Disturbances of menstruation in thyroid disease

Both hyper- and hypothyroidism may result in menstrual disturbances. In hyperthyroidism, amenorrhea was described as early as 1840 by von Basedow. The most common manifestation is simple oligomenorrhea (decreased menstrual flow). Anovulatory cycles are very common. Increased bleeding may occur, but is rare in hyperthyroidism. Nowadays hyperthyroidism is diagnosed earlier than it once was, and so the clinical picture is generally milder. So, menstrual disorders are less common than in previous series. In a recent paper, 21.5% of 214 patients had disturbances in their cycle, compared to 50% in some older series. In hypothyroidism, on the contrary, polymenorrhea (increased menstrual bleeding) is more common. Defects in hemostasis may contribute to this. Anovulation may be present. Fertility is reduced in both hyper- and hypothyroidism, and the outcome of pregnancy is more often abnormal than in euthyroid women. It is of interest that in juvenile hypothyroidism precocious puberty has been described. This is probably due to a 'spillover' effect of the glucoprotein hormones: TSH, which is markedly increased in hypothyroidism, has a small FSH- and LH-like effect. Galactorrhea may also be present in hypothyroidism, possibly because TSH, the hypophyseal TSH-releasing hormone, increases the secretion of both TSH and PRL

Antioxidant agents in the treatment of Graves' ophthalmopathy

PURPOSE: To report the effect of antioxidant agents in the treatment of mild and moderately severe Graves' ophthalmopathy. METHODS: Prospective, nonrandomized, comparative study performed at a referral center. A series of 11 patients with mild or moderately severe, active, newly diagnosed Graves' ophthalmopathy were included in the study. Allopurinol (300 mg daily) orally and nicotinamide (300 mg daily) orally were used for 3 months. A complete ophthalmologic examination was performed before and 1 and 3 months after initiation of treatment. The response to treatment was estimated separately for each component of the disease and overall by its effect on a total eye score. Eleven patients with mild or moderately severe, active, newly diagnosed Graves' ophthalmopathy who received placebo were also examined at the same time points. Patients in each group were recruited consecutively. Although nonsmoking was not an exclusion criterion, all patients were cigarette smokers. RESULTS: Nine (82%) of 11 patients treated with oral antioxidants showed improvement of mild to moderately severe Graves' ophthalmopathy versus three (27%) of 11 patients in the control group (P < .05). Soft tissue inflammation was the component of the disease that responded more to treatment. No side effects of antioxidant treatment were recorded. Patients' satisfaction was high. CONCLUSIONS: This pilot study presents encouraging results in the treatment of mild and moderately severe Graves' ophthalmopathy with antioxidant agents. To evaluate these preliminary results, randomized prospec-tive studies are needed. Copyright (C) 2000 Elsevier Science Inc

Radiological signs of bone loss in hyperthyroidism

A radiograph of the left hand was obtained in 117 patients with Graves' disease and 16 with toxic adenoma of the thyroid. In none of these cases radiological signs of thyroid acropachy were found. The Exton Smith index of bone mass was calculated from the second metacarpal bone. On average the bone mass was not significantly reduced in either the male or the female hyperthyroid patients. However, there was a negative correlation between bone mass and duration of the disease, abnormal values being reached on average after 7.26 years in the males and 4.57 in the females. It is suggested that the hyperthyroid state leads to osteoporosis if it remains untreated for several years. Since most patients receive definite treatment at an earlier stage of the disease, the average bone mass of the whole group is not significantly reduced. This may explain some of the controversial findings previously reported

Thyroid autoimmunity in the current iodine environment

Iodine is essential for thyroid function. Thyroid disorders related to iodine deficiency decreased progressively with the continuous iodine prophylaxis and the increased iodine intake. An adverse effect resulting from iodine prophylaxis may be the induction of thyroid autoimmunity. Although experiments performed in animal models suggest that iodine could initiate or exacerbate thyroid autoimmunity, the role of iodine in humans remains controversial. Several observational studies in areas with adequate or high iodine intake suggest that there is an increase in the incidence of thyroid autoimmune disease. Moreover, intervention studies suggest that increased iodine intake may enhance thyroid autoimmunity too. However, not all studies generated the same findings, probably because of genetic, racial, and environmental differences. It seems that autoimmune exacerbation is a transient phenomenon. Studies have shown that in persons presenting thyroid antibodies, the levels of these antibodies progressively decrease when the majority of them react against a nonspecific pattern of thyroglobulin (Tg) epitopes. However, in a small number of these persons, the anti-Tg antibodies are similar to those in patients with patent thyroid autoimmune disease, reacting against specific immunodominant Tg epitopes, and their levels persist. One possible attractive explanation is that enhanced iodine intake increases the antigenicity of Tg through the incorporation of iodine into its molecule and the formation of iodinated Tg epitopes or even the generation of noniodinated pathogenetic Tg epitopes that are normally cryptic. © Mary Ann Liebert, Inc

Free-thyroxine index in mania and depression

Although free-thyroxine index is commonly used as a reliable method of thyroid function investigation,1,2 only Rybakowski and Sowinski3 have used this method for the assessment of thyroid function in mania. In depression, determination of free-thyroxine index by four research groups3,6 revealed contradictory results. For these reasons, it was thought that further research in this area would be justified. © 1978

IODINE METABOLISM IN AUTONOMOUS HOT NODULES OF THE THYROID

The thyroidal iodide clearance rate, the plasma inorganic iodine (PII), the absolute iodine uptake (AIU) by the thyroid, the serum PBI, the intrathyroidal exchangeable iodine pool, the renal iodide clearance rate and the urinary iodine excretion were measured in twenty‐one cases of autonomous hot thyroid nodule with suppression of the normal parenchyma (toxic adenoma, TA), in eight cases of autonomous hot nodule without such suppression (subtoxic adenoma, STA), and in eighteen controls; the 131 I uptake and PB131 I were measured in 390 cases of TA and 111 of STA compared with eighty‐one controls. The most striking finding was a greatly reduced pool of intrathyroidal exchangeable iodine in the TA group. This explained the high PB131 I values (out of proportion to the degree of hyperthyroidism) and the short biological half‐life of radioiodine within the gland. There was no evidence of iodine deficiency, either from the PII or the urinary iodine measurements. Otherwise the patients with TA showed evidence of mild hyperfunction: increased 131I uptake, AIU and PBI, but with a considerable overlap with the normal range. The patients with STA had, in general, laboratory values intermediate between the TA group and the controls. The intrathyroidal exchangeable iodine pool was not significantly reduced, probably because in STA the normal parenchyma surrounding the nodule was still actively taking part in the exchange, whereas in the TA the normal parenchyma constituted a practically dormant iodine pool. Copyright © 1973, Wiley Blackwell. All rights reserve

The single thyroid nodule

Between November, 1966, and March, 1970, 2736 patients with single thyroid nodules were investigated at the Alexandra Hospital. Females were more frequently affected than males, with a ratio of females to males of about 7:1. The right lobe was one and a half times more frequently involved than the left. In both lobes the lower pole was six to eight times more commonly involved than the upper pole. Pathological data after surgical excision were available in 692 of these patients. Malignancy was proved in 81 cases. The overall incidence of carcinoma was 11.7 per cent. Malignant nodules were two to three times more frequent in persons aged below 20 and over 60 and in males than in females. The incidence of carcinoma in cold and warm nodules was 12.8 and 6.6 per cent respectively. No malignancy was foun in a hot nodule or in a toxic adenoma. The location of the nodule was not helpful in predicting malignancy. It is concluded that the incidence of malignancy in cold and warm single thyroid nodules in high, and for this reason surgical removal supplemented with replacement therapy is recommended. Copyright © 1972 British Journal of Surgery Society Ltd

Comparative drug treatment of endocrine exophthalmos

The degree of exophthalmos and the width of the palpebral fissure were studied serially in 58 previously thyrotoxic patients, who were divided into 6 treatment groups: 1. guanethidine eye drops; 2. oral thyroxine; 3. guanethidine eye drops and oral thyroxine; 4. guanethidine and prednisolone eye drops; 5. napththazoline nitrate 0.1% and zine sulfate 0.5% eye drops; and 6. metronidazole orally. Exophthalmos increased significantly in the first and third group, and the palpebral fissure decreased in the first group. It was concluded that guanethidine eye drops should be given when there is marked lid retraction with minimal exophtalmos; that prednisolone eye drops are not indicated in endocrine exophthalmos; and that the combination of guanethidine eye drops with oral thyroxine in different dosages is worth further study. © 1970 Springer-Verlag