AIM:To evaluate the role of thyroid blood flow assessment by color-flow Doppler ultrasonography in the differential diagnosis of thyrotoxicosis and compare it to technetium pertechnetate thyroid scanning. METHODS:Twen...AIM:To evaluate the role of thyroid blood flow assessment by color-flow Doppler ultrasonography in the differential diagnosis of thyrotoxicosis and compare it to technetium pertechnetate thyroid scanning. METHODS:Twenty-six patients with thyrotoxicosis were included in the study. Clinical history was taken and physical examination and thyroid function tests were performed for all patients. Thyroid autoantibodies were measured. The thyroid glands of all patients were evaluated by gray scale ultrasonography for size, shape and echotexture. Color-flow Doppler ultrasonography of the thyroid tissue was performed and spectral flow analysis of both inferior thyroid arteries was assessed. Technetium99 pertechnetate scanning of the thyroid gland was done for all patients. According to thyroid scintigraphy, the patients were divided into two groups:18 cases with Graves' disease and 8 cases with Hashimoto's thyroiditis. All patients had suppressed thyrotropin. The diagnosis of Graves' disease and Hashimoto's thyroiditis was supported by the clinical picture and follow up of patients. RESULTS:Peak systolic velocities of the inferior thyroid arteries were significantly higher in patients with Graves' disease than in patients with thyroiditis (P = 0.004 in the right inferior thyroid artery and P = 0.001 in left inferior thyroid artery). Color-flow Doppler ultrasonography parameters demonstrated a sensitivity of 88.9% and a specificity of 87.5% in the differential diagnosis of thyrotoxicosis. CONCLUSION:Color Doppler flow of the inferior thyroid artery can be used in the differential diagnosis of thyrotoxicosis, especially when there is a contraindication of thyroid scintigraphy by radioactive material in some patients.展开更多
BACKGROUND The literature on thyrotoxicosis caused by excessive ingestion of exogenous thyroid hormone is limited,and most cases reported have involved pediatric clinical studies.CASE SUMMARY A 21-year-old woman initi...BACKGROUND The literature on thyrotoxicosis caused by excessive ingestion of exogenous thyroid hormone is limited,and most cases reported have involved pediatric clinical studies.CASE SUMMARY A 21-year-old woman initially presented with palpitation and chest tightness after an overdose of levothyroxine(10 mg).The patient transiently lost consciousness and developed atrial fibrillation during hospitalization.We used propylthiouracil to decrease the peripheral conversion of T4 to T3 and inhibit the synthesis of endogenous thyroxine,propranolol to control heart rate,hydrocortisone to correct severe thyrotoxicosis,and hemoperfusion to increase levothyroxine clearance.The patient recovered and was discharged.CONCLUSION For patients with thyrotoxicosis after taking excess levothyroxine,it is critical to monitor vital signs and initiate effective treatment.展开更多
Diffuse sclerosing variant of papillary thyroid carcinoma (DSVPC) is a rare variant of conventional papillary thyroid carcinoma which was first reported in 1985. It appears to be more aggressive than conventional type...Diffuse sclerosing variant of papillary thyroid carcinoma (DSVPC) is a rare variant of conventional papillary thyroid carcinoma which was first reported in 1985. It appears to be more aggressive than conventional type of papillary thyroid carcinoma. We present a case in a 14-year-old girl who initially presented with thyrotoxicosis and was later diagnosed with DSVPC on subsequent ultrasound and fine need leaspiration when cervicallymph node was evident on clinical examination. Concomitant thyrotoxicosis in thyroid carcinoma is uncommon. The prevalence, clinical presentation, characteristic radiological and histological features, management and prognosis of DSVPC are discussed with literature review. We also hope to illustrate through this case that ultrasound as a non-invasive imaging modality is an invaluable tool for workup in functional thyroid problems and concomitant malignancy may not be that uncommon, so that we could provide prompt treatment to our patients.展开更多
Two healthy dogs weighing 18 kg and 13 kg each received an intravenous injection of 7 μg/kg 25-hydroxyvitamin D3 (25OHD3). Subsequently, they were blood-sampled in order to determine the plasma levels of 25(OH)D3 ove...Two healthy dogs weighing 18 kg and 13 kg each received an intravenous injection of 7 μg/kg 25-hydroxyvitamin D3 (25OHD3). Subsequently, they were blood-sampled in order to determine the plasma levels of 25(OH)D3 over 4-hourly time intervals and for a time period of 24 hours. After a period of 18 days since the last blood sampling, the animals were brought to a hyperthyroid state and the intravenous injection of 7 μg/kg 25OHD3 was repeated. Blood sampling was performed every 4 hours and over a time period of 24 hours in order to determine the levels of 25OHD3. The graphic plotting of plasma levels of 25OHD3 in the euthyroid state did not differ from that in the hyperthyroid state. This finding in dog animal experimentation is indicative that the increased levels of thyroid hormones did not affect the activity of CYP27B1 and CYP24A1 enzymes that are related to the catabolism of 25OHD3 over a minimum of 24 hours period.展开更多
Secondary hyperparathyroidism （SHPT） is a common complication in chronic kidney disease （CKD） that is characterized by excessive synthesis of parathyroid hormone （PTH） and parathyroid hyperplasia.The prevalence ...Secondary hyperparathyroidism （SHPT） is a common complication in chronic kidney disease （CKD） that is characterized by excessive synthesis of parathyroid hormone （PTH） and parathyroid hyperplasia.The prevalence of CKD is estimated to be 5-10%, and the burden of CKD-associated diseases is alarmingly high.Despite advances in medical therapy for SHPT, surgical parathyroidectomy remains the definitive therapy for refractory SHPT, which drastically decreases PTH levels and ameliorates symptoms related to severe SHPT.展开更多
In clinical practice,serum electrolytes of patients with hyperthyroidism are often ignored.The prevalence of hypercalcemia in patients with thyrotoxicosis was 17% to 50% in literatures,1,2 and asymptomatic serum calci...In clinical practice,serum electrolytes of patients with hyperthyroidism are often ignored.The prevalence of hypercalcemia in patients with thyrotoxicosis was 17% to 50% in literatures,1,2 and asymptomatic serum calcium elevation has been documented in up to 20%.1 We described a case of hypercalcemia related to thyrotoxicosis,which had been neglected by the doctors at the first visit.展开更多
BACKGROUND The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019(COVID-19). SARS-CoV-2 infections not only re...BACKGROUND The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019(COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2.CASE SUMMARY A 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room(ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction(PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test,serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography,and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient’s condition worsened, and a cesarean section was performed under general anesthesia;a healthy boy was delivered, and 12 h after delivery, the patient’s seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves’ disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures.CONCLUSION In pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.展开更多
Along with hereditary myopathies, there are many exogenic (the same a not hereditary) muscle affections due to the pathology of endocrine gland’s functioning. These forms of muscle pathology are called endocrine myop...Along with hereditary myopathies, there are many exogenic (the same a not hereditary) muscle affections due to the pathology of endocrine gland’s functioning. These forms of muscle pathology are called endocrine myopathies. In the cases of thyroid gland hyperfunction (the same a thyrotoxicosis), different regions of neuromuscular system may be involved in the pathological process. Thyrotoxic myopathy (TM) which is a subject of this investigation, occupies one of the first places between thyrotoxic (the same a thyrotoxicosis) neuromuscular affections. Meanwhile, for a long time in literature there was no clarity about the degree of muscle weakness and atrophy to diagnose TM in a patient. It’s because of the fact that the majority of patients complain of increased fatigue and general weakness due to thyrotoxicosis. In present time TM diagnostics is very rare. TM is a phenocopy (the clinical similar) of many neuromuscular diseases. However in literature, the data about peculiarities of clinical picture of TM is almost completely absent, it isn’t known about the frequency of affection of the isolated muscles or muscle groups, the topography of muscle weakness and successive involvement of isolated muscles in the pathological process during different stages of thyrotoxicosis and myopathy. The questions of differential diagnosis with similar neuromuscular disorders are described very poorly. In present article, we accent our attention at the clinical differentiation of the TM with other neuromuscular diseases, namely muscular dystrophy, myasthenia gravis, polymyositis, Addison’s disease, proximal spinal muscular atrophy, steroid myopathy and neurosis. In our opinion, the early diagnosis of TM may help the diagnosis of thyrotoxicosis in patients who have no classical clinical signs of this disease, i.e. in patients with latent thyrotoxicosis.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
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
Objective: Management of Graves' orbitopathy (GO) continues to be a challenge to clinical endocrinologists. In the last few years, surveys on GO management have succeeded in elucidating trends in Europe and Latin ...Objective: Management of Graves' orbitopathy (GO) continues to be a challenge to clinical endocrinologists. In the last few years, surveys on GO management have succeeded in elucidating trends in Europe and Latin America. To determine how endocrinologists in China assess and treat patients with GO and gain insight into how to make the management of this disease more uniform and standardized. Methods: Based on the questionnaire used in the European survey on GO, a questionnaire in China was drafted and circulated to the members of Chinese Society of Endocrinology (CSE) during the annual meeting. Results: A total of 124 valid responses were analysed. Almost all respondents (94.4%) claimed that a multidisciplinary approach for GO management was valuable. Over 80% of the participants advocated the assessment of exophthalmometry, vision, visual fields by perimetry, eye movements, and fundoscopy. Glucocorticoids were preferred as the first-line therapy by 92.7% of respondents, among them, 59.7% choose the intravenous route. The treatment strategy for GO with intravenous glucocorticoids therapy still remains debatable. Anti-thyroid drugs (ATDs) were the most common choice (72.6%) for first-line therapy of coexisting hyperthyroidism. Treatment options for GO were very similar among Chinese, Latin-American and Eu-ropean respondents, whereas radioactive iodine and surgical treatment were more often indicated for co-existing hyperthyroidism in China. Conclusion: The appropriate treatment for patients with GO is controversial even among thyroid specialists. Further training of thyroid specialists, easier access of patients to multidisciplinary centres and establishment of practice guidelines are required for the management of this condition in China. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).展开更多
文摘AIM:To evaluate the role of thyroid blood flow assessment by color-flow Doppler ultrasonography in the differential diagnosis of thyrotoxicosis and compare it to technetium pertechnetate thyroid scanning. METHODS:Twenty-six patients with thyrotoxicosis were included in the study. Clinical history was taken and physical examination and thyroid function tests were performed for all patients. Thyroid autoantibodies were measured. The thyroid glands of all patients were evaluated by gray scale ultrasonography for size, shape and echotexture. Color-flow Doppler ultrasonography of the thyroid tissue was performed and spectral flow analysis of both inferior thyroid arteries was assessed. Technetium99 pertechnetate scanning of the thyroid gland was done for all patients. According to thyroid scintigraphy, the patients were divided into two groups:18 cases with Graves' disease and 8 cases with Hashimoto's thyroiditis. All patients had suppressed thyrotropin. The diagnosis of Graves' disease and Hashimoto's thyroiditis was supported by the clinical picture and follow up of patients. RESULTS:Peak systolic velocities of the inferior thyroid arteries were significantly higher in patients with Graves' disease than in patients with thyroiditis (P = 0.004 in the right inferior thyroid artery and P = 0.001 in left inferior thyroid artery). Color-flow Doppler ultrasonography parameters demonstrated a sensitivity of 88.9% and a specificity of 87.5% in the differential diagnosis of thyrotoxicosis. CONCLUSION:Color Doppler flow of the inferior thyroid artery can be used in the differential diagnosis of thyrotoxicosis, especially when there is a contraindication of thyroid scintigraphy by radioactive material in some patients.
文摘BACKGROUND The literature on thyrotoxicosis caused by excessive ingestion of exogenous thyroid hormone is limited,and most cases reported have involved pediatric clinical studies.CASE SUMMARY A 21-year-old woman initially presented with palpitation and chest tightness after an overdose of levothyroxine(10 mg).The patient transiently lost consciousness and developed atrial fibrillation during hospitalization.We used propylthiouracil to decrease the peripheral conversion of T4 to T3 and inhibit the synthesis of endogenous thyroxine,propranolol to control heart rate,hydrocortisone to correct severe thyrotoxicosis,and hemoperfusion to increase levothyroxine clearance.The patient recovered and was discharged.CONCLUSION For patients with thyrotoxicosis after taking excess levothyroxine,it is critical to monitor vital signs and initiate effective treatment.
文摘Diffuse sclerosing variant of papillary thyroid carcinoma (DSVPC) is a rare variant of conventional papillary thyroid carcinoma which was first reported in 1985. It appears to be more aggressive than conventional type of papillary thyroid carcinoma. We present a case in a 14-year-old girl who initially presented with thyrotoxicosis and was later diagnosed with DSVPC on subsequent ultrasound and fine need leaspiration when cervicallymph node was evident on clinical examination. Concomitant thyrotoxicosis in thyroid carcinoma is uncommon. The prevalence, clinical presentation, characteristic radiological and histological features, management and prognosis of DSVPC are discussed with literature review. We also hope to illustrate through this case that ultrasound as a non-invasive imaging modality is an invaluable tool for workup in functional thyroid problems and concomitant malignancy may not be that uncommon, so that we could provide prompt treatment to our patients.
文摘Two healthy dogs weighing 18 kg and 13 kg each received an intravenous injection of 7 μg/kg 25-hydroxyvitamin D3 (25OHD3). Subsequently, they were blood-sampled in order to determine the plasma levels of 25(OH)D3 over 4-hourly time intervals and for a time period of 24 hours. After a period of 18 days since the last blood sampling, the animals were brought to a hyperthyroid state and the intravenous injection of 7 μg/kg 25OHD3 was repeated. Blood sampling was performed every 4 hours and over a time period of 24 hours in order to determine the levels of 25OHD3. The graphic plotting of plasma levels of 25OHD3 in the euthyroid state did not differ from that in the hyperthyroid state. This finding in dog animal experimentation is indicative that the increased levels of thyroid hormones did not affect the activity of CYP27B1 and CYP24A1 enzymes that are related to the catabolism of 25OHD3 over a minimum of 24 hours period.
文摘Secondary hyperparathyroidism （SHPT） is a common complication in chronic kidney disease （CKD） that is characterized by excessive synthesis of parathyroid hormone （PTH） and parathyroid hyperplasia.The prevalence of CKD is estimated to be 5-10%, and the burden of CKD-associated diseases is alarmingly high.Despite advances in medical therapy for SHPT, surgical parathyroidectomy remains the definitive therapy for refractory SHPT, which drastically decreases PTH levels and ameliorates symptoms related to severe SHPT.
文摘In clinical practice,serum electrolytes of patients with hyperthyroidism are often ignored.The prevalence of hypercalcemia in patients with thyrotoxicosis was 17% to 50% in literatures,1,2 and asymptomatic serum calcium elevation has been documented in up to 20%.1 We described a case of hypercalcemia related to thyrotoxicosis,which had been neglected by the doctors at the first visit.
文摘BACKGROUND The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019(COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2.CASE SUMMARY A 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room(ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction(PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test,serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography,and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient’s condition worsened, and a cesarean section was performed under general anesthesia;a healthy boy was delivered, and 12 h after delivery, the patient’s seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves’ disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures.CONCLUSION In pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.
文摘Along with hereditary myopathies, there are many exogenic (the same a not hereditary) muscle affections due to the pathology of endocrine gland’s functioning. These forms of muscle pathology are called endocrine myopathies. In the cases of thyroid gland hyperfunction (the same a thyrotoxicosis), different regions of neuromuscular system may be involved in the pathological process. Thyrotoxic myopathy (TM) which is a subject of this investigation, occupies one of the first places between thyrotoxic (the same a thyrotoxicosis) neuromuscular affections. Meanwhile, for a long time in literature there was no clarity about the degree of muscle weakness and atrophy to diagnose TM in a patient. It’s because of the fact that the majority of patients complain of increased fatigue and general weakness due to thyrotoxicosis. In present time TM diagnostics is very rare. TM is a phenocopy (the clinical similar) of many neuromuscular diseases. However in literature, the data about peculiarities of clinical picture of TM is almost completely absent, it isn’t known about the frequency of affection of the isolated muscles or muscle groups, the topography of muscle weakness and successive involvement of isolated muscles in the pathological process during different stages of thyrotoxicosis and myopathy. The questions of differential diagnosis with similar neuromuscular disorders are described very poorly. In present article, we accent our attention at the clinical differentiation of the TM with other neuromuscular diseases, namely muscular dystrophy, myasthenia gravis, polymyositis, Addison’s disease, proximal spinal muscular atrophy, steroid myopathy and neurosis. In our opinion, the early diagnosis of TM may help the diagnosis of thyrotoxicosis in patients who have no classical clinical signs of this disease, i.e. in patients with latent thyrotoxicosis.
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.
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Objective: Management of Graves' orbitopathy (GO) continues to be a challenge to clinical endocrinologists. In the last few years, surveys on GO management have succeeded in elucidating trends in Europe and Latin America. To determine how endocrinologists in China assess and treat patients with GO and gain insight into how to make the management of this disease more uniform and standardized. Methods: Based on the questionnaire used in the European survey on GO, a questionnaire in China was drafted and circulated to the members of Chinese Society of Endocrinology (CSE) during the annual meeting. Results: A total of 124 valid responses were analysed. Almost all respondents (94.4%) claimed that a multidisciplinary approach for GO management was valuable. Over 80% of the participants advocated the assessment of exophthalmometry, vision, visual fields by perimetry, eye movements, and fundoscopy. Glucocorticoids were preferred as the first-line therapy by 92.7% of respondents, among them, 59.7% choose the intravenous route. The treatment strategy for GO with intravenous glucocorticoids therapy still remains debatable. Anti-thyroid drugs (ATDs) were the most common choice (72.6%) for first-line therapy of coexisting hyperthyroidism. Treatment options for GO were very similar among Chinese, Latin-American and Eu-ropean respondents, whereas radioactive iodine and surgical treatment were more often indicated for co-existing hyperthyroidism in China. Conclusion: The appropriate treatment for patients with GO is controversial even among thyroid specialists. Further training of thyroid specialists, easier access of patients to multidisciplinary centres and establishment of practice guidelines are required for the management of this condition in China. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
