ABSTRACT
The paper introduces professor SHENG Can-ruo's experience in treatment of goiter with the combination of acupuncture and herbal medication. Professor SHENG believes that this disease is mostly related with emotional injury, improper diet and geographical and climatic factors, as well as body constitution. Qi stagnation, phlegm retention, blood stagnation and interaction of phlegm and stasis are the essential pathogenesis of goiter. Either acupuncture or herbal medication should focus on "phlegm and stasis" in treatment. Besides, the theory of western medicine should also be considered. In western medicine, thyroid enlargement is classified into Ⅰ, Ⅱ and Ⅲ degrees of struma, thus, the pathogenesis and treatment with Chinese medicine should be adjusted accordingly. The created "four throat points", combined with acupuncture at distal points, relieve the local masses. The basic herbal formula is prepared and the couplet medicines are modified based on syndrome differentiation. The integrated acupuncture and herbal medication regulates emotions and provides a comprehensive treatment for goiter.
Subject(s)
Humans , Acupuncture Therapy , Combined Modality Therapy , Goiter/drug therapy , Medicine, East Asian Traditional , NeckABSTRACT
Background & objectives: Despite, the extensive salt iodization programmes implemented in India, the prevalence of goiter has not reduced much in our country. The most frequent cause of hypothyroidism and goiter in iodine sufficient areas is Hashimoto’s thyroiditis (HT). This study records the clinical presentation, biochemical status, ultrasonographic picture and cytological appearance of this disease in a coastal endemic zone for goiter. Methods: Case records of patients with cytological diagnosis of HT were studied in detail, with reference to their symptoms, presence of goiter, thyroid function status, antibody levels and ultrasound picture. Detailed cytological study was conducted in selected patients. Results: A total of 144 patients with cytological proven HT/lymphocytic thyroiditis were studied. Ninety per cent of the patients were females and most of them presented within five years of onset of symptoms. Sixty eight per cent patients had diffuse goiter, 69 per cent were clinically euthyroid and 46 per cent were biochemically mildly hypothyroid. Antibody levels were elevated in 92.3 per cent cases. In majority of patients the sonographic picture showed heterogeneous echotexture with increased vascularity. Cytological changes were characteristic. Interpretation & conclusions: our study showed predominance of females in the study population in 21-40 yr age group with diffuse goiter. We suggest that in an endemic zone for goiter, all women of the child bearing age should be screened for HT.
Subject(s)
Adult , Biopsy, Fine-Needle , Carbimazole/administration & dosage , Cytodiagnosis , Female , Goiter/diagnosis , Goiter/drug therapy , Goiter/pathology , Hashimoto Disease/diagnosis , Hashimoto Disease/drug therapy , Hashimoto Disease/pathology , Humans , Iodine/metabolism , Male , Middle AgedABSTRACT
The aim of this article is to review current information documented on antithyroid drug induced vasculitis. MEDLINE was searched for studies between 1960 and 2009 with the key words [antithyroid drugs and vasculitis], [antithyroid drugs and diffuse alveolar hemorrhage], and [antithyroid drugs and glomerolonephritis]. Ninety-two articles met the selection criteria. The data obtained showed that 15 to 46% of patients treated with propylthiouracil [PTU] developed anti-neutrophil cytoplasmic antibody [ANCA], in contrast to 0 to 3% of the patients treated with methimazole [MMI], the former being the most often reported for causing vasculitis, a disease seen most commonly in association with Graves' disease. Signs of PTU-induced vasculitis include fever, malaise, anemia, lymphadenopathy, skin lesions, arthralgia, hematuria/proteinuria, diffuse alveolar hemorrhage [DAH], pleural effusion, and crescentic glomerulonephritis. Once PTU-induced vasculitis is determined, the simple withdrawal of PTU usually causes resolution of the symptoms within 1-4 weeks. Overall prognosis of antithyroid drug-induced vasculitis is much better than that of primary vasculitis. Antithyroid medications such as PTU can induce [ANCA]-associated vasculitis. Its pathogenesis might be multifactorial. Diagnosis is based on the relationship between clinical vasculitis, and the antithyroid drugs prescribed, and the excluding of any other medical states that mimic vasculitis. After the diagnosis, antithyroid drugs should be discontinued immediately, and the prognosis is usually good
Subject(s)
Humans , Antithyroid Agents/adverse effects , Propylthiouracil/adverse effects , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Hyperthyroidism , Goiter/drug therapy , PrognosisABSTRACT
El objetivo del tratamiento en el bocio tóxico difuso (BTD) es lograr la disminución en la producción de hormonas tiroideas y consecuentemente una mejoría clínica rápida(AU)
Subject(s)
Humans , Male , Female , Pregnancy , Aged , Antithyroid Agents/therapeutic use , Thyroid Diseases/therapy , Goiter/drug therapyABSTRACT
Ectopic thyroid gland is a rare embryological fault of thyroid development. Dual ectopic thyroid is even more rare and only 8 cases have been reported in the literature. The author presents a case of dual ectopic thyroid in a 16-year-old boy with an anterior neck mass, which is gradually growing in size particularly in the last 2 years. The initial diagnosis was thyroglossal duct cyst. Thyroid function test revealed elevated thyroid-stimulating hormone. Ultrasound of the neck did not show thyroid gland in its normal pretracheal position. Thyroid scan [Technetium 99] revealed the diagnosis of dual thyroid ectopia [lingual and subhyoid]
Subject(s)
Humans , Male , Goiter/diagnosis , Goiter/drug therapy , Neck/diagnostic imaging , Neck/diagnostic imaging , Thyroid Gland , Thyrotropin/blood , /blood , Technetium , Thyroxine/blood , ThyroxineABSTRACT
We reported two unrelated Thai girls with resistance to thyroid hormone. The affected patients presented with goiter and no other stigmata of hyperthyroidism. Their serum T4, T3, free T4 and free T3 concentrations were high and they had normal levels of TSH. The affected girl in family 1 was treated with an antithyroid drug for 1-9/12 years. The affected girl in family 2 was only observed her thyroid function tests. TRH test showed normal TSH response in both girls. Analysis of the thyroid hormone receptor beta gene of both affected girls revealed the same missense mutation, changing the guanine in nucleotide 1234 to an adenine which results in the replacement of the normal alanine (GCT) with a threonine (ACT) at codon 317. Two proposita were heterozygous, and this mutation was not present in their parents compatible with a neo-mutation.
Subject(s)
Adolescent , Base Sequence , Child , Drug Resistance/genetics , Female , Goiter/drug therapy , Humans , Molecular Sequence Data , Mutation , Pedigree , Polymerase Chain Reaction , Receptors, Thyroid Hormone/genetics , Thailand , Thyroid Function Tests , Thyroid Hormones/pharmacologySubject(s)
Humans , Female , Iodized Oil , Goiter/drug therapy , /etiology , /chemically induced , AdolescentABSTRACT
Se realizó un estudio descriptivo y retrospectivo de 107 pacientes con bocio difuso eutiroideo para evaluar los resultados del tratamiento con hormonas tiroideas. Según disminuyó o no el tamaño del bocio se definieron las categorías de respuesta: satisfactoria y no satisfactoria. Se realizaron cortes evaluativos al año, a los 5, 10 y 15 años. Como variables predictoras de la respuesta empleamos: edad, peso inicial de la glándula, antecedentes familiares de tiroidopatías, tiempo de evolución del bocio y dosis de hormonas empleadas. Se aplicaron las pruebas de chi cuadrado y de regresión logística. Se recogieron además las reacciones adversas referidas y la posible asociación con la dosis. Durante el período evaluado, el bocio disminuyó aproximadamente 8 g de 39,74 a 31,35 g como promedio y sólo fue significativo en el primer año de tratamiento (p < 0,001). El riesgo relativo para desarrollar una respuesta no satisfactoria: al año fue, 3 veces mayor cuando el tiempo de evolución referido del bocio era mayor de 1 año y 64 porciento menor cuando se empleó dosis supresiva; a los 5 años, 5 veces mayor cuando el tiempo de evolución era mayor de 1 año; a los 10 años fue 4 y 3 veces mayor cuando el tiempo de evolución fue mayor de 1 año y la edad, superior a los 30, respectivamente; a los 15 años ninguna variable predijo la respuesta. El nerviosismo, la disminución de peso y la sudación fueron los síntomas más frecuentes y se relacionaron con el empleo de dosis supresivas en los primeros 5 años (p < 0,01). Se concluyó que el tiempo máximo para evaluar la respuesta osciló entre 1 y 2 años y que los bocios de poco tiempo de evolución y de causa autoinmune, constituyeron signos de buen pronóstico
Subject(s)
Goiter/drug therapy , Thyroid Hormones/therapeutic use , Treatment OutcomeABSTRACT
Long-term effects of thyroid hormone suppressive therapy on the heart were evaluated in 45 patients by non-invasive techniques. Fifteen patients were athyreotic after surgery for differentiated thyroid cancer and 30 had diffuse or nodular goiter. Mean age of the group was 42 +/- 12 years. Twenty-four age- and sex-matched subjects were taken as controls. Mean daily dose of levothyroxine was 158 +/- 36 micrograms. Plasma thyroid stimulating hormone (TSH) levels were within normal range. Mean serum T4 and free T4 were significantly higher (p < 0.001) whereas mean serum T3 and free T3 did not differ from the control levels. Non-invasive cardiac assessment was done by a standard 12 lead electrocardiogram (ECG), ambulatory electrocardiographic (Holter) monitoring and echocardiographic study. Six patients had left ventricular hypertrophy in ECG. Holter monitoring demonstrated a higher average heart rate in patients compared to controls (86 +/- 10 vs 72 +/- 6 beats/min; p < 0.001). Supraventricular premature beats were more frequent in patients than in the control group (98% vs 60%; p < 0.06). Echocardiogram showed an increased left ventricular (LV) mass index in patient group (98 +/- 28 vs 78 +/- 16 gm/m2; p < 0.02). LV systolic function was increased with higher values of fractional shortening (40 +/- 8% vs 34 +/- 6%; p < 0.05) and rate-adjusted velocity of shortening (1.4 +/- 0.12 vs 1.02 +/- 0.16 circumferences/sec; p < 0.01). It is concluded that long-term levothyroxine suppressive therapy has significant effects on the cardiac functions.
Subject(s)
Adult , Arrhythmias, Cardiac/chemically induced , Atrial Premature Complexes/chemically induced , Case-Control Studies , Echocardiography , Electrocardiography , Electrocardiography, Ambulatory , Female , Goiter/drug therapy , Heart/drug effects , Heart Rate/drug effects , Humans , Hypertrophy, Left Ventricular/chemically induced , Male , Thyroid Neoplasms/drug therapy , Thyrotropin/blood , Thyroxine/administration & dosage , Time FactorsABSTRACT
A case of relapsing polychondritis presenting with a painful goitre and odynophagia is reported. Relapsing polychondritis is an uncommon disease and its presentation to a surgeon in such a manner is rather unusual. It is a progressive inflammatory disorder of articular and nonarticular cartilages and in most cases involves the ear, larynx, trachea, eye and skin .The heart may also be affected. This condition is associated with a high morbidity and mortality. The clinical course of the disease is highly variable and the management is centred on accurate diagnosis and early institution of steroid therapy
Subject(s)
Humans , Female , Goiter/drug therapy , Multiple Organ FailureABSTRACT
L'augmentation de volume du corps thyroide constitue un motif frequent de consultation au Burkina Faso. Cette etude porte sur 170 cas de goitres colliges en consultation de medecine interne a l'Hopital National de Ouagadougou et se propose d'apprecier les aspects epidemiologiques; cliniques; etiologiques et therapeutiques des goitres en milieu hospitalier dans une zone d'endemie. Dans cette etude; il ressort que les goitres sont surtout frequents dans le sexe feminin; de volume modere a eleve; et diffus et/ou nodulaires. Il s'agit de goitres anciens evoluant dans 75 pour cent des cas depuis plus de 1 an. 75 pour cent de ces goitres sont normofonctionnels et lorsqu'ils sont diffus; homogenes et jeunes; ils repondent bien au traitement medical avec une egale efficacite en utilisant l'iode (par voie voie orale ou en solution injectable) ou les hormones thyroidiennes a visee frenatrice. Les goitres nodulaires (nodule unique ou multiple) repondent mal a ce traitement; necessitant le recours a la chirurgie. Les resultats de ce traitement chirurgical sont bons mais il necessite le recours a une hormotherapie substitutive souvent definitive lorsque la resection a ete large (thyroidectomie totale ou subtotale). Le cancer thyroidien; a craindre devant les goitres anciens et devant tout nodule thyroidien froid a ete rarement observe (2 cas). Cependant la gravite de son evolution doit rendre systematique sa recherche devant tout goitre ou nodule suspect. L'importance de la carence en iode dans notre milieu exige un traitement preventif intensif en amont par l'administration d'iode
Subject(s)
Goiter/drug therapy , Goiter/epidemiology , Goiter/surgery , Iodine/therapeutic useSubject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Preoperative Care , Dexamethasone/therapeutic use , Hyperthyroidism/surgery , Ipodate/therapeutic use , Thyroidectomy , Thyroxine/blood , Triiodothyronine/blood , Drug Therapy, Combination , Goiter/surgery , Goiter/drug therapy , Hyperthyroidism/drug therapySubject(s)
Adolescent , Adult , Child , Child, Preschool , Follow-Up Studies , Goiter/drug therapy , Humans , Iodized Oil/therapeutic use , Retrospective StudiesABSTRACT
O objetivo do estudo foi avaliar o efeito da administraçäo de iodo a pacientes portadores de bócio difuso atóxico, com teste de perclorato negativo. A resposta de TSH ao TRH e às concentraçöes séricas de T3 total e T4 livre foram estudadas em 8 pacientes da regiäo de Campinas antes e durante a administraçäo de iodeto de potásio (KI) 450 a 600mg/dia por 8 semanas. Näo foram observados aumento de volume do bócio ou quadro compatível com hipotiroidismo ou tirotoxicose neste período. Os auto-anticorpos da tiróide mantiveram-se negativos antes e durante a ingestäo de KI. Apenas um paciente apresentou elevaçäo de T3 após a ingestäo de KI. Os níveis de TSH mantiveram-se inalterados. Os valores de FT4 tornaram-se significativamente (p < 0,01) mais elevados e 5 pacientes apresentaram diminuiçäo sensível do incremento de TSH ao TRH. Os valores de FT4 correlacionaram-se de maneira inversa (p < 0,05) ao incremento do TSH. Os dados sugerem existir risco de induçäo de tirotoxicose em portadores de bócio, mesmo difuso, pela administraçäo de iodo, principalmente nos pacientes procedentes de regiöes endêmicas