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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of 131I in the treatment of multinodular goiters (MNG) is well established. We evaluated the effect of 30 microCi 131I (1.11 GBq) in 18 patients with MNG with the aid of two injections of 0.1 mg recombinant human TSH (rhTSH), given on d 1 and 2. A dose of 30 microCi 131I was given on d 3. TSH, T3, free T4, and thyroglobulin were measured on d 1, 2, 3, 5, 10, 30, 60, 90, and 180, and antithyroid antibodies were measured on d 1, 30, 90, and 180. Twenty-four-hour 131I uptake measured 1-3 months before rhTSH increased from 12.3 +/- 6.2 to 53.5 +/- 10.9% (P < 0.0001), free T4 from 1.3 +/- 0.2 to peak 3.2 +/- 1.1 ng/dl levels (P < 0.0001), T3 from 113.9 +/- 35.0 to peak 332.2 +/- 123.0 ng/dl levels (P < 0.0001), TSH from 0.76 +/- 0.71 to peak 18.9 +/- 5. 3 mU/liter levels (P < 0.0001), and thyroglobulin from 280.9 +/- 370.0 to peak 1838.5 +/- 1360.7 ng/dl levels (P = 0.001). Painful thyroiditis (33%) and mild thyrotoxicosis (39%) constituted minor side effects. There were no changes in echocardiographic parameters, done before and after rhTSH administration, on d 3. Hypothyroidism developed in 65%. Mean goiter size, measured by computed tomography, decreased from 97.9 +/- 45.4 to 65.5 +/- 47.3 ml (P < 0.0001; reduction: 39 +/- 19%) after 6 months. We conclude that rhTSH is a safe and efficient therapeutic tool in the treatment of MNG allowing the use of outpatient therapeutic 131I doses.
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PMID:Recombinant human thyrotropin as adjuvant in the treatment of multinodular goiters with radioiodine. 1571

Opiates suppress TSH in experimental animals but are reported to increase TSH in human subjects. We describe a patient in severe pain treated with morphine, whose previously normal TSH fell to a level usually associated with hyperthyroidism. After returning to a normal concentration, TSH again decreased with morphine administration. This suggests that, in contrast to the stimulation of TSH secretion that has been reported in unstressed experimental subjects, morphine can inhibit TSH secretion during stress in man as it does in experimental animals. This observation is consistent with the known sensitization of opiate receptors by stress. Consideration should be given to the possibility that severe suppression of TSH by opiates in stressed patients may induce clinically significant central hypothyroidism.
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PMID:Suppression of thyrotropin by morphine in a severely stressed patient. 1586 59

This paper comments on the role and emergence of the biopsychosocial model in modern medical literature and health care settings. The evolution of the biopsychosocial model and its close association with modern pain theory is also examined. This paper seeks to discuss the place of this model with respect to the management of hypothyroidism. This discussion represents a forerunner to a randomised control trial that will seek to investigate the effect of a biopsychosocial-based treatment regime on hypothyroidism.
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PMID:The biopsychosocial model and hypothyroidism. 1596 49

We describe the case of a 22-year old male undergoing a total thyroidectomy for euthyroid multi-nodular goitre (TSH: 1.6 microUI/ml). He was discharged treated with LT4 100 mg id. After discharge, he went into full clinical and laboratorial hypothyroidism (TSH = 396 microUI/mL). We were able to rule out failure to take the medication and concomitant use of drugs. In the evaluation of intestinal absorption, only the D-Xylose test proved to be abnormal. After unsuccessful administration of oral T4 and T3, under close nursing supervision, intramuscular (IM) and subcutaneous (SC) forms of administration of T4 were experimented. While both forms achieved normal levels of thyroid hormones, we opted for IM injection as the patient complained of local pain during SC administration. This seems to be the second case described in which it was necessary to resort to parenteral administration of T4 to achieve clinical and laboratorial euthyroidism.
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PMID:[A rare case of malabsorption of thyroid hormones]. 1619 61

Chronic muscle pain (myalgia) is a common problem throughout the world. Seemingly simple, it is actually a difficult problem for the clinician interested in determining the aetiology of the pain, as well as in managing the pain. The two common muscle pain conditions are fibromyalgia and myofascial pain syndrome. Fibromyalgia is a chronic, widespread muscle tenderness syndrome, associated with central sensitisation. It is often accompanied by chronic sleep disturbance and fatigue, visceral pain syndromes like irritable bowel syndrome and interstitial cystitis. Myofascial pain syndrome is an overuse or muscle stress syndrome characterised by the presence of trigger points in muscle. The problem these syndromes pose lies not in making the diagnosis of muscle pain. Rather, it is the need to identify the underlying cause(s) of persistent or chronic muscle pain in order to develop a specific treatment plan. Chronic myalgia may not improve until the underlying precipitating or perpetuating factor(s) are themselves managed. Precipitating or perpetuating causes of chronic myalgia include structural or mechanical causes like scoliosis, localised joint hypomobility, or generalised or local joint laxity; and metabolic factors like depleted tissue iron stores, hypothyroidism or Vitamin D deficiency. Sometimes, correction of an underlying cause of myalgia is all that is needed to resolve the condition.
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PMID:A review of myofascial pain and fibromyalgia--factors that promote their persistence. 1625 10

Purinergic system exerts a significant influence on the modulation of pain pathways at the spinal site. Adenosine has antinociceptive properties in experimental and clinical situations, while ATP exerts pronociceptive actions in different pain models. In this study we investigated the hydrolysis of ATP to adenosine in synaptosomes from spinal cord in parallel with the nociceptive response of rats at different ages after hypothyroidism induction. Hypothyroidism elicited a significant increase in AMP hydrolysis to adenosine in synaptosomes from spinal cord of rats subjected to neonatal hypothyroidism and in 420-day-old rats submitted to thyroidectomy. Accordingly, these rats presented an analgesic response as a consequence of hypothyroidism. In contrast, the ATP hydrolysis was decreased in the spinal cord of 60-day-old hypothyroid rats in parallel with a significant increase in nociceptive response. These results indicate the involvement of adenine nucleotides in the control of the hypothyroidism-induced nociceptive response during development.
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PMID:Nociceptive response and adenine nucleotide hydrolysis in synaptosomes isolated from spinal cord of hypothyroid rats. 1629 9

An observational study of thyroid function tests performed in patients with headache prior to referral to a neurological clinic found no headache cases attributable to either hypothyroidism or hyperthyroidism. The role of thyroid dysfunction in the aetiology of headache remains uncertain.
J Headache Pain 2006 Feb
PMID:Thyroid dysfunction and headache. 1640 54

The authors review the epidemiology, clinical manifestations, diagnosis, and treatment of fungal thyroiditis cases previously reported in the medical literature. Aspergillus was by far the most common cause of fungal thyroiditis. Immunocompromised patients, such as those with leukemia, lymphoma, autoimmune diseases, and organ-transplant patients on pharmacological immunosuppression were particularly at risk. Fungal thyroiditis was diagnosed at autopsy as part of disseminated infection in a substantial number of patients without clinical manifestations and laboratory evidence of thyroid dysfunction. Local signs and symptoms of infection were indistinguishable from other infectious thyroiditis and included fever, anterior cervical pain, thyroid enlargement sometimes associated with dysphagia and dysphonia, and clinical and laboratory features of transient hyperthyroidism due to the release of thyroid hormone from follicular cell damage, followed by residual hypothyroidism. Antemortem diagnosis of fungal thyroiditis was made by direct microscopy and culture of a fine-needle aspirate, or/and biopsy in most cases. Since most patients with fungal thyroiditis had disseminated fungal infection with delay in diagnosis and treatment, the overall mortality was high.
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PMID:Fungal thyroiditis: an overview. 1648 84

Hypothyroidism is a frequently diagnosed endocrine disorder that has characteristic clinical signs and symptoms. Myopathy is one of the manifestations of hypothyroidism and relatively common. We report a case of Hoffmann's Syndrome due to hypothyroid myopathy documented by clinical features, laboratory findings and positive response to thyroid hormone replacement therapy. A man, age of 22, was diagnosed as having primary hypothyroidism at the age of five, had been describing progressive weakness in his arms and legs for two months and complained about generalized muscle cramps and pain. He was diagnosed with Hoffmann's syndrome with low levels of thyroid hormones and high levels of muscle enzymes. After six months of thyroid hormone replacement therapy, both the clinical picture and laboratory findings were remarkably improved.
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PMID:Early diagnosis and treatment reverse clinical features in Hoffmann's syndrome due to hypothyroid myophaty: a case report. 1648 71

The aim of the study was to evaluate the condition of bone system in 335 subjects with thyroid gland dysfunction (TGD), residing in iodine deficit areas. Among the subjects there were 116 individuals with thyrotoxicosis (TT), and 219--with hypothyroidism (HT). The control group included 200 practically healthy people of comparable age and sex. The examination included: evaluation of pain syndrome intensity using a 4-point scale; revealing of atraumatic fracture background; measurement of serum levels of thyroid stimulating hormone (TSH) andfree thyroxin by immune-enzyme assay; measurement of bone mineral density (BMD) by dual-energy x-ray absorptiometry using a Dexa-Scan DX-10 device (Direx, Israel) with evaluation of the results according to 1994 WHO recommendations. 79.3% of TT patients and 68% of HT patients suffered from pain syndrome. The difference in atraumatic fracture rate between the groups was insignificant. The mean BMD values in subjects with TGD dysfunction corresponded to osteopenia, while in the control group they were within normal limits. The difference in osteopenic syndrome rate between TT and HTpatients was insignificant, although osteopenia was revealed in 25% of TT patients. The frequency of BMD decrease grew with age; however, this parameter was higher in all groups of patients with TGD vs. control. The most prone to osteopenia are postmenopausal women regardless of thyroid dysfunction character; difference in BMD decrease frequency between men and women with preserved menstrual function, was insignificant. Osteopenic syndrome was more frequent in men with TGD then in healthy men. Thus, in residents of iodine deficit areas TGD is a factor of BTMD decrease.
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PMID:[The problem of osteopenia in a iodine-deficit area]. 1651 1


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