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Among the endocrine disorders, thyroid disease ranks second only to diabetes mellitus in prevalence. Hyperthyroidism accounts for a considerable portion of thyroid disease, occurring in both sexes and at virtually all ages. All forms of the condition are readily treatable, and the cost of treatment is not excessive, so accurate diagnosis has clear and satisfying rewards for both patient and physician. An awareness of the various causes of the disease and alertness to the often unusual ways that thyrotoxicosis can present are important elements of diagnosis. In addition, effective use of laboratory tests is essential.
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PMID:Hyperthyroidism. The clinical spectrum. 156 Nov 62

The authors relate the data on vegetative sweating fibers studied by the method of evoked skin sympathetic potentials in patients with diabetes mellitus, Charcot-Marie atrophy, spinal amyotrophy, Guillain-Barre syndrome, essential hyperhidrosis, and in those with Raynaud's phenomenon and thyrotoxicosis. A remarkable decrease of conduction by sweating fibers was revealed in patients with diabetes mellitus, Charcot-Marie atrophy and Raynaud's phenomenon; a moderate decrease was shown by the patients with Guillain-Barre syndrome and by those with spinal amyotrophy. The conclusion is made about the high information content of the method.
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PMID:[Electrophysiological analysis of the functions of the sweat gland fibers in various diseases]. 165 95

The purpose of the study was to examine vegetative innervation of the pupil in different diseases associated and not associated with vegetative disorders. In addition to the ++clinico-neurological method, the main method of examination was to study the pupillary cycle (determination of the time of the pupillary cycle (TPC) with the aid of a slit lamp). Fifty healthy test subjects and 262 patients suffering from different somatic and neurologic diseases were examined. The patients were divided in 9 clinical groups: spinal amyotrophy, neural Charcot-Marie amyotrophy, Guillain-Barre syndrome, diabetes mellitus, thyrotoxicosis, hemicrania, Raynaud's disease, idiopathic hyperhidrosis, vegetative crises. The data obtained demonstrate varying grades of the rise of the TPC in the indicated diseases, which reflects varying degrees of vegetative innervation of the pupil insufficiency. However, no well-defined correlation was obtained between the intensity of the psychovegetative syndrome and the TPC. Therefore, it has been shown that the method of determining the TPC is unsophisticated and noninvasive and can be successfully used in different forms of pathology to identify vegetative insufficiency at different stages of the disease.
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PMID:[Evaluation of the autonomic innervation of the pupil]. 165 96

The incidence of thyrotoxicosis accompanied by overt diabetes has been reported to be 2 to 3%. Several workers have suggested the possible role of immunological and inherited factors in the occurrence of thyrotoxic patients with overt diabetes. We investigated, therefore, the clinical characteristics, backgrounds, and HLA antigens in thyrotoxic patients with overt diabetes. In nine thyrotoxic patients with overt diabetes (group DM) (3 men and 6 females, average age of 45.8 +/- 2.9 yr), mean levels of free-triiodothyronine (FT3) and free thyroxine (FT4) were 8.2 +/- 0.8 pg/ml and 4.9 +/- 0.4 ng/dl, respectively. Although these levels were extremely high, they were significantly lower than those levels in forty thyrotoxic patients without overt diabetes (group ND) (8 men and 32 females, average age 35.1 +/- 4.5 yr). Mean levels of both thyrotrophin receptor-antibody (TR-Ab) and thyroid simulating antibody (TS-Ab) in group DM were relatively lower than those in group ND. Mean titers of both antithyroid antibody (TGHA) and antimicrosomal antibody (MCHA) in group DM were also relatively lower than those in group ND, respectively. Regarding the clinical features in thyrotoxic patients with overt diabetes, mean duration of diabetes mellitus was 4.1 +/- 2.5 years with mean levels of fasting plasma glucose (FPG), HbA1c, and serum fructosamine 208.1 +/- 34.0 mg/dl, 10.6 +/- 0.6%, and 3.9 +/- 0.9 mmol/L, respectively. Seven patients in group DM frequently had ketosis or ketoacidosis in their histories, and they had been treated with insulin injection. However, the diabetic complications in group DM were moderate or severe.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[HLA-antigens in thyrotoxic patients with overt diabetes mellitus]. 181 23

100 consecutive Chinese patients with SLE were recruited for study of HLA-A, B and DR antigen. Clinical and serological parameters were analysed with respect to the HLA antigens. B5 was associated with presence of other autoimmune diseases (thyrotoxicosis, myasthenia gravis, diabetes mellitus, corrected p less than 0.025); absence of malar rash (corrected p less than 0.025); B35, with male sex (corrected p less than 0.025); DR2 with anti-Ro (anti-SSA) antibody (p less than 0.05). Previous study of association with B13, B17 was not present in our cohort. Except for malar rash, subclassification of disease status with respect to HLA antigen did not reveal significant association.
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PMID:Immunogenetics in Chinese patients with SLE. 203 Nov 54

This outline is based on dietary advice, regular exercise, diabetes education (including glucose monitoring) and, if necessary, an oral hypoglycaemic agent or insulin. Precipitating factors such as dietary indiscretions, infections, drugs, thyrotoxicosis and haemochromatosis should be sought, and associated cardiovascular risk factors such as obesity, hyperlipidaemia, hypertension and a history of smoking should receive attention.
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PMID:The patient with newly diagnosed diabetes mellitus. 220 16

We previously showed that for Singapore diabetics, a low prevalence of islet cell antibodies (ICA) and insulin autoantibodies (IAA) were observed, unlike the high prevalence rates in Caucasian populations. In this report, we have measured other autoimmune markers (thyroid autoantibodies, thyrotrophin [TSH] receptor antibodies, rheumatoid factor and anti-dsDNA antibodies) to assess the extent of autoimmunity in our newly diagnosed diabetes patients and those with long-standing diabetes. Results indicate that there is a raised prevalence of thyroid autoantibodies in diabetics compared to the general population. Thyroid autoantibodies occurred in 24.3% (28/115) of the patients; thyroid microsomal antibodies (16.5%, 19/115) was much higher than for thyroglobulin antibodies (1.7%, 2/115). Prevalence rates of thyroid autoantibodies were lower in diabetics who were newly diagnosed (21.6%, 11/51), compared to those with long-standing disease (25.5%, 14/55). Three patients (3/9) with gestational diabetes were also positive for thyroid autoantibodies. TSH receptor antibodies associated with Graves' disease, were found in two patients. However, they also had thyrotoxicosis. Five patients (4.3%, 5/115) were detected with rheumatoid factor, but were clinically asymptomatic. Anti-dsDNA antibodies were not detected in any of the subjects. The presentation of thyroid autoantibodies or rheumatoid factor with age did not coincide with diabetes-associated ICA and IAA. It may mean that inspite of prevalence of subclinical autoimmunity in diabetes, autoimmunity against beta-cell lesions is not associated with the overall autoimmune tendency in our diabetes.
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PMID:Humoral immune abnormalities in diabetes mellitus. 222 99

The mechanism of glucose intolerance in thyrotoxicosis was investigated in 119 patients with Graves's disease with careful consideration of the age-related deterioration of glucose tolerance. Before and after treatment of thyrotoxicosis with antithyroid drug, changes of blood glucose (BG) and serum immunoreactive insulin (IRI) in response to 50 g oral glucose tolerance test (OGTT) and insulin binding to red blood cell (RBC) were evaluated. In control subjects, the sigma IRI/sigma BG ratio after 50-g OGTT decreased progressively with age without significant change in absolute sigma IRI value, suggesting the occurrence of age-related insulin resistance. Glucose intolerance was much more apparent in hyperthyroid patients because of age-related relative decrease of insulin secretion. Such a decrease of insulin secretion was not found in age-matched postgastrectomy patients with a similar degree of hyperglycemia, however. Maximal binding of labeled insulin and number of insulin receptors of RBC were decreased in old patients but binding affinity was unchanged. Elevation of BG was partially suppressed when serum thyroxine (T4) and triiodothyronine (T3) were reduced to moderately supernormal levels, whereas sigma BG, sigma IRI, sigma IRI/sigma BG ratio, and insulin binding to RBC were all returned to normal when normal serum thyroid hormone concentration was maintained. Our data indicate that insufficient insulin secretion and reduced insulin action at the target cell are responsible, at least in large part, for age-related glucose intolerance in hyperthyroid patients.
Diabetes Care
PMID:Effects of antithyroid drug therapy on blood glucose, serum insulin, and insulin binding to red blood cells in hyperthyroid patients of different ages. 258 47

In summary, there are a number of important respiratory manifestations of endocrine diseases. Hypothyroidism may be associated with respiratory failure that can be caused by a reduction in central respiratory drive, upper airway obstruction, and associated restrictive pulmonary function from pleural effusions or an intrinsic decrease in lung volumes. Hyperthyroidism can present with dyspnea as a major clinical manifestation because of the increase in central respiratory drive associated with thyrotoxicosis. Cardiac dysfunction associated with hyperthyroidism may lead to pulmonary edema in some patients. Hypoparathyroidism may occur acutely, especially after thyroid surgery and be associated with hypocalcemia and acute tetany, laryngeal stridor, and muscle weakness. Ovarian tumors, both benign and malignant, may present with unilateral or bilateral effusions. Finally, patients with diabetes mellitus are at increased risk of developing a variety of pulmonary disorders. Acute and chronic pulmonary infections are the most common respiratory abnormalities in patients with diabetes, although cardiogenic and noncardiogenic pulmonary edema can also be a complication of their disease.
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PMID:Pulmonary manifestations of endocrine and metabolic disorders. 268 69

The special characteristics of postpartum thyroid syndromes are summarized in Table 8. Many of the cases will pass unnoticed, although a higher detection rate is to be expected if postpartum thyroid disease becomes better known among physicians and the general public. Screening in early pregnancy of women with a previous or family history of thyroid disease and in women with other autoimmune disorders (such as diabetes mellitus type 1) may be worthwhile. The initial manifestation of postpartum thyroiditis, often appearing during the first three months postpartum, is a thyrotoxic phase characterized by a low RAIU ('painless thyroiditis' or 'destruction-induced thyrotoxicosis'). Subsequently, a transient hypothyroid phase supervenes. In a small proportion of women hypothyroidism becomes permanent. After a subsequent pregnancy recurrence is the rule. Women who are genetically disposed to Graves' disease may experience thyrotoxicosis with a high RAIU usually appearing later than three months postpartum. As the thyroid function abnormalities are usually mild and transient it is often appropriate to withhold treatment. However, in women with pronounced symptoms treatment should be started. When the postpartum period has passed gradual withdrawal of treatment should be attempted. In women who have experienced postpartum thyroid dysfunction, the risk of developing permanent thyroid disease in later life seems important and therefore long-term follow-up is recommended.
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PMID:Postpartum thyroiditis. 306 21


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