Endocrinology and Metabolism

Review Article

Thyroid
Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms: Gan Qing, Wan Nur Amalina Zakaria, Fatimah Zahra Mohamad Rom, Wan Nor Fazila Hafizan Wan Nik, Hani Ajrina Zulkeflee, Siti Nadirah Ab Rahim; Endocrinol Metab. 2025;40(6):821-829. Published online December 11, 2025; DOI: https://doi.org/10.3803/EnM.2025.2554

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Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare but potentially fatal complication of thyrotoxicosis, characterized by transient episodes of muscle weakness in the setting of hypokalemia and underlying hyperthyroidism. Although thyrotoxicosis is more common in females, THPP predominantly affects males, especially in Asian populations, in which its prevalence is notably higher. Early recognition is essential to prevent serious complications such as cardiac arrhythmias and respiratory failure; however, THPP is frequently misdiagnosed, particularly in Western countries, due to clinical overlap with familial hypokalemic periodic paralysis. The pathophysiology of THPP involves thyroid hormone–induced upregulation of Na⁺/K⁺-ATPase and heightened β-adrenergic sensitivity, which promote intracellular potassium shifts. Postprandial insulin surges following high carbohydrate intake further exacerbate this effect. Genetic susceptibility, including human leukocyte antigen haplotypes and mutations in ion channel genes (e.g., KCNE3, CACNA1S, SCN4A, and KCNJ18), plays a critical role. The resulting hypokalemia leads to hyperpolarization of muscle membranes, impairing excitability and causing paralysis. Structural muscle changes, such as sarcoplasmic reticulum proliferation and sodium channel dysfunction, may also contribute to THPP. Electrolyte abnormalities, including hypophosphatemia, hypomagnesemia, and hypocalcemia, are common due to transcellular shifts. This review underscores the importance of understanding the hormonal, genetic, and cellular mechanisms underlying THPP to enhance diagnostic accuracy and guide effective treatment strategies.

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Novel CACNA1S Mutation c.3491 A>C in Hypokalemic Periodic Paralysis: First Report with Functional Validation
Haiyan Shu, Chen Chen, Jianmei Yang
Journal of Molecular Neuroscience.2026;[Epub] CrossRef
Andamento ventennale della tireotossicosi e della paralisi periodica tireotossica: uno studio di coorte di popolazione
Letizia Meomartino, Gloria Selvatico, Gianluca Aimaretti, Loredana Pagano
L'Endocrinologo.2026; 27(3): 355. CrossRef

Original Articles

Thyroid
Microvascular Ultrasonography Vascularity Index as a Rapid and Simplified Assessment Tool for Differentiating Graves’ Disease from Destructive Thyroiditis and Managing Thyrotoxicosis: Han-Sang Baek, Chaiho Jeong, Jeonghoon Ha, Dong-Jun Lim; Endocrinol Metab. 2025;40(3):394-404. Published online February 25, 2025; DOI: https://doi.org/10.3803/EnM.2024.2206

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Background
Thyrotoxicosis presents significant diagnostic challenges in distinguishing Graves’ disease (GD) from destruction-induced thyrotoxicosis (DT) using ultrasound imaging. We evaluated a new technology, microvascular ultrasonography (MVUS) to effectively differentiate between GD and DT, and observe the MVUS changes during follow-up.
Methods
A total of 264 consecutive patients were prospectively enrolled into two cohorts from August 2022 to March 2024 at one tertiary referral hospital: cohort 1 comprised patients initially presenting with thyrotoxicosis (n=185; 98 with GD and 87 with DT). Cohort 2 included patients either with GD considering antithyroid drug discontinuation or with DT in the follow-up phase after treatment (n=77). Ultrasound imaging was conducted using the MVUS technique, and the vascularity index (MVUS-VI) was automatically calculated as the percentage ratio of color pixels to total grayscale pixels within a specified region of interest.
Results
Diagnostic accuracy highlighted MVUS-VI as the most accurate diagnostic tool, achieving a sensitivity of 79.6%, specificity of 84.3%, with an area under the curve of 0.856 (95% confidence interval, 0.800 to 0.911). Presence of thyroid peroxidase antibody or thyroglobulin antibody affected MVUS-VI’s performance, requiring a higher cut-off value for specificity in this subgroup. Follow-up in cohort 2 (n=77) demonstrated significant normalization in thyroid function and reductions in MVUS-VI from an initial 32.6%±23.4% to 20.8%±13.5% at follow-up (P<0.001).
Conclusion
MVUS-VI provides a rapid, non-invasive diagnostic alternative to traditional methods in differentiating GD from DT, thus aiding in the management of patients with thyrotoxicosis.

Citations

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Update on newer ultrasound systems to study the microvasculature
Orlando Catalano, Antonio Pio Masciotra
La radiologia medica.2025; 130(8): 1283. CrossRef
Diagnostic Approach and Therapeutic Strategies for Ambiguous Thyrotoxicosis
Mijin Kim
The Korean Journal of Medicine.2025; 100(5): 241. CrossRef

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.

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Genetic associations of plasma metabolites with immune cells in hyperthyroidism revealed by Mendelian randomization and GWAS-sc-eQTLs xQTLbiolinks analysis
Yutong Li, Xingyu Song, Yuyang Huang, Sifan Zhou, Linkun Zhong
Scientific Reports.2025;[Epub] CrossRef
Butyrate Ameliorates Graves’ Orbitopathy Through Regulating Orbital Fibroblast Phenotypes and Gut Microbiota
Pingbo Ouyang, Jia Qi, Boding Tong, Yunping Li, Jiamin Cao, Lujue Wang, Tongxin Niu, Xin Qi
Investigative Ophthalmology & Visual Science.2025; 66(3): 5. CrossRef
Serum metabolomics reveals systemic metabolic alterations of Graves’ disease before and after antithyroid drug treatment
Tiantian Li, Luyang Li, Xinpan Wang, Yue Li, Yingyun Gong, Hongwen Zhou, Xuqin Zheng
Endocrine Connections.2025;[Epub] CrossRef
Insight into the metabolic shifts in Graves' hyperthyroidism: a study of acylcarnitine and lipid profiles
Mikael Thomassen Neset, Arve Ulvik, Kristian Løvås, Johnny Laupsa-Borge, Lars Ertesvåg Breivik, Ann-Elin Meling Stokland, Bjørn Gunnar Nedrebø, Eyvind Rødahl, Eystein Husebye, Grethe Åstrøm Ueland, Hans Olav Ueland
European Thyroid Journal.2025;[Epub] CrossRef
Serum metabolome analysis in hyperthyroid cats before and after radioactive iodine therapy
Molly A. Bechtold, Yimei Lin, Meredith L. Miller, Jennifer M. Prieto, Carol E. Frederick, Lucinda L. Bennett, Mark E. Peterson, Kenneth W. Simpson, John P. Loftus, Anu Sayal
PLOS ONE.2024; 19(6): e0305271. CrossRef
Evaluation of the Dysregulation of Cholesterol and Glucose Levels in Graves' Disease Using Clinical Data Analysis
Zainab Razaq Kareem, Fatin Fadhel Al-Kazazz, Ahmed Mahdi Rheima, Ameer Radhi Sultan
Reports of Biochemistry and Molecular Biology.2024; 13(2): 159. CrossRef
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.

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The value of microvascular flow imaging and color Doppler flow imaging in the differential diagnosis of benign and malignant endometrial lesions
F. Li, G.Q. Zhou, L. Tang, C.P. Wang, W.J. Song, Y.N. Wang, R. An, W. Wei, M.S. Zhang, Y. Fu
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Usefulness of the vascularity index for thyroid blood flow assessment: Differentiation between Graves’ disease and painless thyroiditis
Sayo NISHIKAWA, Eijun NISHIHARA, Maki OSHITA, Hiroyuki YAMAOKA, Akira MIYAUCHI, Takashi AKAMIZU
Choonpa Igaku.2026;[Epub] CrossRef
Microvascular Ultrasonography Vascularity Index as a Rapid and Simplified Assessment Tool for Differentiating Graves’ Disease from Destructive Thyroiditis and Managing Thyrotoxicosis
Han-Sang Baek, Chaiho Jeong, Jeonghoon Ha, Dong-Jun Lim
Endocrinology and Metabolism.2025; 40(3): 394. CrossRef
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Jin Wang, Ke Wan, Xin Chang, Rui-Feng Mao
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Caixin Huang, Lihe Zhang, Yuting Jiang, Qiao Zheng, Ting Lei, Liu Du, Hongning Xie
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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
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Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study
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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.

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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.

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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
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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
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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.

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Rutu Shah, Samantha E. Adamson, Sina Jasim
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Cholestyramine in Hyperthyroidism and Thyrotoxicosis: Have You Ever Used It?
Giona Castagna, Lucrezia Zanchi, Alessandro Rossini, Sara Cassibba, Roberto Trevisan, Silvia Ippolito
Endocrines.2025; 6(3): 30. CrossRef
The Application of Mesoporous Silica Nanoparticles in Enhancing the Efficacy of Anti-Atherosclerosis Therapies: A Review
Arif Budiman, Luthfiyyah Mutmainah, Martina Anjelina, Mila Fitriawati, Eufrasia Pilihanto, Salma Amaliah, Diah Aulifa
International Journal of Nanomedicine.2025; Volume 20: 9825. CrossRef
Efficacy and Safety of Adjunctive Bile Acid Sequestrant Therapy for Thyrotoxicosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Diego Moreno Watashi, Aastha Sehgal, Flavia Tejada Frisancho, Brototo Deb, Ayah Arafat, Kenneth Dale Burman
Thyroid®.2025;[Epub] CrossRef
Therapeutic plasma exchange for Graves’ disease in pregnancy
Matthew Lumchee, Mimi Yue, Josephine Laurie, Adam Morton
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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
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Notes on Trauma-Related Thyroid Storm in the Emergency Department
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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.

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Sung-Woo Kim
Clinical Ultrasound.2024; 9(1): 25. CrossRef
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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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.

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Glucocorticoid-induced Thyrotoxic Periodic Paralysis Following Lumbar Nerve Root Block
Saki Uda, Hayato Shimizu, Hiroaki Nishioka
Internal Medicine.2026; 65(8): 1148. CrossRef
Hypokalemic paralysis in an adolescent following dexamethasone and B12 injection: A case report and literature review
Keivan Sahebi, Hassan Foroozand, Mohammad Bahmei, Raziee Taghizadeh, Samane Zare, Soroor Inaloo
Heliyon.2025; 11(2): e41675. CrossRef
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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Diagnostic Approach and Therapeutic Strategies for Ambiguous Thyrotoxicosis
Mijin Kim
The Korean Journal of Medicine.2025; 100(5): 241. CrossRef
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.

Citations

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Thyroid metastases from breast cancer: a case report and brief literature review
Siqi He, Jicheng Li, Donglai Wang, Qiaohong Nong, Guangxin Li, Ying Yin, Xiaoling Liu
Frontiers in Oncology.2025;[Epub] CrossRef

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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Abstract PDF

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

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Graves’ Disease Manifesting Pancytopenia
Eunjin Kwon
International Journal of Thyroidology.2025; 18(1): 102. CrossRef
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.

A Case of Acute Perithyroiditis with Transient Thyrotoxicosis in Childhood.: Soo Min Nam, Mi Yeong Lee, Jang Hyun Koh, Ki Joon Sung, Choon Hee Chung; J Korean Endocr Soc. 2006;21(2):142-145. Published online April 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.2.142

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Abstract PDF

Acute thyroiditis is a rare disease because of the sufficient supply of blood vessels and lymphatics in thyroid tissue, the high concentration of iodide in the thyroid tissue and the nearly completely isolated structure of the thyroid gland from the surrounding tissue via its capsule. The most common route of infection is from a pyriform sinus fistula and then the inflammation spreads from the sinus to the perithyroidal space. Computed tomography (CT) and magnetic resonance imaging (MRI) can show a low echogenic mass encircling thyroid gland and swelling of the perithyroidal tissue in acute suppurative thyroiditis. We experienced a case of acute perithyroiditis with thyrotoxicosis that developed in a 13-year old boy and he was diagnosed by the CT findings. The patient had complained of a low graded fever and neck swelling. The laboratory diagnosis and clinical course was like that of subacute thyroiditis, but the CT finding showed a show low echogenic mass encircling the thyroid glands and swelling of the perithyroidal tissue. Therefore, we diagnosed this patient with acute perithyroiditis. After treatment with antibiotics, he displayed clinical improvement and was discharged.

Citations

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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
Endocrinology and Metabolism.2013; 28(1): 50. CrossRef
Acute Suppurative Thyroiditis Caused by Methicillin - ResistantStaphylococcus Aureusin Healthy Children
Soo hee Jee, Eun Young Kim
Journal of Korean Society of Pediatric Endocrinology.2011; 16(2): 128. CrossRef

A Case of Iodine-induced Thyrotoxicosis with Acromegaly.: Kwang Hyun Kim, Kyu Hong Kim, Ho Yoel Ryu, Su Min Nam, Mi Young Lee, Jang Hyun Koh, Jang Yeol Sin, Choon Hee Chung; J Korean Endocr Soc. 2006;21(1):63-67. Published online February 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.1.63

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Abstract PDF: Hyperthyroidism is seen in 3.5-26% of subjects with acromegaly. Hyperthyroidism can be developed by thyroid stimulating hormone (TSH) dependent mechanism in TSH-secreting adenomas with acromegaly or by TSH independent mechanism through the stimulation of thyroid cells by growth hormone (GH). So, confirming the cause of hyperthyroidism is important to treat that. We report a case of a 56-year-old man who had acromegaly with iodine-induced thyrotoxicosis. He took the sea tangle for 4 years because he had constipation. His face and hands indicated acromegaly. Thyroid function test showed that T3 and free T4 were increased and TSH was decreased. Ultrasonography of neck showed diffuse enlargement of thyroid gland and thyroid scan showed decreased uptake of thyroid gland. So we could confirm iodine-induced thyrotoxicosis due to excessive iodine intake. Serum GH and insulin-like growth factor (IGF)-1 were markedly increased and brain MRI showed heterogenous 1 cm sized pituitary mass in right side. Acromegaly was confirmed by brain MRI, pituitary stimulation test and increased level of GH, IGF-1. He stopped iodine intake. After 6 months, T3, free T4 and TSH were normalized and he is waiting for the surgical removal of pituitary adenoma.

A Case of Thyrotoxicosis Presented as Rhabdomyolysis.: Yil Sik Hyun, Chang Beom Lee, Yong Soo Park, Dong Sun Kim, Woong Hwan Choi, Tae Wha Kim, You Hern Ahn; J Korean Endocr Soc. 2005;20(4):381-384. Published online August 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.4.381

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Abstract PDF

There have been a few reports on rhabdomyolysis caused by thyroid storm, but no cases of thyrotoxicosis related rhabdomyolysis have been reported until now. Here, a rare case of rhabdomyolysis, accompanied by thyrotoxicosis, is reported. A 21-year-old man was admitted to our hospital with severe pain and weakness in both legs. The initial laboratory findings revealed a high muscle enzyme level and severe hypokalemia. In evaluation of the rhabdomyolysis, the thyroid function test was compatible with that of Graves' disease, with the rhabdomyolysis subsequently diagnosed, presenting as thyrotoxicosis. The possible mechanisms for this complaint were hypokalemia-induced muscle ischemia, a thyrotoxicosis-induced excessive hypermetabolic state and pressure-induced muscle ischemia. Therefore, the work up for the cause of rhabdomyolysis should include thyrotoxicosis. The management of rhabdomyolysis is hydration, prevention of acute renal failure, correction of aggravating factors and treatment of the underlying cause, for example, thyrotoxicosis.

Citations

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A Case of Thyrotoxic Periodic Paralysis with Rhabdomyolysis
Seo Hee Lee, Seong Yeol Kim, Hae Ri Lee, Jun Goo Kang, Ohk Hyun Ryu, Chul Sik Kim, Byung Wan Lee, Seong Jin Lee, Eun-Gyoung Hong, Hyeon Kyu Kim, Doo-Man Kim, Jae Myung Yu, Sung-Hee Ihm, Moon Gi Choi, Hyung Joon Yoo
Journal of Korean Endocrine Society.2008; 23(6): 425. CrossRef

A Case of Hashimoto's Thyroiditis with Transient T3-Thyrotoxicosis Induced by Hydatidiform Mole.: Ji Youn Yoo, Hong Ju Moon, Cheol Young Park, Seong Jin Lee, In Kyung Jeong, Eun Gyung Hong, Gi Weon Oh, Hyeon Kyu Kim, Doo Men Kim, Jae Myung Yoo, Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo, Sung Woo Park, Soo Kee Min; J Korean Endocr Soc. 2005;20(3):294-298. Published online June 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.3.294

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Abstract PDF

Human chorionic gonadotropin(HCG) is a member of the glycoproteins family synthesized by the placenta, which consists of 2 noncovalently joined subunits(alpha(alpha) and beta(beta)). The alpha- and beta-subunits have a structural homology with the alpha- and beta-subunits of TSH and LH. The thyrotropic action of HCG results from its structural similarity to TSH, so beta-HCG can bind to the TSH receptor in the thyroid gland. A high level of HCG accompanied by an increased thyroid hormone level, can be observed in gestational trophoblastic disease (GTD), such as a hydatidiform mole or a choriocarcinoma, but the clinical symptoms of hyperthyroidism are rarely observed. We experienced a case of Hashimoto's thyroiditis, where the patient was diagnosed with T3-thyrotoxicosis, which had initially been induced by excess beta-HCG due to an H-mole; after evacuation of the H-mole, the condition was diagnosed as hypothyroidism. It has been speculated that a patient with Hashimoto's thyroiditis could have hyperthyroidism, induced by beta-HCG, due to an H-mole

Citations

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Transient T3 toxicosis associated with Hashimoto’s disease
Sarah Jaroudi, Meredith Gavin, Kathryn Boylan, Alan N. Peiris
Baylor University Medical Center Proceedings.2019; 32(1): 80. CrossRef

A Case of Cerebral Infarction in Young Woman with Graves' Disease and Atrial Fibrillation.: Young Yong An, Yi Sun Jang, Hyung Doo Kim, Ji Young Park, Hong Gun Bin, Hye Soo Kim, Jong Min Lee, Suk Young Kim, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2004;19(5):528-534. Published online October 1, 2004

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Abstract PDF: Thyrotoxicosis associated atrial fibrillation occurs in 9 to 22% of hyperthyroidism patients; its prevalence increases after the age 60 years. Atrial fibrillation is known to be major independent risk factor for a thromboembolic stroke. The characterization of patient subgroups with atrial fibrillation, with high or low rate risk factor of a stroke, would help clinicians decide the benefit or harm to patient of long term anticoagulation therapy. Thyrotoxicosis, old age, hypertension, diabetes, heart failure, history of stroke and thromboembolism are all high risk factors for a stroke in atrial fibrillation patients. Thus, anticoagulation therapy is recommended for stroke prevention in those groups with atrial fibrillation and thyrotoxicosis. Herein is reported a case of acute cerebral infarction, with thyrotoxic atrial fibrillation and congestive heart failure, in a young woman

A Case of Acute Suppurative Thyroiditis Caused by Pyriform Sinus Fistula with Thyrotoxicosis.: Kyung Won Kim, Young Joo Park, Tae Yong Kim, Min Kyung Moon, Sae Won Han, Cheon Jung Eun, Young A Kim, Tae Hoon Jin, Hee Soon Chung, Do Joon Park, Bo Youn Cho; J Korean Endocr Soc. 2004;19(1):69-75. Published online February 1, 2004

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Abstract PDF: This is the first case report about acute suppurative thyroiditis with thyrotoxicosis and pyriform sinus in Korea. A female patient, who was previously healthy, visited our hospital for the treatment of common cold symptoms and neck pain which developed 2 weeks before the visit. The condition of the patient did not improve through the use of antipyretics and even worsened. The patient was admitted to the hospital and was diagnosed with acute suppurative thyroiditis. The culture result of the drained fluid revealed group D Streptococcus. The patients condition was improved after using antibiotics and drainage. After recovery from acute thyroiditis, esophagography was performed and the pyriform sinus was found to be obliterated by chemical cauterization. It is very important yet difficult to differentiate acute thyroiditis with thyrotoxicosis from subacute thyroiditis. In this study, we discussed the differential diagnosis between acute thyroiditis and subacute thyroiditis with a review of literature.

A Case of Thyroid Storm Due to Thyrotoxicosis Factitia.: Kee Sup Song, Seung Hyun Cho, Byoung Eun Park, Soo Jee Yoon, kyung Wook Kim, Su Youn Nam, Young Duk Song, Sung Kil Lim, kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh; J Korean Endocr Soc. 2001;16(2):260-264. Published online April 1, 2001

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Abstract PDF: Thyrotoxicosis factitia, a syndrome that results from a surreptitious ingestion of excess thyroid hormone, has generally been diagnosed in young or middle-aged women who have psychopathological disturbances. An 18-year-old female was admitted to the hospital 24 hours after taking an overdose of more than 50 tablets of synthyroid (levothyroxine, 5mg). She had taken 6 to 9 tablets of synthyroid daily for 6 months for the purpose of weight reduction even though she was not overweight. Because of her stuporous mental state and an acute respiratory failure, she was intubated and treated in the intensive care unit. After careful history taking and after her plasma thyroid hormone levels were determined, we diagnosed a thyroid storm that was caused by a thyrotoxicosis factitia. The laboratory results were, T3 430.0 ng/dL, free T4 70.0 ng/dL, TSH 0.05 IU/mL. Her symptoms improved after treatment by steroids and propranolol. She was discharged 8days after admission. Cases of thyrotoxicosis factitia have been reported very infrequently and, there has been no reports of a thyroid storm due to thyrotoxicosis factitia in Korea. We now report a case of a thyroid storm that resulted from thyrotoxicosis factitia that was caused by the ingestion of a massive dose of thyroid hormone that was takan daily for 6 months. We also present a brief review of the relevant literature.

Original Articles

Differential Diagnostic Value of TSH Receptor Antibody Measurements in Thyrotoxic Postpartum Patients with History of Graves' Disease.: Seong Jin Lee, Yun Ey Chung, Ha Young Kim, Jung Hee Han, Jong Chul Won, Ahm Kim, Jin Sook Ryu, Dae Hyuk Moon, Il Min Ahn; J Korean Endocr Soc. 2001;16(1):75-84. Published online February 1, 2001

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Abstract PDF: BACKGROUND
It is known that pregnancy markedly influences the clinical course of autoimmune thyroid diseases. In the postpartum period, various kinds of autoimmune thyroid dysfunctions can be observed. Thyroid dysfunction is found in 5.5-7.1% of postpartum women in the general population. Among those who show thyroid dysfunction after delivery, some will develop Graves' disease and others will develop postpartum thyroiditis. It is also known that patients with Graves' disease may manifest thyrotoxicosis in the postpartum period because of postpartum thyroiditis or relapse of the Graves' disease itself. We evaluated the clinical features of postpartum thyrotoxicosis in Graves' disease patients to find diagnostic indices that could be used in differentiating between postpartum thyroiditis and relapse of Graves' disease. METHOD: We reviewed the cases with postpartum thyrotoxicosis in patients that had a history of Graves' disease between 1995 and 2000. The diagnosis of postpartum thyroiditis had been made by means of a 99mTc thyroid scan or by the observation of a typical triphasic thyroid function change, in cases where a 99mTc thyroid scan was not possible because of breast feeding. We measured the serum TSH, free T4, free T3, TSH binding inhibiting immunoglobulin (TBII), anti-thyroid peroxidase (TPO) antibody, and anti- thyroglobulin (Tg) antibody serially from the time of the diagnosis of Graves' disease to the time of postpartum thyroid dysfunction. RESULTS: Eleven patients, 5 patients in the postpartum thyroiditis (PPT group) and 6 patients with relapse of the Graves' disease (GD group), were identified. The mean values of TBII of two groups at the time of diagnosis of Graves' disease were 40.9+/-4.8 IU/mL (PPT group), 58.9+/-23.5 IU/mL (GD group) respectively, which were insignificant. The mean values of TBII of the two groups at early pregnancy were 3.2+/-1.9 IU/mL (PPT group), 41.6+/-22.6 IU/mL (GD group) and this difference was statistically significant (p=0.009). The mean values of TBII of the two groups at the time of postpartum thyrotoxicosis were 1.9+/-1.6 IU/mL (PPT group), 51.5+/-23.2 IU/mL (GD group) which were also statistically significant (p=0.003). The mean values of anti-TPO antibody, anti-Tg antibody, disease duration, and treatment duration between the two groups were not significantly different. The onsets of thyroid dysfunction after delivery in the two groups were 2.6+/-2.0 (PPT group), 4.0+/-3.9 (GD group) months which were statistically insignificant. CONCLUSION: These data suggest that the measurement of TBII at the time of the postpartum thyrotoxic period, could help to differentiate postpartum thyroiditis from a relapse of Graves' disease in those patients that have a history of Graves' disease especially when thyroid scan is not possible because of breast feeding.

Prevalence of Thyrotoxicosis and Hypothyroidism in the Subjects for Health Check-Up.: Jae Hoon Chung, Byoung Joon Kim, Yun Ho Choi, Myung Hee Shin, Sung Hoon Kim, Yong Ki Min, Myung Sik Lee, Moon Gyu Lee, Kwang Won Kim; J Korean Endocr Soc. 1999;14(2):301-313. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The prevalence of ovat hyperthyroidism ar hypothyroidism has been estimated up to 5% in the general populatian. Subclinical hyperthyroidism and subclinical hypothyroidism have pevalences of approximately 1% and 6%, ectively. The prevalence of hypothyroidism may be associated with excessive intake of iodine in iodine sufficient areas. Therefore, we assumed the prevalence of thyroid dysfunction in Karea might be different from those af Western cauntries. However, thete have been no surveys to examine the prevalence of thyroid dysfunction in Karea. We performed the study to investigate the prevalence of thyrotoxicosis and hypothyroidism in Korean adults. METHODS: This study was performed in 15019 subjects (8275 men, 6744 women; between 17 and 87 years of age) visited in health promotion center of Samsung Medical Center for 12 months in 1996. Serum T3, T4, and TSH concentrations were measured with RIA or IRMA using commercial kits. History of thyroid dysfunction and current medication were obtained from medical records. The criteria for thyrotoxicosis were TSH level below than 0.30 mU/L and increased T3 or T4 levels (T3 > 3.1 nmol/L or T4 > 152 nmol/L). Patients who had TSH level above than 5.0 mU/L and T4 level below than 77 nmol/L met the criteria for hypothyroidism. RESULTS: The prevalence of thyrotoxicosis was 5.5/1000 population (men 3.6/1000, women 7.7/1000) with peak prevalence in fifth decade. The prevalence of previously undiagnosed thyrotoxicosis was 4.0/1000 (men 2.9/1000, women 5.3/1000). The prevalence of hypothyroidism was 2.8/1000 population (men 1.1/1000, women 4.9/1000) with peak prevalence in seventh decade. The prevalence of previously undiagnosed hypothyroidism was 1.6/1000 (men 0.6/1000, women 2.S/1000). The prevalence of subclinical thyrotoxicosis was 12.4/1000 population (men 11.8/1000, women 13.0/1000). The prevalence of subclinical hypothyroidism was 18.2/1000 population (men 11.2/1000, women 26.7/1000) which frequency was increased with age. CONCLUSION: Although the prevalence of thyrotoxicosis and hypothyroidism was not significantly different from those of other countries, it was lower than expected and female preponderance is not significant. The prevalence of subclinical thyrotoxicosis and subclinical hypothyroidism was lower than those of other countries. The prevalence of subclinical hypothyroidism was higher in women and old ages. (J Kor Soc Endecrinol 14:301~313, 1999)

Case Report

A Case of Thyrotoxicosis During Lithium Therapy.: Young Sik Choi, Yo Han Park, Joon Chul Pyun, Dal Soo Park, Chul Hee Lee, Hyo KYun Chung, Hyun Joo Kim, Soo Yeol Ahn, Jin Sook Jun, Yong Chang Oh; J Korean Endocr Soc. 1998;13(4):629-633. Published online January 1, 2001

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Abstract PDF: Lithium has been established as a drug useful for the treatment of manic depressive disorder. It is now well recognized that long-term administration of this drug is associated with various antithyroid effects such as goiter, and subclinical and overt hypothyroidism. However, it has been associated less commonly with thyrotoxicosis. Recently we experienced a case of thyroitoxicosis during lithium therapy. A 24-year-old man treated with lithium carbonate 900 mg-1,200 mg/day for manic-depressive illness for four weeks. He then complained of nervousness, palpitation, tremor, heat intolerance, and sweating. Neck pain was not noted. At that time the results of thyroid function test were consistent with hyperthyroidism: T3 568.8 ng/dL, TSH 0.01 mU/mL, FT4 6.0 ng/dL, but 24 hr radioiodine uptake was 0.3%. We suspected this case as lithium induced thyrotoxicosis and discontinued lithium administration. After discontinuation of lithium thyrotoxic symptoms were subsided. One month later, thyroid hormon levels became normalized: T 100.2 ng/dL, TSH 0.06 mU/mL, FT4 0.97 ng/dL and 24hr radioiodine uptake was 16%. We report this case with review of literatures.

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