawal. Thyroid hypoechogenicity score (assessed by the same observer with the same equipment) was graded as: 0 absent; 1 mild; 2 moderate; 3 marked. At the withdrawal evaluation a score< 2 and a TRAb value< 10 U/l were considered as normal.RESULTS Twelve and 24 months after withdrawal, there were 10 (25.6%) and 17 (44.7%) relapses, respectively. Neither thyroid hypoechogenicity score nor TRAb values evaluated in basal conditions, showed significant differences between patients remaining euthyroid and those who became again hyperthyroid. In the whole group, the thyroid hypoechogenicity score was significantly lower at the withdrawal than in basal conditions (1.1±1.1vs2±0.8;P < 0.0001); it was significantly lower in patients in remission (P < 0.001), but not in those who relapsed. The thyroid hypoechogenicity score at withdrawal was normal in 23/29 (79.3%) of patients still euthyroid and in 4/10 (40%) of those who relapsed up to the 12th month (P < 0.05); it was normal in 19/21 (90.4%) of patients still euthyroid and in 7/17 (41.2%) of those who relapsed up to the 24th month (P < 0.05). A normal thyroid hypoechogenicity score at withdrawal of MMI had a higher specificity (0.95) and sensitivity (0.59) with respect to TRAb values (0.86 and 0.53, respectively) for the prediction of the relapse of hyperthyroidism at the 24th month.CONCLUSIONS Basal thyroid hypoechogenicity cannot be used as an index of relapse of GD. MMI treatment induces evident changes in thyroid hypoechogenicity, mainly in patients who subsequently go into remission. The absence or a low grade of thyroid hypoechogenicity after MMI treatment seems to be a favourable prognosti

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.d01-1563.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE Treatment with recombinant interferon‐α (rIFN‐α) may induce autoimmunity. We have evaluated the effect of rIFN‐α on pre‐existing thyroid disease with special reference to changes in TSH receptor antibody.DESIGN AND PATIENTS Five patients, who had a history of autoimmune thyroid disease diagnosed between 2 and 16 years earlier (three patients had Graves' disease while two had Hashimoto's thyroiditis), were treated with rIFN‐α for chronic hepatitis C. Before, during and after rIFN‐α therapy, we determined thyroid function, antithyroid antibody, thyroid echogenicity and the surface phenotype of the peripheral and intrathyroidal lymphocytes.RESULTS Four of the patients developed overt hypothyroidism after 4–7 months of rIFN‐α therapy, and two of them had a preceding history of low‐uptake thyrotoxicosis. Recovery of thyroid function was observed in all four patients. Strongly positive blocking type TSH receptor antibody was detected and an increase in the percentage of CD19 positive cells in the intrathyroidal lymphocytes was also observed in three of the patients even though the goitre size increased in two of them. One of the patients became thyrotoxic later when stimulating type TSH receptor antibody became positive. Another patient suffered from reversible hypothyroidism although stimulating type TSH receptor antibody remained strongly positive throughout the clinical course.CONCLUSIONS Our data thus indicated a high incidence of an unusual type of reversible hypothyroidism with TSH receptor antibodies in patients with chronic hepatitis C and pre‐existing autoimmune thyroid disease after recombinant interferon‐α therapy through a mechanism involving both the

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.d01-1564.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE Cognitive and affective functioning is sensitive to changes in thyroid hormones. We have sought to determine: (1) the prevalence of thyroid function abnormalities in a psychiatric population on admission (as compared to the prevalence in a normal population), and (2) whether such thyroid function abnormalities are associated with the occurrence or development of cognitive and affective disorders.DESIGN Serum was collected 2–3 weeks after hospitalization in 3 major clinics from 3756 psychiatric patients in 1987–1990, stored, and assayed in 1993 for the presence of antibodies against the TSH‐receptor and thyroperoxidase (TPO‐Ab) and for TSH levels. The psychiatric cohort was matched with a control population of healthy individuals living in the same area (n = 1877).The prevalence study was followed by a case‐control study involving patients from one clinic that had routinely assigned a DSM‐IIIR classification to its patients. Cases were those admissions with thyroid abnormalities and three subgroups of cases were randomly formed demonstrating either TSH less than 0.4 mU/l (n = 44) or over 4.0 mU/l (n = 44), or TPO‐Ab positivity (n = 50). Cases were compared to random controls from the same psychiatric population, viz patients without thyroid abnormalities (n = 83). Comparison was with respect to their psychiatric follow‐up diagnosis (the investigator was blinded to the thyroid test results).RESULTS Prevalence study. The percentage of patients positive for TSH‐receptor‐Ab was 0.26 (9/3504), for TPO‐Ab was 10.0 (331/3316) and outside the TSH range of 0.4–4.0 mU/l was 10.0 ((332/3316): 5.9% (198/3316)>4.0 mU/l and 4.1% (134/3316)<0.4 mU/l). Abnormal total thyroxine levels were found in only 9.8% of subjects with abnormal TSH, indicating the predominantly subclinical character of the thyroid alteration. In comparison, the healthy area controls over 55 years of age showed the same prevalence of positive TPO‐antibodies and TSH under 0.4 mU/l, but a higher prevalence of TSH over 4.0 mU/l.Case‐control study. In the case control analysis differences could not be noticed with regard to prevalences of dementia, schizophrenia or other psychiatric illnesses apart from the prevalence of affective disorders which were more prevalent in TPO‐Ab positive patients and patients with a low serum TSH. Since prior use of lithium, carbamezapine, carbimazole and/or thyroxine could be a factor of importance in this association, analyses were also carried out excluding patients with such prior drug use. In these analyses affective disorders were still more prevalent in patients with a low serum TSH (particularly in males, 40% in casesvs9% in controls,P  4.0 mU/l) and a subgroup of the affective disorders, viz with a rapid cycling of bipolar disorder (18% in casesvs0% in controls,P < 0.001).CONCLUSION Thoug h causal relations cannot be determined from this cross‐sectional study, this admission survey found early forms of autoimmune thyroid disease, sometimes characterized only by TPO‐Abs, highly significantly associated with rapid cycles of a bipolar disorder. It also found a weak association between s

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.d01-1558.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

A 14‐year‐old girl presented with short stature and progressive virilization. She had not undergone the menarche. On investigation, she had elevated testosterone, androstenedione, dihydroepiandrosterone sulphate and 17α‐hydroxyprogesterone levels, which were all suppressed by overnight dexamethasone to within their normal ranges. An initial diagnosis of 21‐hydroxylase deficiency was revised to 11β‐hydroxylase deficiency after a tetracosactrin stimulation test, which showed only a modest rise in 17α‐hydroxyprogesterone level (from 92 nmol/l at baseline to 133 nmol/l at 60 minutes) and measurement of the basal 11‐deoxycortisol, which was grossly elevated. Treatment with dexamethasone 0.5 mg nocte resulted in suppression of androgens in the daytime, but not in the evening, particularly androstenedione. Treatment with hydrocortisone 10 mg b.d. failed to suppress testosterone or androstenedione over a 24‐hour period. Addition of cyproterone and oestrogen supplements had no effect and significant virilization persisted. Laparoscopic bilateral adrenalectomy was therefore performed as definitive treatment and resulted in remarkable clinical and biochemical improvement. This case illustrates difficulties in correct diagnosis, choice of appropriate steroid regimen and monitoring efficacy of treatment in congenital adrenal hyperplasia due to 11β‐hydroxylase deficiency. More aggressive management with earlier bilateral adrenalectomy may be

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.d01-1556.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Severe congenital insulin resistance in the syndrome of leprechaunism is caused by mutations in the insulin receptor gene. We report a patient with leprechaunism who was homozygous for a mutation resulting in the absence of cell surface insulin receptors. To determine whether the receptor for Insulin‐like growth factor‐I (IGF‐I) is involved in the phenotype of leprechaunism, we studied the effect of insulin and of IGF‐I on cells from this patient.The patient had a homozygous C → T substitution at base pair 8212 in exon 12 of the insulin receptor gene, creating a premature stop codon. This nonsense mutation is in the extracellular portion of the receptor and truncates the insulin receptor proximal to its transmembrane anchor, resulting in the absence of cell surface insulin receptors. This finding indicates that complete absence of the insulin receptor is compatible with life. Secondly, DNA synthesis was studied in skin derived fibroblasts in response to increasing concentrations of either insulin or Insulin‐like growth factor ‐I (IGF‐I), and was assessed by3H‐thymidine incorporation. In this patient’s cells, both of these hormones increased3H‐thymidine incorporation, and the effect was blocked by α‐IR3, a monoclonal antibody that blocks activation of the IGF‐I receptor.These findings confirmed the absence of the insulin receptor and indicated that insulin acts here through activation of the IGF‐I receptor. These data support the contention that the phenotypic and metabolic abnormalities of leprechaunism result from the combination of lack of insulin receptor action and over‐activation by

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.d01-1548.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.d01-1566.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Androgenic manifestations coexisting with hilus cell hyperplasia adjacent to a tumour or an ovarian cyst are extremely rare. We report the case of a post‐menopausal woman with hirsutism associated with hilus cell hyperplasia within the wall of an ovarian cyst. The pattern of steroid secretion revealed increased testosterone release. Suppression of testosterone to ‘normal range’ was seen in response to leuprolide administration. This new approach demonstrates gonadotrophin dependence of hilus cell hyperplasia within an ovarian

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.d01-1549.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.d01-1553.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.d01-1567.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.d01-1553-7742.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY