Endocrinology and Metabolism

Original Articles

Thyroid
Metabolite Changes during the Transition from Hyperthyroidism to Euthyroidism in Patients with Graves’ Disease: Ho Yeop Lee, Byeong Chang Sim, Ha Thi Nga, Ji Sun Moon, Jingwen Tian, Nguyen Thi Linh, Sang Hyeon Ju, Dong Wook Choi, Daiki Setoyama, Hyon-Seung Yi; Endocrinol Metab. 2022;37(6):891-900. Published online December 26, 2022; DOI: https://doi.org/10.3803/EnM.2022.1590

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Background
An excess of thyroid hormones in Graves’ disease (GD) has profound effects on systemic energy metabolism that are currently partially understood. In this study, we aimed to provide a comprehensive understanding of the metabolite changes that occur when patients with GD transition from hyperthyroidism to euthyroidism with methimazole treatment.
Methods
Eighteen patients (mean age, 38.6±14.7 years; 66.7% female) with newly diagnosed or relapsed GD attending the endocrinology outpatient clinics in a single institution were recruited between January 2019 and July 2020. All subjects were treated with methimazole to achieve euthyroidism. We explored metabolomics by performing liquid chromatography-mass spectrometry analysis of plasma samples of these patients and then performed multivariate statistical analysis of the metabolomics data.
Results
Two hundred metabolites were measured before and after 12 weeks of methimazole treatment in patients with GD. The levels of 61 metabolites, including palmitic acid (C16:0) and oleic acid (C18:1), were elevated in methimazole-naïve patients with GD, and these levels were decreased by methimazole treatment. The levels of another 15 metabolites, including glycine and creatinine, were increased after recovery of euthyroidism upon methimazole treatment in patients with GD. Pathway analysis of metabolomics data showed that hyperthyroidism was closely related to aminoacyl-transfer ribonucleic acid biosynthesis and branched-chain amino acid biosynthesis pathways.
Conclusion
In this study, significant variations of plasma metabolomic patterns that occur during the transition from hyperthyroidism to euthyroidism were detected in patients with GD via untargeted metabolomics analysis.

Citations

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Associations of serum keratin 1 with thyroid function and immunity in Graves’ disease
Chao-Wen Cheng, Wen-Fang Fang, Jiunn-Diann Lin, Appuwawadu Mestri Nipun Lakshitha de Silva
PLOS ONE.2023; 18(11): e0289345. CrossRef

Thyroid
Usefulness of Real-Time Quantitative Microvascular Ultrasonography for Differentiation of Graves’ Disease from Destructive Thyroiditis in Thyrotoxic Patients: Han-Sang Baek, Ji-Yeon Park, Chai-Ho Jeong, Jeonghoon Ha, Moo Il Kang, Dong-Jun Lim; Endocrinol Metab. 2022;37(2):323-332. Published online April 13, 2022; DOI: https://doi.org/10.3803/EnM.2022.1413

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Background
Microvascular ultrasonography (MVUS) is a third-generation Doppler technique that was developed to increase sensitivity compared to conventional Doppler. The purpose of this study was to compare MVUS with conventional color Doppler (CD) and power Doppler (PD) imaging to distinguish Graves’ disease (GD) from destructive thyroiditis (DT).
Methods
This prospective study included 101 subjects (46 GDs, 47 DTs, and eight normal controls) from October 2020 to November 2021. All ultrasonography examinations were performed using microvascular flow technology (MV-Flow). The CD, PD, and MVUS images were semi-quantitatively graded according to blood flow patterns. On the MVUS images, vascularity indices (VIs), which were the ratio (%) of color pixels in the total grayscale pixels in a defined region of interest, were obtained automatically. Receiver operating characteristic curve analysis was performed to verify the diagnostic performance of MVUS. The interclass correlation coefficient and Cohen’s kappa analysis were used to analyze the reliability of MVUS (ClinicalTrials.gov:NCT04879173).
Results
The area under the curve (AUC) for CD, PD, MVUS, and MVUS-VI was 0.822, 0.844, 0.808, and 0.852 respectively. The optimal cutoff value of the MVUS-VI was 24.95% for distinguishing GD and DT with 87% sensitivity and 80.9% specificity. We found a significant positive correlation of MVUS-VI with thyrotropin receptor antibody (r=0.554) and with thyroid stimulating immunoglobulin bioassay (r=0.841). MVUS showed high intra- and inter-observer reliability from various statistical method.
Conclusion
In a real time and quantitative manner, MVUS-VI could be helpful to differentiate GD from thyroiditis in thyrotoxic patients, with less inter-observer variability.

Citations

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Association of autoimmune thyroid disease with type 1 diabetes mellitus and its ultrasonic diagnosis and management
Jin Wang, Ke Wan, Xin Chang, Rui-Feng Mao
World Journal of Diabetes.2024; 15(3): 348. CrossRef
The Early Changes in Thyroid-Stimulating Immunoglobulin Bioassay over Anti-Thyroid Drug Treatment Could Predict Prognosis of Graves’ Disease
Jin Yu, Han-Sang Baek, Chaiho Jeong, Kwanhoon Jo, Jeongmin Lee, Jeonghoon Ha, Min Hee Kim, Jungmin Lee, Dong-Jun Lim
Endocrinology and Metabolism.2023; 38(3): 338. CrossRef
Duplex Hemodynamic Parameters of Both Superior and Inferior Thyroid Arteries in Evaluation of Thyroid Hyperfunction Disorders
Maha Assem Hussein, Alaa Abdel Hamid, Rasha M Abdel Samie, Elshaymaa Hussein, Shereen Sadik Elsawy
International Journal of General Medicine.2022; Volume 15: 7131. CrossRef
Case 5: A 41-Year-Old Woman With Palpitation
Jiwon Yang, Kabsoo Shin, Jeongmin Lee, Jeonghoon Ha, Dong-Jun Lim, Han-Sang Baek
Journal of Korean Medical Science.2022;[Epub] CrossRef
Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study
Guillaume Goudot, Yanis Berkane, Eloi de Clermont-Tonnerre, Claire Guinier, Irina Filz von Reiterdank, Antonia van Kampen, Korkut Uygun, Curtis L. Cetrulo, Basak E. Uygun, Anahita Dua, Alexandre G. Lellouch
Frontiers in Physiology.2022;[Epub] CrossRef

Review Article

Miscellaneous
Clinical Characteristics, Management, and Potential Biomarkers of Endocrine Dysfunction Induced by Immune Checkpoint Inhibitors: Shintaro Iwama, Tomoko Kobayashi, Hiroshi Arima; Endocrinol Metab. 2021;36(2):312-321. Published online April 27, 2021; DOI: https://doi.org/10.3803/EnM.2021.1007

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Immune-related adverse events (irAEs) affecting the endocrine glands are among the most frequent irAEs induced by immune checkpoint inhibitors (ICIs) and include hypopituitarism, primary adrenal insufficiency, thyrotoxicosis, hypothyroidism, hypoparathyroidism, and type 1 diabetes mellitus. Since the incidence and clinical features of endocrine irAEs vary according to the ICI used, it is important to understand the characteristics of these irAEs and to manage each one appropriately. Since some endocrine irAEs, including adrenal crisis and diabetic ketoacidosis, are potentially life-threatening, predicting the risk of endocrine irAEs before their onset is critical. Several autoantibodies have been detected in patients who develop endocrine irAEs, among which anti-thyroid antibodies may be predictive biomarkers of thyroid dysfunction. In this review, we describe the clinical features of each endocrine irAE induced by ICIs and discuss their potential biomarkers, including autoantibodies.

Citations

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Clinical characteristics and potential biomarkers of thyroid and pituitary immune-related adverse events
Tomoko Kobayashi, Shintaro Iwama, Hiroshi Arima
Endocrine Journal.2024; 71(1): 23. CrossRef
A case of rapidly progressive insulin-dependent diabetes mellitus without islet autoantibodies developed over two years after the first dose of nivolumab
Kota Nishihama, Yuko Okano, Chisa Inoue, Kanako Maki, Kazuhito Eguchi, Soichiro Tanaka, Atsuro Takeshita, Mei Uemura, Taro Yasuma, Toshinari Suzuki, Esteban C. Gabazza, Yutaka Yano
Diabetology International.2024;[Epub] CrossRef
Endocrinopathies Associated With Immune Checkpoint Inhibitor Use
Anupam Kotwal, Randol Kennedy, Nupur Kikani, Sonali Thosani, Whitney Goldner, Afreen Shariff
Endocrine Practice.2024;[Epub] CrossRef
Recovery from insulin dependence in immune checkpoint inhibitor‐associated diabetes mellitus: A case report
Marie Okubo, Yuji Hataya, Kanta Fujimoto, Toshio Iwakura, Naoki Matsuoka
Journal of Diabetes Investigation.2023; 14(1): 147. CrossRef
Case Report: A Rising Cause of New-Onset Endocrinopathies After Immunotherapy
Charity Tan, Sarah Hendricks, Kristina Hernandez, Martha Benavides, Rupinderjit Samra
The Journal for Nurse Practitioners.2023; 19(5): 104582. CrossRef
Risk of Thyroid Dysfunction in PD-1 Blockade Is Stratified by the Pattern of TgAb and TPOAb Positivity at Baseline
Xin Zhou, Shintaro Iwama, Tomoko Kobayashi, Masahiko Ando, Hiroshi Arima
The Journal of Clinical Endocrinology & Metabolism.2023; 108(10): e1056. CrossRef
Severe thyrotoxicosis induced by tislelizumab: a case report and literature review
Liman Huo, Chao Wang, Haixia Ding, Xuelian Shi, Bin Shan, Ruoying Zhou, Ping Liang, Juan Hou
Frontiers in Oncology.2023;[Epub] CrossRef
Life-Threatening Endocrinological Immune-Related Adverse Events of Immune Checkpoint Inhibitor Therapy
Aleksandra Basek, Grzegorz K. Jakubiak, Grzegorz Cieślar, Agata Stanek
Cancers.2023; 15(24): 5786. CrossRef
Increased Risk of Thyroid Dysfunction by PD-1 and CTLA-4 Blockade in Patients Without Thyroid Autoantibodies at Baseline
Shintaro Iwama, Tomoko Kobayashi, Yoshinori Yasuda, Takayuki Okuji, Masaaki Ito, Masahiko Ando, Xin Zhou, Ayana Yamagami, Takeshi Onoue, Yohei Kawaguchi, Takashi Miyata, Mariko Sugiyama, Hiroshi Takagi, Daisuke Hagiwara, Hidetaka Suga, Ryoichi Banno, Tets
The Journal of Clinical Endocrinology & Metabolism.2022; 107(4): e1620. CrossRef
Biomarkers and risk factors for the early prediction of immune-related adverse events: a review
Ying Zhang, Xiaoling Zhang, Weiling Li, Yunyi Du, Wenqing Hu, Jun Zhao
Human Vaccines & Immunotherapeutics.2022;[Epub] CrossRef
Immune Checkpoint Inhibitors as a Threat to the Hypothalamus–Pituitary Axis: A Completed Puzzle
Agnese Barnabei, Andrea Corsello, Rosa Maria Paragliola, Giovanni Maria Iannantuono, Luca Falzone, Salvatore Maria Corsello, Francesco Torino
Cancers.2022; 14(4): 1057. CrossRef
Elevated TSH Level, TgAb, and Prior Use of Ramucirumab or TKIs as Risk Factors for Thyroid Dysfunction in PD-L1 Blockade
Tomoko Kobayashi, Shintaro Iwama, Ayana Yamagami, Yoshinori Yasuda, Takayuki Okuji, Masaaki Ito, Xin Zhou, Masahiko Ando, Takeshi Onoue, Takashi Miyata, Mariko Sugiyama, Daisuke Hagiwara, Hidetaka Suga, Ryoichi Banno, Tetsunari Hase, Masahiro Morise, Taka
The Journal of Clinical Endocrinology & Metabolism.2022; 107(10): e4115. CrossRef
Preconditioning of the immune system modulates the response of papillary thyroid cancer to immune checkpoint inhibitors
Fabiana Pani, Yoshinori Yasuda, Sylvie T Rousseau, Kevin C Bermea, Solmaz Roshanmehr, Rulin Wang, Srinivasan Yegnasubramanian, Patrizio Caturegli, Luigi Adamo
Journal for ImmunoTherapy of Cancer.2022; 10(12): e005538. CrossRef
Survival benefit of endocrine dysfunction following immune checkpoint inhibitors for nonthyroidal cancers
Anupam Kotwal, Mabel Ryder
Current Opinion in Endocrinology, Diabetes & Obesity.2021; 28(5): 517. CrossRef

Original Articles

Effect of Antiliyolytic Agents on Glueose Metabolism in Thyrotoxic Patients.: Seong Yeon Kim, Kyung Soo Park, Bo Youn Cho, Hong Kyu Lee, Chan Soo Shin, Chang Soon Koh, Hun Ki Min, Tae Geun Oh, Chul Hee Kim, Moon Kyu Lee, Jong Ho Ahn, Kee Up Lee; J Korean Endocr Soc. 1994;9(4):325-331. Published online November 6, 2019

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Abstract PDF: Decreased glucose tolerance is often found in patients with thyrotoxicosis but the pathogenetic mechanisms are poorly understood. Since the concentrations of free fatty acid are usually elevated due to increased lipolysis in thyrotoxicosis, the preferential oxidation of the free fatty acids may explain the decreased glucose tolerance in hyperthyroidism. The aim of this study was to investigate whether lowering plasma free fatty acid(FFA) by acipimox, a long-acting antilipolytic agent, could affect glucose metabolism in thyrotoxicosis. We performed intravenous glucose tolerance test with acipimox or placebo in 6 untreated thyrotoxicmen and 6 age-and body mass index(BMI)-matched controls. The following results were obtained.1) The basal plasma FFA concentration in thyrotoxic patients were significantly higher than those in controls(997.0+-303.4 uEq/L vs. 290.5+-169.1 uEq/L; p<0.01). 2) Plasma FFA concentrations decreased rapidly with acipimox ingestion in both controls and thyrotoxic patients.3) Plasma glucose concentrations were significantly lower with acipimox ingestion than with placebo in thyrotoxic patients from 17min after intravenous glucose load and to the end of the study.4) Plasma insulin concentrations in thyrotoxic patients with acipimox ingestion were higher at 5, 7 min after iv glucose load.5) In thyrotoxic patients, glucose disappearance rate(K_glucose) in acipimox treatment was significantly higher than that in placebo treatment(2.44+-0.84 vs. 1.58+-0.37;p<0.05). 6) K_glucose values were inversely correlated with basal FFA concentrations(r=-0.58, p<0.05). In summary, in thyrotoxic patients with elevated plasma FFA levels, acipimox lowered plasma FFA, which in turn improved glucose tolerance.

Thyroid
Validity and Reliability of the Korean Version of the Hyperthyroidism Symptom Scale: Jie-Eun Lee, Dong Hwa Lee, Tae Jung Oh, Kyoung Min Kim, Sung Hee Choi, Soo Lim, Young Joo Park, Do Joon Park, Hak Chul Jang, Jae Hoon Moon; Endocrinol Metab. 2018;33(1):70-78. Published online March 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.1.70

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Background

Thyrotoxicosis is a common disease resulting from an excess of thyroid hormones, which affects many organ systems. The clinical symptoms and signs are relatively nonspecific and can vary depending on age, sex, comorbidities, and the duration and cause of the disease. Several symptom rating scales have been developed in an attempt to assess these symptoms objectively and have been applied to diagnosis or to evaluation of the response to treatment. The aim of this study was to assess the reliability and validity of the Korean version of the hyperthyroidism symptom scale (K-HSS).

Methods

Twenty-eight thyrotoxic patients and 10 healthy subjects completed the K-HSS at baseline and after follow-up at Seoul National University Bundang Hospital. The correlation between K-HSS scores and thyroid function was analyzed. K-HSS scores were compared between baseline and follow-up in patient and control groups. Cronbach's α coefficient was calculated to demonstrate the internal consistency of K-HSS.

Results

The mean age of the participants was 34.7±9.8 years and 13 (34.2%) were men. K-HSS scores demonstrated a significant positive correlation with serum free thyroxine concentration and decreased significantly with improved thyroid function. K-HSS scores were highest in subclinically thyrotoxic subjects, lower in patients who were euthyroid after treatment, and lowest in the control group at follow-up, but these differences were not significant. Cronbach's α coefficient for the K-HSS was 0.86.

Conclusion

The K-HSS is a reliable and valid instrument for evaluating symptoms of thyrotoxicosis in Korean patients.

Citations

Citations to this article as recorded by

Effect of thyroid-stimulating hormone suppression on quality of life in thyroid lobectomy patients: interim analysis of a multicenter, randomized controlled trial in low- to intermediate-risk thyroid cancer patients (MASTER study)
Ja Kyung Lee, Eu Jeong Ku, Su-jin Kim, Woochul Kim, Jae Won Cho, Kyong Yeun Jung, Hyeong Won Yu, Yea Eun Kang, Mijin Kim, Hee Kyung Kim, Junsun Ryu, June Young Choi
Annals of Surgical Treatment and Research.2024; 106(1): 19. CrossRef
Effect of increased levothyroxine dose on depressive mood in older adults undergoing thyroid hormone replacement therapy
Jae Hoon Moon, Ji Won Han, Tae Jung Oh, Sung Hee Choi, Soo Lim, Ki Woong Kim, Hak Chul Jang
Clinical Endocrinology.2020; 93(2): 196. CrossRef
Clinical Feasibility of Monitoring Resting Heart Rate Using a Wearable Activity Tracker in Patients With Thyrotoxicosis: Prospective Longitudinal Observational Study
Jie-Eun Lee, Dong Hwa Lee, Tae Jung Oh, Kyoung Min Kim, Sung Hee Choi, Soo Lim, Young Joo Park, Do Joon Park, Hak Chul Jang, Jae Hoon Moon
JMIR mHealth and uHealth.2018; 6(7): e159. CrossRef

Brief Report

Thyroid
Cholestyramine Use for Rapid Reversion to Euthyroid States in Patients with Thyrotoxicosis: Jeonghoon Ha, Kwanhoon Jo, Borami Kang, Min-Hee Kim, Dong-Jun Lim; Endocrinol Metab. 2016;31(3):476-479. Published online July 26, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.3.476

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Cholestyramine (CS) is an ion exchange resin, which binds to iodothyronines and would lower serum thyroid hormone level. The use of CS added to conventional antithyroid drugs to control thyrotoxicosis has been applied since 1980's, and several studies indicate that using CS in combination with methimazole (MZ) produces a more rapid decline in serum thyroid hormones than with only MZ treatment. Our recent retrospective review of five patients taking high dose MZ and CS, compared to age-, gender-, initial free thyroxine (T4) level-, and MZ dose-matched 12 patients with MZ use only, showed more rapid decline of both free T4 and triiodothyronine levels without more adverse events. CS could be safely applicable short-term adjunctive therapy when first-line antithyroid medications are not enough to adequately control severe thyrotoxicosis or side effects of antithyroid drug would be of great concern.

Citations

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Therapeutic plasma exchange for Graves’ disease in pregnancy
Matthew Lumchee, Mimi Yue, Josephine Laurie, Adam Morton
Obstetric Medicine.2023; 16(2): 126. CrossRef
Ventricular arrhythmias, antiarrhythmic therapy and thyroidal illness in advanced heart failure: a case report and review of the literature
Fatima Alsalama, Salma Alzaabi, Cynthia Salloum, Marilyne Abi Younes, Feras Bader, Hussam Ghalib, Bassam Atallah
Drugs & Therapy Perspectives.2023; 39(4): 147. CrossRef
Amiodarone Induced Thyrotoxicosis and Treatment Complications in a Man With Cyanotic Congenital Heart Disease: A Case Report
Marvin Wei Jie Chua, Shao Feng Mok
Frontiers in Cardiovascular Medicine.2020;[Epub] CrossRef
Propylthiouracil-induced agranulocytosis as a rare complication of antithyroid drugs in a patient with Graves’ disease
Patrícia Novais Rabelo, Paula Novais Rabelo, Allyne Fernanda de Paula, Samuel Amanso da Conceição, Daniela Pultrini Pereira de Oliveira Viggiano, Daniela Espíndola Antunes, Estela Muszkat Jatene, Sílvia Leda França Moura de Paula, Monike Lourenço Dias, Ma
Revista da Associação Médica Brasileira.2019; 65(6): 755. CrossRef
Notes on Trauma-Related Thyroid Storm in the Emergency Department
Adam Morton
The Journal of Emergency Medicine.2018; 54(2): e35. CrossRef
Risk of embryopathies with use of antithyroidal medications
Stine L. Andersen
Current Opinion in Endocrinology, Diabetes & Obesity.2017; 24(5): 364. CrossRef
Thiamazole

Reactions Weekly.2017; 1644(1): 291. CrossRef

Case Reports

Thyroid
A Case of Acute Suppurative Thyroiditis with Thyrotoxicosis in an Elderly Patient: Bo Sang Kim, Kil Woo Nam, Jeong Eun Kim, Ji Hoon Park, Jun Sik Yoon, Jung Hwan Park, Sang Mo Hong, Chang Bum Lee, Yong Soo Park, Woong Hwan Choi, You Hern Ahn, Dong Sun Kim; Endocrinol Metab. 2013;28(1):50-54. Published online March 25, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.1.50

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Acute suppurative thyroiditis (AST) is a rare condition, as the thyroid gland is relatively resistant to infection. Thyroid function tests are usually normal in AST. A few cases of AST associated with thyrotoxicosis have been reported in adults. We report a case of AST that was associated with thyrotoxicosis in a 70-year-old woman. We diagnosed AST with thyroid ultrasonography and fine needle aspiration of pus. The patient improved after surgical intervention and had no anatomical abnormality. Fine needle aspiration is the best method for the difficult task of differentiating malignancy and subacute thyroiditis from AST with thyrotoxicosis. Earlier diagnosis and proper treatment for AST might improve the outcome.

Citations

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Acute suppurative thyroiditis with Graves disease – A very rare association
Inês Damásio, Joana Maciel, Maria Manuel Costa, Luisa Raimundo
Archives of Endocrinology and Metabolism.2023;[Epub] CrossRef
Thyrotoxicosis as a rare presentation in acute suppurative thyroiditis: a case report
Zeynab Seyedjavadeyn, Seyed Amir Miratashi Yazdi, Alireza Samimiat, Matin Vahedi
Journal of Medical Case Reports.2023;[Epub] CrossRef
Subakute Thyreoiditis und akute suppurative Thyreoiditis
Christian Trummer, Verena Theiler-Schwetz, Stefan Pilz
Journal für Klinische Endokrinologie und Stoffwechsel.2020; 13(3): 124. CrossRef
Infection of Thyroid Cyst Occurring 1 Month after Fine-Needle Aspiration in an Immunocompetent Patient
Jung Kyu Park, Eon Ju Jeon
International Journal of Thyroidology.2018; 11(2): 182. CrossRef
Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
Endocrinology and Metabolism.2014; 29(3): 251. CrossRef

Thyrotoxic Periodic Paralysis Induced by Dexamethasone.: Eun Ju Lee, Tae Kyoon Kim, Min Jeong Kwon, Soon Hee Lee, Jeong Hyun Park; Endocrinol Metab. 2012;27(4):299-302. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.299

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Abstract PDF

Thyrotoxic periodic paralysis (TPP) is a disease characterized by sudden onset and muscle paralysis. It occurs in the setting of hypokalemia of thyrotoxicosis. Cases of TPP induced by a glucocorticoid such as prednisolone or methylprednisolone have been reported. We report on two patients, each of whom received a dexamethasone injection and subsequently developed TPP. Both patients experienced sudden, flaccid paralysis of both extremities after the injection but recovered completely after receiving a potassium replacement. Laboratory results revealed thyrotoxicosis. The patients were diagnosed with Graves' disease and discharged after receiving treatment with methimazole and propranolol. This report provides the clinical description of TPP induced by dexamethasone injection. These cases suggest that clinicians must consider the presence of hyperthyroid disease in patients who develop acute paralysis after treatment with a glucocorticoid, even in the absence thyrotoxic symptoms. Furthermore, physicians should be aware that TPP can occur even in response to dexamethasone used for treatment of thyrotoxic crisis or Graves' ophthalmopathy.

Citations

Citations to this article as recorded by

Glucocorticoid-Induced Hypokalemic Periodic Paralysis after Short-Term Use of Tenofovir with Hypophosphatemia: A Case Report
Yujin Shin, Yonglee Kim, Kyong Young Kim, Jong Ha Baek, Soo Kyoung Kim, Jung Hwa Jung, Jong Ryeal Hahm, Min Young Kim, Jaehoon Jung, Hosu Kim
Medicina.2021; 58(1): 52. CrossRef

A Case of Painless Thyroiditis Followed by Graves' Disease.: Gyeong Jae Na, Ji Hyun Kim, Se Yoon Park, Ki Won Kim, Hee Ja Ko, Sung Wan Jeon, Yeo Joo Kim, Sang Jin Kim; Endocrinol Metab. 2012;27(2):147-150. Published online June 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.2.147

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Abstract PDF

A 30-year-old man was admitted to our hospital because of fatigue, palpitation and severe weakness of both legs. The admission laboratory findings revealed thyrotoxicosis, and 131I thyroid scintigraphic imaging revealed a low radioactive iodine uptake. He was treated for painless thyroiditis for about 4 months. However, thyrotoxic state had continued and radioactive iodine uptake was markedly increased in the follow up scan. Painless thyroiditis often relapses, but rarely develops into Graves' disease. This is a rare case in which painless thyroiditis was followed by Graves' disease.

Citations

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A Case of Severe Recurrent Painless Thyroiditis Requiring Thyroidectomy
So Hyun Park, Il Seong Nam-Goong, Young Il Kim, Yun Sun Kim, Yung Min Kim, Eun Sook Kim
Journal of Korean Thyroid Association.2015; 8(1): 113. CrossRef

A Case of Graves' Disease Presented as Generalized Seizure Attack.: So Young Park, Su Kyoung Park, Sung Hwan Suh, Duk Kyu Kim, Sang Ho Kim, Mi Kyoung Park, Song Yee Han, Seung Hee Ryu, Su Mi Woo, Sung Woo Lee, Neul Bom Yoon; Endocrinol Metab. 2012;27(2):142-146. Published online June 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.2.142

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Abstract PDF: Hyperthyroidism is diagnosed when a patient is presented with typical symptoms, such as weight loss, palpitation, and hand tremor. However, early diagnosis is difficult in elders, because they have no typical symptoms, but only cardiovascular or muscular symptoms. In hyperthyroidism, there are often with neurologic changes, leading to various neurologic symptoms. Generalized or focal seizures are rarely reported in thyrotoxicosis and thyrotoxic crisis. Further, cases of hyperthyroidism presented as generalized seizure attack are extremely rare. We report a case of hyperthyroidism. A patient is presented at the hospital with mental change, as well as generalized seizure, who was finally diagnosed to have Graves' disease. A 56-year-old male was admitted to the hospital because of mental change with generalized seizure attack. Initial neurologic evaluations, including a brain magnetic resonance imaging and electroencephalogram proved to be normal. But, thyroid function test showed abnormal results. We diagnosed him as Graves' disease and prescribed anti-thyroid drug. Thereafter, there has been no recurrence of neurologic symptoms for 12 months.

Original Article

Differential Diagnostic Value of Total T3/Free T4 Ratio in Graves' Disease and Painless Thyroiditis Presenting Thyrotoxicosis.: Sang Min Lee, Soo Kyoung Kim, Jong Ryeal Hahm, Jung Hwa Jung, Ho Su Kim, Sungsu Kim, Soon Il Chung, Bong Hoi Choi, Tae Sik Jung; Endocrinol Metab. 2012;27(2):121-125. Published online June 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.2.121

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Abstract PDF

BACKGROUND
It is important to differentiate Graves' disease from that of painless thyroiditis in patients with thyrotoxicosis. In this study, we evaluated the usefulness of total T3 to free T4 ratio in making a differential diagnosis between Graves' disease and painless thyroiditis. METHODS: We reviewed medical records of thyrotoxic patients, who had been diagnosed with Graves' disease or painless thyroiditis, from October 2009 to July 2011. We assessed clinical characteristics, serum levels of total T3, free T4, thyroid stimulating hormone, thyrotropin-binding inhibitory immunoglobulin, and findings of 99mTechnetium thyroid scan. We analyzed the total T3/free T4 ratios between Graves' disease and painless thyroiditis patients. RESULTS: A total of 76 untreated thyrotoxic patients "49 Graves' disease and 27 painless thyroiditis" were examined. The total T3, free T4 levels and the total T3/free T4 ratios were significantly higher in patients with Graves' disease than in those with painless thyroiditis (P < 0.001). In the total T3/free T4 ratio > 73, the possibility of Graves' disease was significantly higher than in painless thyroiditis (sensitivity, 75.5%; specificity, 70.3%). The sensitivity and specificity of the total T3/free T4 ratio in patients with free T4 < 3.6 ng/dL have been increased (sensitivity, 100%; specificity, 71.4%). CONCLUSION: The total T3/free T4 ratios was useful for making a differential diagnosis between Graves' disease and painless thyroiditis.

Citations

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Comparison of 99mTc Pertechnetate Thyroid Uptake Rates by Gamma Probe and Gamma Camera Methods for Differentiating Graves’ Disease and Thyroiditis
Meihua Jin, Jonghwa Ahn, Seong-gil Jo, Jangwon Park, Min Ji Jeon, Won Gu Kim, Tae Yong Kim, Won Bae Kim, Young Kee Shong, Jin-Sook Ryu
Nuclear Medicine and Molecular Imaging.2022; 56(1): 42. CrossRef
Interpretation of puzzling thyroid function tests
Jee Hee Yoon, Ho-Cheol Kang
Journal of the Korean Medical Association.2018; 61(4): 241. CrossRef
The High Proportion of Painless Thyroiditis as a Cause of Thyrotoxicosis in Korea
Sang Il Mo, A Jeong Ryu, Yeo Joo Kim, Sang Jin Kim
Journal of Korean Thyroid Association.2015; 8(1): 61. CrossRef

Case Reports

Thyroid Dysfunction Induced by Metastatic Thyroid Cancer: Report of Two Cases.: Kang Hee Ahn, Bo Kyung Choi, Won Jin Kim, Bo Gwang Choi, Yun Kyung Jeon, Sang Soo Kim, Soo Hyung Lee, Bo Hyun Kim, Yong Ki Kim, In Ju Kim; Endocrinol Metab. 2010;25(4):370-373. Published online December 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.4.370

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Abstract PDF: Metastases to the thyroid gland are not frequently observed in clinical practice, although an overall incidence of secondary thyroid malignant tumors has been reported to range from 1.25% to 24% in autopsy series. Generally, patients with metastatic thyroid cancer present with euthyroidism and they do not develop thyroid dysfunction. Thyroid dysfunctions, including hypothyroidism and hyperthyroidism, rarely occur in patients with metastatic thyroid cancer. We describe here a case of hypothyroidism induced by thyroid metastasis from cancer of an unknown primary site in a 53-year-old man and another case of thyrotoxicosis induced by thyroid metastasis from lung cancer in a 65-year-old man.

A Case of Graves' Disease with Pancytopenia.: Jong Ho Shin, Hyun Jin Kim, Si Bum Kim, Dong Pil Kim, Bong Suk Ko, Dong Soon Kim, Ji Myung Kim, Soo Jung Gong, Jung Ae Lee; J Korean Endocr Soc. 2009;24(4):272-276. Published online December 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.4.272

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Hematological disorders, and especially single lineage abnormalities, have been described in patients suffering with thyrotoxicosis, but pancytopenia is a rare complication of thyrotoxicosis. Pancytopenia with thyrotoxicosis has been reported to be totally reversible with antithyroid drug treatment. We experienced a case with pancytopenia associated with Graves' disease in a 57-year-old woman who had no specific cause of pancytopenia. She presented with dyspnea and palpitation. The laboratory findings revealed thyrotoxicosis and pancytopenia. Increased radioisotope uptake was seen on the thyroid scan and normal cellularity and maturation were found in the bone marrow aspiration biopsy. Based on these findings, she was diagnosed as suffering from Gravesyendisease with pancytopenia. After treatment with propylthiouracil, the blood cell counts were restored to normal as the patient achieved a euthyroid state. We report here on a case of Graves' disease that was complicated by pancytopenia, and all this was normalized after treatment for hyperthyroidism.

Citations

Citations to this article as recorded by

Non-myeloproliferative Pancytopenia: A Rare Presentation of Thyrotoxicosis
Izzathunnisa Rahmathullah, Maheswaran Umakanth, Suranga Singhapathirane
Cureus.2023;[Epub] CrossRef
Pancytopenia in a surgical patient, a rare presentation of hyperthyroidism
Prabhat Jha, Yogendra Prasad Singh, Bikal Ghimire, Binit Kumar Jha
BMC Surgery.2014;[Epub] CrossRef
A Case of Pancytopenia with Hyperthyroidism
Tae Hoon Kim, Ji Sung Yoon, Byung Sam Park, Dong Won Lee, Jae Ho Cho, Jun Sung Moon, Eui Hyun Kim, Kyu Chang Won, Hyoung Woo Lee
Yeungnam University Journal of Medicine.2013; 30(1): 47. CrossRef

A Patient with Primary Amyloidosis Misrecognized as Thyrotoxicosis-induced Heart Failure.: Seok Ju Lee, Seung Hwan Lee, Jung Yeon Chin, Youn Mi Song, Sung Won Lee, Min Hee Kim, Mi Ja Kang, Kang Woo Lee, Hyuk Sang Kwon, Kun Ho Yoon, Ho Young Son, Bong Yun Cha; J Korean Endocr Soc. 2008;23(5):332-336. Published online October 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.5.332

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Abstract PDF: Amyloidosis is caused by deposition of insoluble amyloid protein in the extracellular space of organs and tissues. The causes of amyloidosis are classified as primary, secondary, and hereditary, and symptoms develop according to which organ is involved. Cardiac amyloidosis induces cardiomyopathy and is developed by deposition of amyloid proteins in cardiac tissue. We diagnosed a patient with rhabdomyolysis and thyrotoxicosis with underlying Graves' disease 5 years ago. The patient was readmitted recently complaining of general weakness and mild dyspnea, and was diagnosed as relapsed thyrotoxicosis. An echocardiogram was performed for the evaluation of dyspnea and the findings were compatible with infiltrative cardiomyopathy due to amyloidosis. A biopsy of the abdominal subcutaneous fat and rectal mucosa was performed, and diagnosis was amyloidosis with histologic findings. The cause of heart failure was therefore cardiac amyloidosis rather than thyrotoxicosis. This case indicates the importance of evaluating the cause of heart failure in patients with thyrotoxicosis.

Amiodarone Induced Thyrotoxicosis (Type II).: Cho Young Ju, Hearn Kook Kim, Hyoung Jung Chung, Yong Jin Park, Jin Yeob Kim, Seung Mun Jung, Su Jung Choi, Gil Hyun Kang, Myoung Sook Shim; J Korean Endocr Soc. 2007;22(3):229-234. Published online June 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.3.229

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Abstract PDF: Amiodarone is an iodinated benzofuran derivative, that is highly effective as an agent for the treatment of various cardiac arrhythmias; these arrthymias, range from paroxysmal atrial fibrillation to life-threatening ventricular tachyarrhythmias. Yet amiodarone is associated with several side effects that include dysfunction of liver, thyroid or various other organs. Two main forms of amiodarone induced thyrotoxicosis (AIT) have been described; type I AIT develops in an abnormal thyroid gland (nodular goiter, latent Graves' disease) and it is due to amiodarone-induced true hyperthyroidism; type II AIT occurs in an apparently normal thyroid gland and it is due to amiodarone-induced destructive thyroiditis. We recently experienced a case of type II thyrotoxicosis that was induced by amiodarone treatment for ventricular tachycardia after acute myocardial infarction. The symptoms of thyrotoxicosis were relieved after withdrawal of amiodarone and administering steroid. Type I AIT has often been reported on but type II AIT is relatively rare. We report here on a case of type II amiodarone induced thyrotoxicosis along with a literature review.

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