Introduction: Graves’ disease is the most common cause of hyperthyroidism. Its treatment uses synthetic antithyroid drugs but the use of aggressive radical therapy such as surgery or non-aggressive therapy such as io...Introduction: Graves’ disease is the most common cause of hyperthyroidism. Its treatment uses synthetic antithyroid drugs but the use of aggressive radical therapy such as surgery or non-aggressive therapy such as iodine-131 is not uncommon. Treatment of Graves’ disease with radioactive iodine or iratherapy is a simple, inexpensive, well-tolerated treatment. It was introduced in Senegal in 2016. We report through this work the preliminary assessment of the only nuclear medicine service in Senegal in the management of Graves’ disease by iodine-131. Patients and Methods: Retrospective study of the first cases of Graves’ disease treated with iratherapy in Senegal. Socio-demographic, clinical, paraclinical, therapeutic and evolutionary aspects were studied. Radiation protection rules have been implemented and contraception has been effective for six months in women of childbearing age. Results: 25 patients were collected with a mean age of 45 years, twenty women (80%), a family goiter in 24% and a psycho-affective context in 64% of cases. Thyrotoxicosis syndrome was associated with goiter in 68% of patients and exophthalmos in 64%. Thyroid ultrasound performed in 20 patients showed vascular goiter in 80% and thyroid scintigraphy in 3 patients, homogeneous and diffuse hyperfixation. TRAK dosed in 8 patients was still positive. All patients had received first-line medical treatment. The average duration of this treatment was more than 18 months in 92%. The empirically used iodine-131 activity averaged 15.35 mCi. Oral corticosteroid therapy was prescribed in 7 patients for the prevention of malignant orbitopathy. No early side effects were noted. The remission rate at 3 months was 52% and at 6 months was 88% to 92%. Conclusion: The effectiveness of radioactive iodine, in particular ablative doses in the treatment of hyperthyroidism, is no longer to be demonstrated. Taking into account our socioeconomic context, iratherapy should be a treatment of choice for hyperthyroidism with a good quality/price ratio and excellent tolerance.展开更多
BACKGROUND Thyroid cancer is not commonly observed in patients with Graves’disease(GD).The presence of thyroid nodules in GD is not uncommon.However,a link bet-ween these two entities has been reported.Herein,we repo...BACKGROUND Thyroid cancer is not commonly observed in patients with Graves’disease(GD).The presence of thyroid nodules in GD is not uncommon.However,a link bet-ween these two entities has been reported.Herein,we report the case of a patient with GD and thyroid cancer in Saudi Arabia,which has not been reported previously in our region.CASE SUMMARY A 26-year-old male patient with GD,receiving carbimazole for 2 years,presented to our hospital.His hyperthyroidism was controlled clinically and biochemically.On clinical examination,he was found to have a left-sided thyroid nodule.Ultra-sound revealed a 2.6 cm hypoechoic nodule with high vascularity.He was then referred for fine needle aspiration which showed that the nodule was highly suspicious for malignancy.The patient underwent total thyroidectomy and was diagnosed with multifocal classical micropapillary thyroid cancer.Post thyroid-ectomy he received radioactive iodine ablation along with levothyroxine replace-ment therapy.CONCLUSION Careful preoperative assessment and thyroid gland ultrasound might assist in screening and diagnosing thyroid cancer in patients with GD.展开更多
<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Background:</strong> Resistance to anti-thyroid drugs (ATDs) is a rare entity recently described...<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Background:</strong> Resistance to anti-thyroid drugs (ATDs) is a rare entity recently described. We report two African observations in the treatment of Graves’ disease. <strong>Case 1:</strong> A 19-year-old Senegalese woman presented on admission with thyrotoxicosis syndrome associated with diffuse goitre and Grave’s orbitopathy. TSH levels were low (0.005 mIU/ml;N = 0.27 - 4.20) and fT4 elevated (60 pmol/L;N = 12 - 22]. Combination therapy with propranolol (40 mg/day) and carbimazole (starting dose of 45 mg/day and increased to 60 mg/day) was initiated. In view of the persistence of symptoms despite good therapeutic compliance, carbimazole was replaced by methimazole with an initial starting dose of 40 mg/day, followed by 60 mg/day. Despite the change in therapy, clinical symptoms of thyrotoxicosis persisted, and fT4 levels remained elevated. The patient was diagnosed with resistance to ATDs in Graves’ disease. Total thyroidectomy following 10 days of preoperative preparation with 1% Lugol’s solution was performed successfully. <strong>Case 2:</strong> A 22-year-old woman was referred for continued management of Graves’ disease with elevated thyroid-stimulating hormone receptor antibody (TRAb) levels (34 UI/mL;N < 1.75). Treatment included propranolol (80 mg/day) and carbimazole at an unusual dose of 80 mg/day. Combined therapy was clinically and biologically ineffective, with an fT4 level of 100 pmol/L [N: 12 - 22]. Upon admission, methimazole (40 mg/day) followed by propylthiouracil (800 mg/day) replaced carbimazole. Despite good patient compliance, the patient’s symptoms remained unaltered and fT4 levels elevated. A total robot thyroidectomy using the right axillary approach was performed successfully after 10 days of preoperative preparation, including prednisone (40 mg/day) combined with 1% Lugol’s solution. <strong>Conclusion: </strong>Resistance to ATDs complicates the management of Graves’ disease. Total thyroidectomy following preoperative preparation with Lugol’s solution and/or corticosteroids was shown to be successful.</span> </div>展开更多
Objectives: To assess the clinical particularities and management of Graves’ disease at the Medical Clinic II of the Abass Ndao Hospital Centre in Dakar. Patients and methods: This was a retrospective, descriptive st...Objectives: To assess the clinical particularities and management of Graves’ disease at the Medical Clinic II of the Abass Ndao Hospital Centre in Dakar. Patients and methods: This was a retrospective, descriptive study on records of patients monitored for Graves' disease from 1 January 2010 to 31 December 2014 (5 years). Socio-demographic, clinical treatment and changing parameters were evaluated. Outcomes: 878 patients were included and among them 542 had been monitored for at least 18 months. The sex ratio (M/F) was 0.2 and the average age was 34.8 ± 12 years. The average consultation period was 10.7 ± 2 months. Free T4 at diagnosis was > 80 pmol/l (36.6%). Prolonged medical treatment was reported in 96.7% of patients. The average dose for initial therapy with Carbimazole was 37 ± 9 mg/day. Beta-blockers were used in 64% and anxiolytics in 40.5% of cases. The average period for administering the maintenance dose was 5.6 months. Patients’ attendance and compliance stood at 17.7% and 53.1% respectively. Complications, mainly cardiothyreosis, were found in 13% of cases. Goitre regression was found in 13.9% of cases and that of exophthalmos stood at 19.5%. Among our patients, 38.2% were lost to follow-up. The remission rate was 36.5% and thyroidectomy involved 14.5% of patients. Only stage of goiter (p = 0.007) and initial free T4 value (p = 0.003) were statistically associated with remission. Conclusion: Graves’ disease management raises follow-up problems. Indeed, the medical treatment is long while the number of patients lost to follow-up is high. As the only radical alternative available is surgery, it is therefore essential to promote the development of radioactive iodine therapy to expand the therapeutic choice.展开更多
Down syndrome (DS) is the most common chromosomal abnormality in humans, and the most frequent cause of mental retardation. Patients affected by this syndrome show an increased prevalence of autoimmune diseases. The m...Down syndrome (DS) is the most common chromosomal abnormality in humans, and the most frequent cause of mental retardation. Patients affected by this syndrome show an increased prevalence of autoimmune diseases. The most common of those is Hypothyroidism. We present a case report describing the association of Down syndrome with Hyperthyroidism. An 18-year-old patient presented with a history of recurrent throat infections and intermittent diarrhea, having developed a total alopecia areata within one month from the first visit to the physician. After consultations with general practitioners, he was directed to an Endocrinology Ambulatory and diagnosed with a clear case of Graves’ disease associated with Down syndrome. Treatment was started with methimazole 20 mg/day, and after two months, was adjusted to 40 mg/day. The patient reached adequate clinical and laboratory balance after five months of treatment. Thus, the association between Down syndrome and Graves’ Disease is relevant in medical practice, due to its specific characteristics on diagnosis, and the need of an adequate treatment regarding this disease association.展开更多
Context and Objective: Graves’ disease is an autoimmune disorder of the thyroid gland that occurs in genetically predisposed individuals. It represents the most frequent cause of hyperthyroidism with a clear female p...Context and Objective: Graves’ disease is an autoimmune disorder of the thyroid gland that occurs in genetically predisposed individuals. It represents the most frequent cause of hyperthyroidism with a clear female predominance. The objective of our work was to report the sociodemographic, clinical, therapeutic, and evolutionary characteristics of Graves’ disease at the University Hospital of Conakry. Methods: This was a cross-sectional, descriptive study, over the period from December 2016 to June 2021, at the endocrinology consultation of Donka University Hospital. Epidemiological, clinical, therapeutic, and evolutionary variables of patients followed up for Graves’ disease were collected and analyzed. The diagnosis of Graves’ disease was based on the presence of clinical signs of thyrotoxicosis, diffuse goiter, exophthalmos, and or T-RAK positivity. Results: Graves’ disease was related to 33% of thyroid consultations and 64% of hyperthyroidism. The sex ratio M/F was 0.07. The median age of the patients was 39.4 ± 13 years. The main reason for consultation was thyrotoxicosis syndrome, dominated by cardiovascular signs (92%). TRAK was performed in 38 patients with a positive result in 89%, i.e., a mean level of 17.93 mUI/l. All patients were treated with synthetic antithyroid drugs, with a favorable clinical evolution. Surgery was considered in 4 patients after the stabilization of the thyroid function. The follow-up was considered regular in 49 patients (49%). Conclusion: Graves’ disease is the most frequent hyperthyroidism in Conakry with a clear predominance of women, especially young women. Efforts should be focused on improving diagnosis and the access to treatment for better patient compliance.展开更多
Graves’ disease and Hashimoto’s thyroiditis are two common autoimmune diseases. Their association with other autoimmune diseases is not exceptional. However, the co-occurrence of these two diseases is not often desc...Graves’ disease and Hashimoto’s thyroiditis are two common autoimmune diseases. Their association with other autoimmune diseases is not exceptional. However, the co-occurrence of these two diseases is not often described. In this case, report, we describe the observation of a patient who had long been followed for exophthalmos and pretibial myxedema as a sign of thyrotoxicosis. Examination of this patient revealed a clinical picture of clinical and biological hypothyroidism related to Hashimoto’s thyroiditis. This case had made it possible to retain an association between Hashimoto’s thyroiditis and basedowdisease, which is rarely described. This observation underscores the importance of monitoring these patients with autoimmune disease systematically even if there is no clinical manifestation.展开更多
Context: Highly active antiretroviral therapy (HAART) inhibits the HIV replication and consequently increases CD4 levels and decreases viral load. This immune system improvement can trigger various immunological pheno...Context: Highly active antiretroviral therapy (HAART) inhibits the HIV replication and consequently increases CD4 levels and decreases viral load. This immune system improvement can trigger various immunological phenomena, entity called Immune Reconstitution Syndrome (IRS). Graves’ disease is a late Immune Reconstitution consequence. Patient: We report the case of a 48 years old man with HIV infection who developed Graves’ disease three years after he was on effective HAART because of the Immune Reconstitution Syndrome. At presentation he had a very low CD4 T-cell count (17 cells/μL). When he started HAART he presented a lipodystrophy syndrome. HAART was changed because of the persistent low CD4-T cells count (less than 100 cell/μL). Afterwards serum lipid levels began to decrease and that was the first manifestation of Graves’ disease, which was diagnosed when CD4 T-cells increased up to 343 cell/μL. Our patient developed Graves’ disease 36 months after initiating effective HAART with protease inhibitors which was coincident with viral suppression and a rise of CD4 T cells. Conclusion: The most immunosuppressed patients with a CD4 T cell count less than 100 cells/μL are at greatest risk for the development of Immune Reconstitution Syndrome after HAART initiation. We conclude that clinicians will have to consider the importance of the early diagnosis of thyroid disease to bring an adequate treatment.展开更多
Background: Differentiating Graves hyperthyroidism from the other causes of hyperthyroidism, using serum TRAb testing is essential step for diagnosis. Objectives: To study importance of TRAb in the diagnosis of Graves...Background: Differentiating Graves hyperthyroidism from the other causes of hyperthyroidism, using serum TRAb testing is essential step for diagnosis. Objectives: To study importance of TRAb in the diagnosis of Graves’ disease, distinguishing it from thyroiditis, and comparing it with clinical features and other tests such as TPOAb, US thyroid and thyroid scintiscan. Methods: A cross-sectional study was conducted on 120 patients attending endocrine clinicErbil city. Patients were studied on clinical feature basis and investigated with serum TRAb, TPOAb, TSH, Free T4, and Ultrasound examination of thyroid gland. Fisher exact test and Chi Square test of independence, Correlation coefficient and t-test of independence were used. Results: Fifty-two patients were found to have Graves’ disease;There was significant correlation between TRAb positivity and diagnosis of Graves’ disease p 0.05. Conclusion: A positive correlation was found between TRAb titer and positivity and no significant relation between TPOAb levels between Graves’ disease patients compared with thyroiditis patients, respectively.展开更多
Objective Graves’disease is the most common autoimmune thyroid disease and its prevalence and clinical manifestations are disparate between females and males.Costimulatory molecules play an essential role in regulati...Objective Graves’disease is the most common autoimmune thyroid disease and its prevalence and clinical manifestations are disparate between females and males.Costimulatory molecules play an essential role in regulating autoimmune responses.The objective of this study was to determine if expression of inhibitory molecules was correlated with treatment by dihydrotestosterone(DHT)in an in vivo BALB/c mouse model of experimental autoimmune Graves’disease.Methods Female BALB/c mice were immunized three times with thyroid stimulating hormone receptor A-subunit encoded by adenovirus to establish a Graves’disease model.Three different doses of DHT or a matching placebo were administered by implantation of slow-release pellets a week before the first immunization.Four weeks after the third immunization,the mice were euthanatized,and then the spleen and thymus were removed.Total thyroxine and free thyroxine levels in serum of mice were detected using a radioimmunoassay kit.Real-time polymerase chain reaction was performed to estimate the expression of costimulatory molecules in lymphocytes from the spleen and thymus.Flow cytometry was used to analyze the percentage of CD4^+T cells in splenic lymphocytes.Quantitative data were compared with unpaired t-tests.Correlation between two variables was analyzed using Analysis of Variance.Results Treatment with DHT can dramatically reduce total thyroxine and free thyroxine levels.Higher expression of programmed death-1 was found in the spleen of Graves’disease mice receiving 5 mg of DHT treatment(0.635±0.296 vs.0.327±0.212;t=2.714,P=0.014),similarly,T-cell immunoglobulin domain and mucin domain 3(TIM-3)in both the spleen(1.004±0.338 vs.0.646±0.314;t=2.205,P=0.022)and the thymus(0.263±0.127 vs.0.120±0.076;t=3.221,P=0.004)also increased after 5 mg of DHT treatment compared with the parallel placebo model mice.Moreover,the percentage of CD4^+T cells declined in the splenic lymphocytes of Graves’disease mice treated with 5 mg of DHT(19.90%±3.985%vs.24.05%±2.587%;t=2.804,P=0.012).A significant negative association was observed between expression of TIM-3 in the spleen and serum levels of total thyroxine(r=-0.7106,P=0.014)as well as free thyroxine(r=-0.6542,P=0.029).Conclusion This study demonstrates that DHT can ameliorate experimental autoimmune Graves’disease,which may occur by up-regulating expression of programmed death-1 and TIM-3 and inhibiting development of CD4^+T cells.展开更多
Objective: To investigate the association of Graves’ disease and Graves’ ophthalmopathy with the C/T transition polymorphism at position –318 of promoter and the A/G transition polymorphism at position 49 of exon 1...Objective: To investigate the association of Graves’ disease and Graves’ ophthalmopathy with the C/T transition polymorphism at position –318 of promoter and the A/G transition polymorphism at position 49 of exon 1 within cytotoxic T lymphocyte associated antigen-4 (CTLA-4) gene. Methods: Thirty-three patients with ophthalmopathy of Graves’ disease, fifty-six Graves’ patients without ophthalmopathy and sixty normal subjects as control were involved in the present case-control study. The polymorphisms were evaluated by polymerase chain reaction fragment length polymorphism (PCR-RFLP). Com-parisons were made of gene frequencies and allele frequencies between the groups. Results: The gene frequencies of CT and allele frequencies of T were much higher in Graves’ patients with ophthalmopathy than that in the group without ophthalmopathy (P=0.020, P=0.019). The gene frequencies of GG and allele frequencies of G in patients with Graves’ disease were significantly increased as compared with control group (P=0.008, P=0.007). The data suggest that smokers with Graves’ disease seemed to be more predisposed to ophthalmopathy than non-smokers (P=0.018). Conclusion: Our results suggest that an allele of T at position –318 of promoter is associated with genetic susceptibility to Graves’ ophthalmopathy while an allele of G at position 49 of exon 1 is associated with genetic susceptibility to Graves’ disease instead. Smoking is believed to be a major risk factor for ophthalmo-pathy.展开更多
Aim: to describe the salient relationships between Graves’ disease (GD) and both Turner syndrome (TS) and Down syndrome (DS). Design: to conduct a secondary analysis of current literature on this topic. Results: 1) t...Aim: to describe the salient relationships between Graves’ disease (GD) and both Turner syndrome (TS) and Down syndrome (DS). Design: to conduct a secondary analysis of current literature on this topic. Results: 1) the prevalences of GD in TS and in DS young patients are 1.7% and 6.5‰, respectively, i.e. higher than that in pediatric general population (around 1‰);2) in both these chromosomopathies GD presentation is often preceded by Hashimoto’s thyroiditis (HT) antecedents;3) in both TS and DS, GD presents with a clinical picture very similar to that observed in GD patients without these chromosomopathies;4) in TS, clinical course of GD under pharmacological therapy is very similar to that observed in non-TS girls;5) in DS, clinical course of GD under pharmacological therapy is less severe than that in non-DS patients. Conclusions: in the children with either TS or DS, GD is characterized by two common epidemiological peculiarities, i.e. increased prevalence rate and elevated frequency of HT antecedents.展开更多
Graves’ disease is the most common cause of hyperthyroidism. Adequate management is an area of controversy, especially when it comes to children. The objective of our study was to assess the outcome of Graves’ disea...Graves’ disease is the most common cause of hyperthyroidism. Adequate management is an area of controversy, especially when it comes to children. The objective of our study was to assess the outcome of Graves’ disease treatment in Albert Royer Children Hospital of Dakar. This was a retrospective study conducted from 2001 to 2015, and which involved all children between 0 to 15 years of age who were being monitored in the Albert Royer National Children Hospital. The evolutionary modalities were: stability, remission, failure, relapse, lost to follow-up and death. The data were analyzed with SPSS software version 20.0. For the comparisons, the KHI 2 or Fisher test was used with a significance threshold (p < 0.05). During the study period, 88 children were enrolled. The average age was 8.6 years [ranging from 8 months to 15 years]. The consultation delay was 11.36 months. In our study, 61.4% of the patients were regular in the follow-up, the observance was good in 40.9% of the cases and 19 patients (21.6%) were lost to follow-up. Clinical courses of 69 children after treatment with Carbimazole for 37 months were promising in 21 cases (30.43%), with 17 cases of remission (24.63%) and 4 cases of stability (5.8%). Age older than 10, the initial ATD dose greater than 1 mg/kg/day and the initial free T4 lower than 50 pmol/l were significantly associated with remission with a p value of 0.01;0.024 and 0.004.展开更多
Cholestatic jaundice and elevated liver enzymes are uncommon, but recognized, manifestations of neonatal thyrotoxicosis. Current guidelines for evaluation of cholestatic jaundice and reviews in Neonatology literature ...Cholestatic jaundice and elevated liver enzymes are uncommon, but recognized, manifestations of neonatal thyrotoxicosis. Current guidelines for evaluation of cholestatic jaundice and reviews in Neonatology literature do not discuss hyperthyroidism in the differential diagnosis of cholestatic jaundice. We report two cases of neonatal thyrotoxicosis secondary to neonatal Graves’ disease that presented with cholestatic jaundice and elevated liver enzymes at birth. Early recognition of thyrotoxicosis as a cause of the hepatic disease in the neonate is crucial to prevent unnecessary diagnostic procedures and to initiate timely treatment.展开更多
Objectives: Analyzing the trend in the serum inflammatory cytokines levels in a historical cohort of patients treated with combination of chloroquine and methimazole. Material and methods: We analyzed the pro-inflamma...Objectives: Analyzing the trend in the serum inflammatory cytokines levels in a historical cohort of patients treated with combination of chloroquine and methimazole. Material and methods: We analyzed the pro-inflammatory serum cytokines level [Interleukin-6(IL-6), Tumor Necrosis Factor alpha (TNF-α), Interleukin 1 alpha (IL-1 α) and Interferon gamma (INF-γ)] in the stored blood samples of 22 patients with Graves’ disease who previously randomized to receive either chloroquine and methimazole combination therapy or methimazole monotherapy. Total T3, T4 and TSH levels were measured by an enzyme linked immunosorbent assay (ELISA) method (DRG, New York, USA) and the result was published previously. In this study we used an ELISA method (Bender Medsystem Vienna Austria) to measure serum pro-inflammatory cytokines in the first 6 months of trial. Results: No significant differences in serum cytokines concentration were observed between the two treatment groups (p > 0.05). Although it was not statistically significant, serum INF-gamma concentration tended to be lower in the chloroquine group after four months of therapy (p = 0.12). Conclusion: In this study we found changes in the serum thyroid hormones level did not accompany concomitant changes in the serum cytokines levels in two treatment groups. Therefore it is possible that chloroquine reduce serum thyroid hormones levels independent of its immunomodulatory effect.展开更多
Summary of Lupus and Basedow Disease Association: The association lupus auto-immune thyroid disease is well known. Lupus is most commonly associated with Hashimoto’s thyroiditis. As for Graves’ disease, it is most o...Summary of Lupus and Basedow Disease Association: The association lupus auto-immune thyroid disease is well known. Lupus is most commonly associated with Hashimoto’s thyroiditis. As for Graves’ disease, it is most often associated with pernicious anaemia, vitiligo, idiopathic purpura and myasthenia gravis. To our knowledge, we report the first case of lupus associated with Graves’ disease in sub-Saharan Africa. Observation: A female patient of 52 years old has been followed since February 2010 for systemic lupus diagnosed on biological and immunological clinical ACR criteria. There was no skin ailment and kidneys involved. Combined treatment with high-dose corticosteroids early and rapid decrease and hydroxychloroquine was established with good clinical and biological evolution. One year later the patient developed thyrotoxicosis syndrome and vascular goitre without exophthalmos associated with the presence of antibodies anti receptor of TSH leading to the diagnosis of Graves’ disease. The patient has been treated with synthetic anti-thyroid and beta blocker allowing the regression of clinical symptoms and the normalization of thyroid hormones. Since then, the patient had not shown other signs of systemic affection. Conclusion: Systemic diseases are often associated with autoimmune thyreopathies. But association of lupus with Graves’ disease has been rarely described in the literature. One should always watch out for the occurrence of thyroid disease in front of any systemic disease and vice versa.展开更多
Introduction: Mostly reported common side effects of carbimazole are cutaneous allergies and severe agranulocytosis. However, hepatotoxicity is rarely described. Thus, we report four observations of carbimazole drug-i...Introduction: Mostly reported common side effects of carbimazole are cutaneous allergies and severe agranulocytosis. However, hepatotoxicity is rarely described. Thus, we report four observations of carbimazole drug-induced hepatitis during the treatment of Graves’ disease, which imputability is likely and probably an immuno-allergic mechanism. Observations: They were four women whose average age was 43 years, with extreme ages of 32 and 54. Patients were monitored and treated with carbimazole in doses contained between 40 mg and 60 mg per day. Clinical manifestations of liver injury were mainly dominated by cholestatic jaundice, found in 100% of our patients. A painful sensitivity of the right hypochondrium was concomitant with jaundice for two patients. The jaundice time to onset after the beginning of treatment with carbimazole varies between 1 month and 6 months. They all had acute hepatitis. The biological assays used to determine the type of liver injury showed, in all cases, a mixed, cholestatic and cytolytic hepatitis. Therapeutically, in all patients, carbimazole was stopped as soon as the suspicion of its incrimination in the occurrence of liver damage was set up. They all had a substitution of carbimazole with benzylthiouracil. Evolution was favorable for all patients, after therapeutic substitution. It was marked by disappearance of jaundice and normalization of the liver biological parameters within a maximum delay of two months after stopping carbimazole use. Conclusion: Treatment with synthetic antithyroid drugs, particularly carbimazole that is most widely used in our regions, requires clinical and biological monitoring. This surveillance, which is often difficult in Africa because of the limited economic resources, can lead to the occurrence of side effects such as potentially serious drug-induced hepatitis, but which has been favorable in our observations.展开更多
Pretibial myxoedema (PM) is a late and rare manifestation of autoimmune thyroiditis, particularly in patients with Graves’ disease. It occurs in 0.5% to 4.3% of patients [1], and is usually associated with high level...Pretibial myxoedema (PM) is a late and rare manifestation of autoimmune thyroiditis, particularly in patients with Graves’ disease. It occurs in 0.5% to 4.3% of patients [1], and is usually associated with high levels of thyroid hormones. The classification of PM includes four forms: non-pitting edema;plaque;nodular;or elephantiasis [1]. Mild PM often regresses spontaneously, but the severe, elephantiasic variant is typically progressive and refractory to treatment. Elephantiasic pretibial myxoedema (EPM) is characterized by massive edema, skin fibrosis and verrucous nodule formation, and it clinically resembles lymphedema. Herein, we describe a man with Graves’ disease presenting with EPM for nearly 2 years. Although advanced cases have been described in the literature, to our knowledge, none have reached this level of severity.展开更多
<strong>Background:</strong> Alternating thyroid function between hypo- and hyperthyroidism is a very rare phenomenon attributed to the switch between the types of thyroid stimulating hormone receptor auto...<strong>Background:</strong> Alternating thyroid function between hypo- and hyperthyroidism is a very rare phenomenon attributed to the switch between the types of thyroid stimulating hormone receptor autoantibodies;thyroid stimulating antibody and thyroid stimulating hormone blocking antibody. <strong>Case Presentation:</strong> We report an 18 years old male who presented with hyperthyroidism attributed to Graves’ disease. He was treated with antithyroid medication. During follow up, his thyroid function was switching between hyper- and hypothyroidism which was difficult to treat with antithyroid medication. His laboratory investigations revealed high thyroid stimulating immunoglobulin and TSH binding inhibitory immunoglobulin. Due to the difficultly of managing him with antithyroid medication, he was offered a definitive management for his Graves’ disease. <strong>Conclusion:</strong> This case demonstrates a rare challenging presentation of Graves’ disease. Patients presenting with fluctuation in thyroid function between hyper-and hypothyroidism need a definitive management for Graves’ disease.展开更多
BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease...BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease 2019(COVID-19)and to save lives.Vaccine safety is one of the issues under surveillance and a possible correlation between vaccines and thyroid function has been reported.However,reports of the impact of coronavirus vaccines on those with Graves’disease(GD)are rare.CASE SUMMARY This paper presents two patients with underlying GD in remission,both developed thyrotoxicosis and one developed thyroid storm following the adenovirus-vectored vaccine(Oxford-AstraZeneca,United Kingdom).The objective of this article is to raise awareness regarding a possible association between COVID-19 vaccination and the onset of thyroid dysfunction in patients with underlying GD in remission.CONCLUSION Receiving either the mRNA or an adenovirus-vectored vaccine for SARS-CoV-2could be safe under effective treatment.Vaccine induced thyroid dysfunction has been reported,but the pathophysiology still not well understood.Further investigation is required to evaluate the possible predisposing factors for developing thyrotoxicosis especially in patients with underlying GD.However,early awareness of thyroid dysfunction following vaccination could avoid a lifethreatening event.展开更多
文摘Introduction: Graves’ disease is the most common cause of hyperthyroidism. Its treatment uses synthetic antithyroid drugs but the use of aggressive radical therapy such as surgery or non-aggressive therapy such as iodine-131 is not uncommon. Treatment of Graves’ disease with radioactive iodine or iratherapy is a simple, inexpensive, well-tolerated treatment. It was introduced in Senegal in 2016. We report through this work the preliminary assessment of the only nuclear medicine service in Senegal in the management of Graves’ disease by iodine-131. Patients and Methods: Retrospective study of the first cases of Graves’ disease treated with iratherapy in Senegal. Socio-demographic, clinical, paraclinical, therapeutic and evolutionary aspects were studied. Radiation protection rules have been implemented and contraception has been effective for six months in women of childbearing age. Results: 25 patients were collected with a mean age of 45 years, twenty women (80%), a family goiter in 24% and a psycho-affective context in 64% of cases. Thyrotoxicosis syndrome was associated with goiter in 68% of patients and exophthalmos in 64%. Thyroid ultrasound performed in 20 patients showed vascular goiter in 80% and thyroid scintigraphy in 3 patients, homogeneous and diffuse hyperfixation. TRAK dosed in 8 patients was still positive. All patients had received first-line medical treatment. The average duration of this treatment was more than 18 months in 92%. The empirically used iodine-131 activity averaged 15.35 mCi. Oral corticosteroid therapy was prescribed in 7 patients for the prevention of malignant orbitopathy. No early side effects were noted. The remission rate at 3 months was 52% and at 6 months was 88% to 92%. Conclusion: The effectiveness of radioactive iodine, in particular ablative doses in the treatment of hyperthyroidism, is no longer to be demonstrated. Taking into account our socioeconomic context, iratherapy should be a treatment of choice for hyperthyroidism with a good quality/price ratio and excellent tolerance.
文摘BACKGROUND Thyroid cancer is not commonly observed in patients with Graves’disease(GD).The presence of thyroid nodules in GD is not uncommon.However,a link bet-ween these two entities has been reported.Herein,we report the case of a patient with GD and thyroid cancer in Saudi Arabia,which has not been reported previously in our region.CASE SUMMARY A 26-year-old male patient with GD,receiving carbimazole for 2 years,presented to our hospital.His hyperthyroidism was controlled clinically and biochemically.On clinical examination,he was found to have a left-sided thyroid nodule.Ultra-sound revealed a 2.6 cm hypoechoic nodule with high vascularity.He was then referred for fine needle aspiration which showed that the nodule was highly suspicious for malignancy.The patient underwent total thyroidectomy and was diagnosed with multifocal classical micropapillary thyroid cancer.Post thyroid-ectomy he received radioactive iodine ablation along with levothyroxine replace-ment therapy.CONCLUSION Careful preoperative assessment and thyroid gland ultrasound might assist in screening and diagnosing thyroid cancer in patients with GD.
文摘<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Background:</strong> Resistance to anti-thyroid drugs (ATDs) is a rare entity recently described. We report two African observations in the treatment of Graves’ disease. <strong>Case 1:</strong> A 19-year-old Senegalese woman presented on admission with thyrotoxicosis syndrome associated with diffuse goitre and Grave’s orbitopathy. TSH levels were low (0.005 mIU/ml;N = 0.27 - 4.20) and fT4 elevated (60 pmol/L;N = 12 - 22]. Combination therapy with propranolol (40 mg/day) and carbimazole (starting dose of 45 mg/day and increased to 60 mg/day) was initiated. In view of the persistence of symptoms despite good therapeutic compliance, carbimazole was replaced by methimazole with an initial starting dose of 40 mg/day, followed by 60 mg/day. Despite the change in therapy, clinical symptoms of thyrotoxicosis persisted, and fT4 levels remained elevated. The patient was diagnosed with resistance to ATDs in Graves’ disease. Total thyroidectomy following 10 days of preoperative preparation with 1% Lugol’s solution was performed successfully. <strong>Case 2:</strong> A 22-year-old woman was referred for continued management of Graves’ disease with elevated thyroid-stimulating hormone receptor antibody (TRAb) levels (34 UI/mL;N < 1.75). Treatment included propranolol (80 mg/day) and carbimazole at an unusual dose of 80 mg/day. Combined therapy was clinically and biologically ineffective, with an fT4 level of 100 pmol/L [N: 12 - 22]. Upon admission, methimazole (40 mg/day) followed by propylthiouracil (800 mg/day) replaced carbimazole. Despite good patient compliance, the patient’s symptoms remained unaltered and fT4 levels elevated. A total robot thyroidectomy using the right axillary approach was performed successfully after 10 days of preoperative preparation, including prednisone (40 mg/day) combined with 1% Lugol’s solution. <strong>Conclusion: </strong>Resistance to ATDs complicates the management of Graves’ disease. Total thyroidectomy following preoperative preparation with Lugol’s solution and/or corticosteroids was shown to be successful.</span> </div>
文摘Objectives: To assess the clinical particularities and management of Graves’ disease at the Medical Clinic II of the Abass Ndao Hospital Centre in Dakar. Patients and methods: This was a retrospective, descriptive study on records of patients monitored for Graves' disease from 1 January 2010 to 31 December 2014 (5 years). Socio-demographic, clinical treatment and changing parameters were evaluated. Outcomes: 878 patients were included and among them 542 had been monitored for at least 18 months. The sex ratio (M/F) was 0.2 and the average age was 34.8 ± 12 years. The average consultation period was 10.7 ± 2 months. Free T4 at diagnosis was > 80 pmol/l (36.6%). Prolonged medical treatment was reported in 96.7% of patients. The average dose for initial therapy with Carbimazole was 37 ± 9 mg/day. Beta-blockers were used in 64% and anxiolytics in 40.5% of cases. The average period for administering the maintenance dose was 5.6 months. Patients’ attendance and compliance stood at 17.7% and 53.1% respectively. Complications, mainly cardiothyreosis, were found in 13% of cases. Goitre regression was found in 13.9% of cases and that of exophthalmos stood at 19.5%. Among our patients, 38.2% were lost to follow-up. The remission rate was 36.5% and thyroidectomy involved 14.5% of patients. Only stage of goiter (p = 0.007) and initial free T4 value (p = 0.003) were statistically associated with remission. Conclusion: Graves’ disease management raises follow-up problems. Indeed, the medical treatment is long while the number of patients lost to follow-up is high. As the only radical alternative available is surgery, it is therefore essential to promote the development of radioactive iodine therapy to expand the therapeutic choice.
文摘Down syndrome (DS) is the most common chromosomal abnormality in humans, and the most frequent cause of mental retardation. Patients affected by this syndrome show an increased prevalence of autoimmune diseases. The most common of those is Hypothyroidism. We present a case report describing the association of Down syndrome with Hyperthyroidism. An 18-year-old patient presented with a history of recurrent throat infections and intermittent diarrhea, having developed a total alopecia areata within one month from the first visit to the physician. After consultations with general practitioners, he was directed to an Endocrinology Ambulatory and diagnosed with a clear case of Graves’ disease associated with Down syndrome. Treatment was started with methimazole 20 mg/day, and after two months, was adjusted to 40 mg/day. The patient reached adequate clinical and laboratory balance after five months of treatment. Thus, the association between Down syndrome and Graves’ Disease is relevant in medical practice, due to its specific characteristics on diagnosis, and the need of an adequate treatment regarding this disease association.
文摘Context and Objective: Graves’ disease is an autoimmune disorder of the thyroid gland that occurs in genetically predisposed individuals. It represents the most frequent cause of hyperthyroidism with a clear female predominance. The objective of our work was to report the sociodemographic, clinical, therapeutic, and evolutionary characteristics of Graves’ disease at the University Hospital of Conakry. Methods: This was a cross-sectional, descriptive study, over the period from December 2016 to June 2021, at the endocrinology consultation of Donka University Hospital. Epidemiological, clinical, therapeutic, and evolutionary variables of patients followed up for Graves’ disease were collected and analyzed. The diagnosis of Graves’ disease was based on the presence of clinical signs of thyrotoxicosis, diffuse goiter, exophthalmos, and or T-RAK positivity. Results: Graves’ disease was related to 33% of thyroid consultations and 64% of hyperthyroidism. The sex ratio M/F was 0.07. The median age of the patients was 39.4 ± 13 years. The main reason for consultation was thyrotoxicosis syndrome, dominated by cardiovascular signs (92%). TRAK was performed in 38 patients with a positive result in 89%, i.e., a mean level of 17.93 mUI/l. All patients were treated with synthetic antithyroid drugs, with a favorable clinical evolution. Surgery was considered in 4 patients after the stabilization of the thyroid function. The follow-up was considered regular in 49 patients (49%). Conclusion: Graves’ disease is the most frequent hyperthyroidism in Conakry with a clear predominance of women, especially young women. Efforts should be focused on improving diagnosis and the access to treatment for better patient compliance.
文摘Graves’ disease and Hashimoto’s thyroiditis are two common autoimmune diseases. Their association with other autoimmune diseases is not exceptional. However, the co-occurrence of these two diseases is not often described. In this case, report, we describe the observation of a patient who had long been followed for exophthalmos and pretibial myxedema as a sign of thyrotoxicosis. Examination of this patient revealed a clinical picture of clinical and biological hypothyroidism related to Hashimoto’s thyroiditis. This case had made it possible to retain an association between Hashimoto’s thyroiditis and basedowdisease, which is rarely described. This observation underscores the importance of monitoring these patients with autoimmune disease systematically even if there is no clinical manifestation.
文摘Context: Highly active antiretroviral therapy (HAART) inhibits the HIV replication and consequently increases CD4 levels and decreases viral load. This immune system improvement can trigger various immunological phenomena, entity called Immune Reconstitution Syndrome (IRS). Graves’ disease is a late Immune Reconstitution consequence. Patient: We report the case of a 48 years old man with HIV infection who developed Graves’ disease three years after he was on effective HAART because of the Immune Reconstitution Syndrome. At presentation he had a very low CD4 T-cell count (17 cells/μL). When he started HAART he presented a lipodystrophy syndrome. HAART was changed because of the persistent low CD4-T cells count (less than 100 cell/μL). Afterwards serum lipid levels began to decrease and that was the first manifestation of Graves’ disease, which was diagnosed when CD4 T-cells increased up to 343 cell/μL. Our patient developed Graves’ disease 36 months after initiating effective HAART with protease inhibitors which was coincident with viral suppression and a rise of CD4 T cells. Conclusion: The most immunosuppressed patients with a CD4 T cell count less than 100 cells/μL are at greatest risk for the development of Immune Reconstitution Syndrome after HAART initiation. We conclude that clinicians will have to consider the importance of the early diagnosis of thyroid disease to bring an adequate treatment.
文摘Background: Differentiating Graves hyperthyroidism from the other causes of hyperthyroidism, using serum TRAb testing is essential step for diagnosis. Objectives: To study importance of TRAb in the diagnosis of Graves’ disease, distinguishing it from thyroiditis, and comparing it with clinical features and other tests such as TPOAb, US thyroid and thyroid scintiscan. Methods: A cross-sectional study was conducted on 120 patients attending endocrine clinicErbil city. Patients were studied on clinical feature basis and investigated with serum TRAb, TPOAb, TSH, Free T4, and Ultrasound examination of thyroid gland. Fisher exact test and Chi Square test of independence, Correlation coefficient and t-test of independence were used. Results: Fifty-two patients were found to have Graves’ disease;There was significant correlation between TRAb positivity and diagnosis of Graves’ disease p 0.05. Conclusion: A positive correlation was found between TRAb titer and positivity and no significant relation between TPOAb levels between Graves’ disease patients compared with thyroiditis patients, respectively.
基金supported by the National Natural Science Foundation(grant number 81670725,2017.01-2020.12)Key Research and Development Project of Shaanxi Province(grant number 2017ZDXM-SF-060,2017.01-2019.12)。
文摘Objective Graves’disease is the most common autoimmune thyroid disease and its prevalence and clinical manifestations are disparate between females and males.Costimulatory molecules play an essential role in regulating autoimmune responses.The objective of this study was to determine if expression of inhibitory molecules was correlated with treatment by dihydrotestosterone(DHT)in an in vivo BALB/c mouse model of experimental autoimmune Graves’disease.Methods Female BALB/c mice were immunized three times with thyroid stimulating hormone receptor A-subunit encoded by adenovirus to establish a Graves’disease model.Three different doses of DHT or a matching placebo were administered by implantation of slow-release pellets a week before the first immunization.Four weeks after the third immunization,the mice were euthanatized,and then the spleen and thymus were removed.Total thyroxine and free thyroxine levels in serum of mice were detected using a radioimmunoassay kit.Real-time polymerase chain reaction was performed to estimate the expression of costimulatory molecules in lymphocytes from the spleen and thymus.Flow cytometry was used to analyze the percentage of CD4^+T cells in splenic lymphocytes.Quantitative data were compared with unpaired t-tests.Correlation between two variables was analyzed using Analysis of Variance.Results Treatment with DHT can dramatically reduce total thyroxine and free thyroxine levels.Higher expression of programmed death-1 was found in the spleen of Graves’disease mice receiving 5 mg of DHT treatment(0.635±0.296 vs.0.327±0.212;t=2.714,P=0.014),similarly,T-cell immunoglobulin domain and mucin domain 3(TIM-3)in both the spleen(1.004±0.338 vs.0.646±0.314;t=2.205,P=0.022)and the thymus(0.263±0.127 vs.0.120±0.076;t=3.221,P=0.004)also increased after 5 mg of DHT treatment compared with the parallel placebo model mice.Moreover,the percentage of CD4^+T cells declined in the splenic lymphocytes of Graves’disease mice treated with 5 mg of DHT(19.90%±3.985%vs.24.05%±2.587%;t=2.804,P=0.012).A significant negative association was observed between expression of TIM-3 in the spleen and serum levels of total thyroxine(r=-0.7106,P=0.014)as well as free thyroxine(r=-0.6542,P=0.029).Conclusion This study demonstrates that DHT can ameliorate experimental autoimmune Graves’disease,which may occur by up-regulating expression of programmed death-1 and TIM-3 and inhibiting development of CD4^+T cells.
文摘Objective: To investigate the association of Graves’ disease and Graves’ ophthalmopathy with the C/T transition polymorphism at position –318 of promoter and the A/G transition polymorphism at position 49 of exon 1 within cytotoxic T lymphocyte associated antigen-4 (CTLA-4) gene. Methods: Thirty-three patients with ophthalmopathy of Graves’ disease, fifty-six Graves’ patients without ophthalmopathy and sixty normal subjects as control were involved in the present case-control study. The polymorphisms were evaluated by polymerase chain reaction fragment length polymorphism (PCR-RFLP). Com-parisons were made of gene frequencies and allele frequencies between the groups. Results: The gene frequencies of CT and allele frequencies of T were much higher in Graves’ patients with ophthalmopathy than that in the group without ophthalmopathy (P=0.020, P=0.019). The gene frequencies of GG and allele frequencies of G in patients with Graves’ disease were significantly increased as compared with control group (P=0.008, P=0.007). The data suggest that smokers with Graves’ disease seemed to be more predisposed to ophthalmopathy than non-smokers (P=0.018). Conclusion: Our results suggest that an allele of T at position –318 of promoter is associated with genetic susceptibility to Graves’ ophthalmopathy while an allele of G at position 49 of exon 1 is associated with genetic susceptibility to Graves’ disease instead. Smoking is believed to be a major risk factor for ophthalmo-pathy.
文摘Aim: to describe the salient relationships between Graves’ disease (GD) and both Turner syndrome (TS) and Down syndrome (DS). Design: to conduct a secondary analysis of current literature on this topic. Results: 1) the prevalences of GD in TS and in DS young patients are 1.7% and 6.5‰, respectively, i.e. higher than that in pediatric general population (around 1‰);2) in both these chromosomopathies GD presentation is often preceded by Hashimoto’s thyroiditis (HT) antecedents;3) in both TS and DS, GD presents with a clinical picture very similar to that observed in GD patients without these chromosomopathies;4) in TS, clinical course of GD under pharmacological therapy is very similar to that observed in non-TS girls;5) in DS, clinical course of GD under pharmacological therapy is less severe than that in non-DS patients. Conclusions: in the children with either TS or DS, GD is characterized by two common epidemiological peculiarities, i.e. increased prevalence rate and elevated frequency of HT antecedents.
文摘Graves’ disease is the most common cause of hyperthyroidism. Adequate management is an area of controversy, especially when it comes to children. The objective of our study was to assess the outcome of Graves’ disease treatment in Albert Royer Children Hospital of Dakar. This was a retrospective study conducted from 2001 to 2015, and which involved all children between 0 to 15 years of age who were being monitored in the Albert Royer National Children Hospital. The evolutionary modalities were: stability, remission, failure, relapse, lost to follow-up and death. The data were analyzed with SPSS software version 20.0. For the comparisons, the KHI 2 or Fisher test was used with a significance threshold (p < 0.05). During the study period, 88 children were enrolled. The average age was 8.6 years [ranging from 8 months to 15 years]. The consultation delay was 11.36 months. In our study, 61.4% of the patients were regular in the follow-up, the observance was good in 40.9% of the cases and 19 patients (21.6%) were lost to follow-up. Clinical courses of 69 children after treatment with Carbimazole for 37 months were promising in 21 cases (30.43%), with 17 cases of remission (24.63%) and 4 cases of stability (5.8%). Age older than 10, the initial ATD dose greater than 1 mg/kg/day and the initial free T4 lower than 50 pmol/l were significantly associated with remission with a p value of 0.01;0.024 and 0.004.
文摘Cholestatic jaundice and elevated liver enzymes are uncommon, but recognized, manifestations of neonatal thyrotoxicosis. Current guidelines for evaluation of cholestatic jaundice and reviews in Neonatology literature do not discuss hyperthyroidism in the differential diagnosis of cholestatic jaundice. We report two cases of neonatal thyrotoxicosis secondary to neonatal Graves’ disease that presented with cholestatic jaundice and elevated liver enzymes at birth. Early recognition of thyrotoxicosis as a cause of the hepatic disease in the neonate is crucial to prevent unnecessary diagnostic procedures and to initiate timely treatment.
文摘Objectives: Analyzing the trend in the serum inflammatory cytokines levels in a historical cohort of patients treated with combination of chloroquine and methimazole. Material and methods: We analyzed the pro-inflammatory serum cytokines level [Interleukin-6(IL-6), Tumor Necrosis Factor alpha (TNF-α), Interleukin 1 alpha (IL-1 α) and Interferon gamma (INF-γ)] in the stored blood samples of 22 patients with Graves’ disease who previously randomized to receive either chloroquine and methimazole combination therapy or methimazole monotherapy. Total T3, T4 and TSH levels were measured by an enzyme linked immunosorbent assay (ELISA) method (DRG, New York, USA) and the result was published previously. In this study we used an ELISA method (Bender Medsystem Vienna Austria) to measure serum pro-inflammatory cytokines in the first 6 months of trial. Results: No significant differences in serum cytokines concentration were observed between the two treatment groups (p > 0.05). Although it was not statistically significant, serum INF-gamma concentration tended to be lower in the chloroquine group after four months of therapy (p = 0.12). Conclusion: In this study we found changes in the serum thyroid hormones level did not accompany concomitant changes in the serum cytokines levels in two treatment groups. Therefore it is possible that chloroquine reduce serum thyroid hormones levels independent of its immunomodulatory effect.
文摘Summary of Lupus and Basedow Disease Association: The association lupus auto-immune thyroid disease is well known. Lupus is most commonly associated with Hashimoto’s thyroiditis. As for Graves’ disease, it is most often associated with pernicious anaemia, vitiligo, idiopathic purpura and myasthenia gravis. To our knowledge, we report the first case of lupus associated with Graves’ disease in sub-Saharan Africa. Observation: A female patient of 52 years old has been followed since February 2010 for systemic lupus diagnosed on biological and immunological clinical ACR criteria. There was no skin ailment and kidneys involved. Combined treatment with high-dose corticosteroids early and rapid decrease and hydroxychloroquine was established with good clinical and biological evolution. One year later the patient developed thyrotoxicosis syndrome and vascular goitre without exophthalmos associated with the presence of antibodies anti receptor of TSH leading to the diagnosis of Graves’ disease. The patient has been treated with synthetic anti-thyroid and beta blocker allowing the regression of clinical symptoms and the normalization of thyroid hormones. Since then, the patient had not shown other signs of systemic affection. Conclusion: Systemic diseases are often associated with autoimmune thyreopathies. But association of lupus with Graves’ disease has been rarely described in the literature. One should always watch out for the occurrence of thyroid disease in front of any systemic disease and vice versa.
文摘Introduction: Mostly reported common side effects of carbimazole are cutaneous allergies and severe agranulocytosis. However, hepatotoxicity is rarely described. Thus, we report four observations of carbimazole drug-induced hepatitis during the treatment of Graves’ disease, which imputability is likely and probably an immuno-allergic mechanism. Observations: They were four women whose average age was 43 years, with extreme ages of 32 and 54. Patients were monitored and treated with carbimazole in doses contained between 40 mg and 60 mg per day. Clinical manifestations of liver injury were mainly dominated by cholestatic jaundice, found in 100% of our patients. A painful sensitivity of the right hypochondrium was concomitant with jaundice for two patients. The jaundice time to onset after the beginning of treatment with carbimazole varies between 1 month and 6 months. They all had acute hepatitis. The biological assays used to determine the type of liver injury showed, in all cases, a mixed, cholestatic and cytolytic hepatitis. Therapeutically, in all patients, carbimazole was stopped as soon as the suspicion of its incrimination in the occurrence of liver damage was set up. They all had a substitution of carbimazole with benzylthiouracil. Evolution was favorable for all patients, after therapeutic substitution. It was marked by disappearance of jaundice and normalization of the liver biological parameters within a maximum delay of two months after stopping carbimazole use. Conclusion: Treatment with synthetic antithyroid drugs, particularly carbimazole that is most widely used in our regions, requires clinical and biological monitoring. This surveillance, which is often difficult in Africa because of the limited economic resources, can lead to the occurrence of side effects such as potentially serious drug-induced hepatitis, but which has been favorable in our observations.
文摘Pretibial myxoedema (PM) is a late and rare manifestation of autoimmune thyroiditis, particularly in patients with Graves’ disease. It occurs in 0.5% to 4.3% of patients [1], and is usually associated with high levels of thyroid hormones. The classification of PM includes four forms: non-pitting edema;plaque;nodular;or elephantiasis [1]. Mild PM often regresses spontaneously, but the severe, elephantiasic variant is typically progressive and refractory to treatment. Elephantiasic pretibial myxoedema (EPM) is characterized by massive edema, skin fibrosis and verrucous nodule formation, and it clinically resembles lymphedema. Herein, we describe a man with Graves’ disease presenting with EPM for nearly 2 years. Although advanced cases have been described in the literature, to our knowledge, none have reached this level of severity.
文摘<strong>Background:</strong> Alternating thyroid function between hypo- and hyperthyroidism is a very rare phenomenon attributed to the switch between the types of thyroid stimulating hormone receptor autoantibodies;thyroid stimulating antibody and thyroid stimulating hormone blocking antibody. <strong>Case Presentation:</strong> We report an 18 years old male who presented with hyperthyroidism attributed to Graves’ disease. He was treated with antithyroid medication. During follow up, his thyroid function was switching between hyper- and hypothyroidism which was difficult to treat with antithyroid medication. His laboratory investigations revealed high thyroid stimulating immunoglobulin and TSH binding inhibitory immunoglobulin. Due to the difficultly of managing him with antithyroid medication, he was offered a definitive management for his Graves’ disease. <strong>Conclusion:</strong> This case demonstrates a rare challenging presentation of Graves’ disease. Patients presenting with fluctuation in thyroid function between hyper-and hypothyroidism need a definitive management for Graves’ disease.
文摘BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease 2019(COVID-19)and to save lives.Vaccine safety is one of the issues under surveillance and a possible correlation between vaccines and thyroid function has been reported.However,reports of the impact of coronavirus vaccines on those with Graves’disease(GD)are rare.CASE SUMMARY This paper presents two patients with underlying GD in remission,both developed thyrotoxicosis and one developed thyroid storm following the adenovirus-vectored vaccine(Oxford-AstraZeneca,United Kingdom).The objective of this article is to raise awareness regarding a possible association between COVID-19 vaccination and the onset of thyroid dysfunction in patients with underlying GD in remission.CONCLUSION Receiving either the mRNA or an adenovirus-vectored vaccine for SARS-CoV-2could be safe under effective treatment.Vaccine induced thyroid dysfunction has been reported,but the pathophysiology still not well understood.Further investigation is required to evaluate the possible predisposing factors for developing thyrotoxicosis especially in patients with underlying GD.However,early awareness of thyroid dysfunction following vaccination could avoid a lifethreatening event.
