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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hyper- and hypothyroidism in the elderly do--as many other diseases--not present with the typical clinical picture known from textbook descriptions. Thus hyperthyroidism may be the cause of common complaints and symptoms such as weight loss, fatigue, lack of appetite and cardiac failure with tachycardiac arrhythmias. Due to completely unspecific symptoms and signs, the hypothyroid elderly patient will initially be presented to a psychiatrist, neurologist, dermatologist, gastroenterologist or ENT-specialist rather than to an endocrinologist or geriatrician. The serious consequences which may result from overlooking hyper- and hypothyroidism in the elderly can be prevented if the possibility of thyroid disease is more frequently taken into consideration, if the diagnosis is based on modern in-vitro measurements, and if hyper- and hypothyroidism are systematically looked for in groups at risk, i.e. in inhabitants of old people's, homes, nursing homes as well as in patients of psychiatric and geriatric hospitals.
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PMID:[Diagnostic and therapeutic problems of hyper- and hypothyroidism in the aged]. 644 66

We examined the thyroid status of 58 patients with primary biliary cirrhosis (PBC) using total serum thyroxin, thyroid hormone binding ratio, free thyroxin index, serum TSH, antithyroglobulin, and antimicrosomal antibodies. Seven patients were known to be hypothyroid prior to the diagnosis of PBC. Six additional patients were found to have biochemical evidence of hypothyroidism. The prevalence of hypothyroidism was 12% if we include only those six PBC patients with newly diagnosed hypothyroidism or 22% if we include all 13 patients. Five of the 58 patients had evidence for an elevation of thyroid hormone binding capacity. Three hypothyroid patients had normal total thyroxins with low thyroid hormone binding ratios. Two euthyroid patients had elevated total T4s with low thyroid hormone binding ratio and normal FTI. The prevalence of positive antimicrosomal antibodies was 34%, including 11 euthyroid PBC patients. The prevalence of positive antithyroglobulin antibodies was 20% including five euthyroid patients. There was no association between HLA DR3 or DR5 and the patients with hypothyroidism and/or antithyroid antibodies. Because fatigue, lethargy, and anorexia as well as hypercholesterolemia are common features of both hypothyroidism and PBC, patients with PBC should be screened for evidence of thyroid dysfunction. Thyroid disease may precede the diagnosis of PBC by several years. Therefore, the development of cholestatic liver disease in a patient with known autoimmune thyroiditis should arouse suspicion of PBC.
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PMID:Increased incidence of hypothyroidism in primary biliary cirrhosis. 662 57

A 47-year-old housewife was admitted to our hospital because of general fatigue and constipation suggesting hypothyroidism. For 3 years before admission, general fatigue, arrhythmia, dry skin, drowsiness, cold intolerance and hypermenorrhea occurred insidiously. She had habitually taken considerable amounts of seaweed every day, e.g. more than 50 g of " Kombu " for more than 5 years and at least 1 g of " Wakame " for 6 months. On admission, serum thyroxine (T4) was 1.3 micrograms/dl, serum triiodothyronine (T3) was 47 ng/dl, TSH was 132 microunits/ml, and 123I thyroidal uptake was 60% at 3 hr. and 75% at 24 hr. Anti-thyroglobulin hemagglutination antibodies and anti-thyroid microsomal hemagglutination antibodies were both negative. When seaweed was omitted from her diet, T4 rose to 6.3 micrograms/dl and T3 rose to 113 ng/dl, whereas TSH lowered to 11 microunits/ml in 2 weeks. The seaweed-free diet was continued and 4 months later, when she had become euthyroid, an open biopsy of the thyroid gland was carried out. Histological examination of the specimen revealed a marked colloid deposition without characteristic features of Hashimoto's disease. Five months after admission, with the daily administration of 100 mg potassium iodide (KI), the effects of inorganic iodide on thyroid function had begun to be seen. On the 16th day of the KI regimen, palpitation and tachycardia (pulse rate 160/min.) with multifocal ventricular premature beat appeared, and T4 on the 11th day was 5.9 micrograms/dl, which was clearly lower than the pretreatment level of 8.4 micrograms/dl. KI was discontinued on the 16th day, and one week after the withdrawal, T4, T3 and TSH all returned to the pretreatment level. For more than 3 years on a seaweed-free diet, she remained euthyroid without any thyroid regimen. To see the effects of inorganic iodide on thyroid function after this long period on a seaweed-free diet, KI was again administered. One hundred mg/day KI for 14 days followed by 200 mg/day for 21 days had virtually no effect on T4, T3 and free T4 and she remained well. None of the perchlorate discharge tests performed on 3 occasions during the 6 month period after the initiation of the seaweed-free diet showed a discharge.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A case of iodide myxedema observed for 3 years under a low iodide diet--especially on the restoration of the mechanism of escape from the Wolff-Chaikoff effect]. 674 70

The magnitude of the thyroid-stimulating hormone (TSH) response induced by thyrotropin-releasing hormone (TRH) helps identify patients whose thyroid is failing. Many of these patients have been found to have Hashimoto's thyroiditis, symptomless autoimmune thyroiditis (SAT), and subclinical hypothyroidism. While patients with SAT are clinically euthyroid, what might be "symptomless" for the endocrinologist might be a syndrome presenting with psychiatric symptoms to the psychiatrist. As a preliminary test of this hypothesis, we tested 100 consecutive admissions to a psychiatric hospital who complained of depression or lack of energy. Fifteen (15%) of 100 patients were identified from the baseline thyroxin (T4), triiodothyronine (T3) resin uptake (RU), T3 radioimmunoassay (T3RIA), TSH, and TRH test who met criteria for either subclinical, mild, or overt hypothyroidism. Of these 15 patients, 9 (60%) had positive thyroid microsomal antibodies with titers of greater than or equal to 1:10. Our data suggest that SAT is not symptomless and may be an important diagnosis to consider in the evaluation of depressed, anergic, or atypical patients.
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PMID:"Symptomless" autoimmune thyroiditis in depression. 681 Apr 1

Rat respiratory muscles underwent considerable changes in histochemical fibre type profile in response to hypo- and hyperthyroidism. Hypothyroidism increased the proportion of type 1 slow oxidative fibres in diaphragm and to a lesser extent in intercostal muscles. Hyperthyroidism resulted in a decreased proportion of type 1 fibres in both diaphragm and intercostals. These changes were broadly comparable to those reported previously in rat limb muscles. In normal rat respiratory muscles, the type 1 fibres were characterized by very high levels of beta-hydroxybutyrate dehydrogenase which was thought to contribute to the fatigue-resistance of these muscles. The type 2B fast glycolytic fibres, and to a lesser extent type 2A fast oxidative fibres, contained high levels of mitochondrial alpha-glycerophosphate dehydrogenase, an enzyme known to be specifically affected in dysthyroid states. The implications of the observed changes in fibre type profile with respect to the oxidative metabolism of rat respiratory muscles are discussed.
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PMID:Changes in histochemical profile of rat respiratory muscles in hypo- and hyperthyroidism. 682 43

The clinical manifestations of biochemically-confirmed acquired hypothyroidism in nineteen children and adolescents were reviewed to evaluate the symptoms and signs in the early stage of the disease. The group consisted of 14 girls and 5 boys ranging in age from 4 to 15 years. In 13 of the 19 patients with profound biochemical hypothyroidism, classical symptoms were often absent and clinical signs limited. In these patients, hypothyroidism was presumed to have been short in duration and consequence of chronic lymphocytic thyroiditis. In the remaining 6 patients, hypothyroidism was long-standing and clinical presentation classical, including disproportionate weight gain, fatigue, cold intolerance, myxedematous feature, growth retardation and constipation. Goiter was the most consistent finding in both groups and was present in all instances of spontaneously acquired primary hypothyroidism. These observations emphasize the importance of routine examination of the thyroid gland, particularly in preadolescent and adolescent girls. The finding of goiter may be the only detectable sign of hypothyroidism in the early stage of the disease. Biochemical evaluation should not be deferred because of a clinically euthyroid presentation. Replacement therapy must be instituted when findings indicate a hypothyroid state. Failure to recognize and treat hypothyroidism in these pubertal patients may compromise the adult height, since skeletal maturation will proceed under the influence of sex hormones despite the presence of hypothyroidism.
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PMID:Clinical recognition of juvenile hypothyroidism in the early stage. 689 85

This report describes the diagnosis of acquired type I von Willebrand disease in a 30-year-old woman (G5P5) who presented with complaints of excessive bleeding in the postpartum period. The patient's additional complaints of fatigue, depression, and inability to lose weight resulted in laboratory testing that indicated hypothyroidism due to thyroiditis. Clinical symptoms and laboratory tests for von Willebrand disease and hypothyroidism normalized with L-thyroxine replacement. Thyroiditis resulting in symptomatic hypothyroidism occurs in 2-4 per cent of postpartum women. The possibility of underlying hypothyroidism should be considered for those patients, especially if they are parous women, who appear to have an acquired bleeding disorder suggestive of von Willebrand disease.
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PMID:Acquired von Willebrand's disease: a rare manifestation of postpartum thyroiditis. 748 84

This is a report on a patient 57 years old, hospitalized because of expressed fatigue, nausea, vomiting and epigastrium pain. Hyperpigmentation of skin and mucous and hypotension were present; and hypocorticism was suspected while ex iuvantibus substitutional therapy of corticosteroides was introduced. By testing thyroid gland function, hypothyroidism was established, so we suspected the presence of united pluriglandular insufficiency--Schmidt Syndrome. The patient reacted well to the substitutional therapy of hydrocortisone and levothyroxine. The diagnosis has been confirmed at the Clinic for Endocrinology in Novi Sad and today the patient has regular checks at the outpatients clinic for endocrinology in Sombor. The discussion contains important diagnostic and therapeutic problems.
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PMID:[Addison's disease]. 773 45

Hypothyroidism, the most common disorder of thyroid function is especially common in the adult female population. The disease affects every major organ system and metabolic process. The diagnosis of primary hypothyroidism can be perplexing to the clinician because of its insidious onset and wide array of nonspecific manifestations. Complaints of fatigue, muscle weakness, lethargy, and weight gain are often at first attributed to emotional or other health problems. Additionally, patients may not seek medical care because they are unaware that they are ill. Clinicians need to be familiar with the signs and symptoms of hypothyroidism so that a timely diagnosis and treatment can be initiated. This article reviews the etiology, pathophysiology and clinical manifestations of hypothyroidism as well as the methods of diagnosis and treatment. Elements of patient education are described with particular emphasis on the chronic nature of hypothyroidism and the need for life long treatment.
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PMID:Hypothyroidism: common complaints, perplexing diagnosis. 776 Oct 41

A 16-year-old depressed adolescent, who had received sertraline treatment for the previous 18 months, developed insomnia, daytime somnolence and lack of energy. His thyroid function tests revealed low levels of total T4 with normal levels of free T4 and TSH, and a normal thyrotropin-releasing hormone (TRH) stimulation test. Discontinuing sertraline resulted in improved sleep and disappearance of daytime somnolence. Although daytime somnolence and low levels of total T4 can mimic hypothyroidism, in this case sertraline only displaced the bound-fraction of total T4 and was not associated with true hypothyroidism.
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PMID:Effects of long term treatment with sertraline (Zoloft) simulating hypothyroidism in an adolescent. 777 34


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