Thyrotoxicosis: relations between clinical state and biochemical changes during carbimazole treatment.
(49/89)
The relation between clinical and biochemical changes in thyrotoxicosis were studied in 12 patients with Graves's disease who were being treated with carbimazole. Clinical assessment (using the Crooks-Wayne index) was combined with the measurement of free thyroxine and triiodothyronine indices (FT4I and FT3I) and the assessment of two tissue markers of thyroid hormone action--sex-hormone-binding globulin (SHBG) levels and the thyrotrophin responses to TRH. In general the FT4I and FT3I fell rapidly once treatment was started, and returned to normal in one to four weeks, followed shortly by SHBG levels. The thyrotrophin response returned at this time in two patients, who still had borderline high levels of FT3I and SHBG. The clinical score fell more slowly and variably and was less closely related to any of the biochemical indices than these were to each other. During the early phase of treatment with antithyroid drug the clinical evaluation may be an unreliable indicator of persisting thyroid hormone excess, and when the patient seems clinically but not biochemically thyrotoxic the symptoms should be treated on their own merits with beta-blocking drugs and not with increased doses of antithyroid drugs. (+info)
Thyroid suppressibility: follow-up for two years after antithyroid treatment.
(50/89)
In hyperthyroidism suppression and non-suppression of early radioiodine neck uptake by exogenous thyroid hormone after a course of antithyroid drugs does not indicate clearly those patients who will eventually relapse or have a remission. Sixty-four hyperthyroid patients have been followed up for two years after an 18 to 24 months' course of carbimazole. Twenty-eight patients had suppressed at the end of the carbimazole course and 20 of these remained in remission for two years, and 36 were non-suppressed and 21 of these relapsed.Patients with the highest neck uptakes relapsed soonest after stopping treatment. Pronounced rebound occurred in neck uptakes at one month after stopping treatment, both in patients who relapsed and in those who remained in remission. By one year after stopping treatment those who remained in remission had shown a further fall in early neck uptake. In two patients who relapsed after exposure to stressful events no change in 20-minute radioiodine neck uptakes was found in relation to the supposed stress. (+info)
Hyperthyroidism--a disease of old age?
(51/89)
In a three-year project in which thyroid studies were undertaken for broad indications 49 cases of thyrotoxicosis were diagnosed; 28 of these patients were 60 years of age or older. Sixteen of these older patients had different forms of atypical thyrotoxicosis, and most were completely without the usual symptoms of the condition. It is concluded that thyrotoxicosis is more frequent in persons over 60 than in younger persons. Many older patients have various forms of masked thyrotoxicosis, and in many cases the correct diagnosis can be made only by undertaking thyroid studies on very wide indications. (+info)
Propranolol in the surgical management of thyrotoxicosis.
(52/89)
Forty-nine thyrotoxic patients prepared for partial thyroidectomy with the beta-adrenoceptor blocking drug, propranolol, and iodine are compared with 42 patients prepared with carbimazole and iodine. The age and sex distribution of the two groups were comparable, but patients with obstructive airways disease and possible cardiac insufficiency were excluded from preparation with propranolol. The mean duration of preoperative treatment with propranolol was 40 days, compared with 89 days for carbimazole. Propranolol treated patients had lower pulse rates before and after operation. The serum PB(127)I values immediately before and after operation were higher in the propranolol group than in the carbimazole group, but were the same in both groups one and four months after operation. The incidence of hypothyroidism at one year after operation was 30% in the carbimazole prepared patients and 31% in the propranolol patients. Serum calcium levels were higher in the propranolol group at the time of operation. No adverse effects from the use of propranolol and at operation the thyroid gland prepared with propranolol was firmer, less friable, more easily mobilised and less likely to bleed than the gland prepared with carbimazole. There is, consequently, less risk of damage to the parathyroid glands and recurrent laryngeal nerves. However, the basal metabolic rate remains high on propranolol therapy and very careful supervision is advised. (+info)
Metabolism of 35S-labelled antithyroid drugs in man.
(53/89)
Differences in the metabolic fate of antithyroid drugs influence the optimal frequency of administration and their therapeutic efficacy. (35)S propylthiouracil differed from the (35)S imidazoles (carbimazole and methimazole) in the more rapid absorption and excretion and the shorter biological half-life in the plasma of the former. Renal function may have a more important influence on the biological half-life of the drugs than thyroid status. Further work is required to determine the optimal frequency of administration for each compound. (+info)
Effect of pretreatment with carbimazole in patients with thyrotoxicosis subsequently treated with radioactive iodine.
(54/89)
Preliminary treatment with carbimazole in a series of 181 patients with thyrotoxicosis selected for treatment with radioactive iodine did not make any significant difference to the subsequent response to (131)I therapy. (+info)
Apathetic thyrotoxicosis.
(55/89)
Apathetic thyrotoxicosis is an atypical though not rare manifestation of hyperthyroidism. The cardinal features are apathy and depression, as opposed to hyperkinesis and mental alertness in the usual thyrotoxic patient, and are unassociated with the usual signs and symptoms of hyperthyroidism, making the diagnosis difficult. We report three cases of apathetic thyrotoxicosis seen during one year. (+info)
Blood levels and management of lithium treatment.
(56/89)
The limited value of plasma measurements in the management of treatment with lithium is discussed in the light of the mechanisms of its therapeutic actions and toxic effects.The plasma level of lithium usually rises twofold or threefold in the three to five hours after ingestion of each dose of delayed-release tablets and then gradually falls. The precise shape and height of the lithium curve depend on gastric emptying, which can be slowed with propantheline or speeded with metoclopramide. Depressed or demented patients may be irregular in taking their tablets and variable in food intake. Both the time of the blood test and this behaviour must be considered before changing the prescribed dose of lithium salt because of a laboratory result. A lithium tolerance curve may be a safer guide to treatment than single measures.Mild intermittent thirst is a common early side effect, and severe persistent thirst with polyuria is an uncommon later effect of daily intakes of at least 1,500 mg lithium carbonate. This diabetes insipidus is reversible, non-progressive, unrelated to plasma level, and distinct in attack from lithium-induced hypothyroidism, which may occur at low dosage but is also usually of late onset and reversible or treatable with thyroxine while lithium is continued. Obesity is another occasional effect of large doses. These side effects and the antimanic and prophylactic effects may have different mechanisms. (+info)