Hyperthyroidism Research Articles

Evaluation of Hyperprolactinemia and Thyroid Disorder among Women with Dysfunctional Uterine Bleeding at Tertiary Care Hospital of western Rajasthan

Background: Women suffers 10 times more with thyroid disorders than men. Alterations in menstrual cycle alters thyroid function which could be either hypo or hyper thyroidism. Abnormal increase in serum prolactin level can cause disturbance in follicle maturation and corpus luteum function, and can lead to inhibition of normal secretion of GR hormone in hypothalamus which results in anovulation. The aim of the present study was to assess the thyroid and the prolactin levels among the women with dysfunctional uterine bleeding at tertiary care Hospital of western Rajasthan. Methods: An observational study was conducted for a period two years i.e from 2020 to 2022 in our institution at the gynaecology OPD with help of pathology department. 250 Patients with the complaints of dysfunctional uterine bleeding of age group between 25 to 70 years were included in the study. Estimation of Free T3, Free T4, TSH and prolactin was done by chemiluminescent immunoassay for the patients. Results: The mean TSH levels among the DUB cases was high. Similarly, hyperprolactinemia was found in cases and the mean prolactin levels were higher in cases. Significantly strong positive correlation between thyroid function and prolactin with p value <0.0001 was found.which indicates that as the TSH level increases prolactin levels also increases. Conclusions: Early detection of hypothyroidism in DUB cases can save the patient from recurrent curettage and at times hysterectomy. The financial implications of screening for prolactin/thyroid hormone abnormalities will have to be evaluated before a general recommendation can be made.

Clinical Association of Thyroid Eye Disease with Disease Severity and Thyroid Functional Status-an Experience of a Tertiary Care Hospital, Karachi

Objectives: To determine the occurrence and severity of thyroid eye disease regarding thyroid function in patients with autoimmune thyroid disease (AITD).
 Study Design: Cross-sectional study.
 Place and Duration of Study: Endocrinology Clinics, Jinnah Postgraduate Medical Centre (JPMC) and Medicell Institute of Diabetes Endocrinology & Metabolism (MIDEM) Karachi Pakistan, from Jan to Dec 2020.
 Methodology: Patients with AITD or the presence of eye disease were included in the study. Socio-demographic, clinical and laboratory parameters, including thyroid function tests (TFTs), thyroid autoantibodies (TRAb, Anti-TPO, Anti-Tg), presence or absence of eye disease and its severity according to NOSPECS, were documented on a predefined proforma.
 Results: A total of 220 patients with a mean age of 35.58±13.52 years and female predominance were included. Hyperthyroid, Hypothyroid and Euthyroid states were found in 125(56.82%), 43(19.5%) and 6(2.7%) of patients, respectively. Eye disease was found in 59(26.81%) patients. The mean NOSPECS score for patients with Grave’s Orbitopathy (GO) for males was 2.56±1.08, and for females, 2.59±1.01. Females had a greater number of TED-related signs and symptoms as compared to men (p=0.01). NOSPECS severity score of TED significantly correlated with fluctuating TFTs and overactive thyroid state (p<0.0001).
 Conclusion: Patients with TED commonly presented with proptosis, lid retraction, and restricted movements. The severity of GO was significantly related to older age, female gender, smoking, fluctuating TFTs and hyperthyroidism. Endocrinologists and Ophthalmologists should both work in collaboration for appropriate management.

2023 AAHA Selected Endocrinopathies of Dogs and Cats Guidelines.

Canine and feline endocrinopathies reflect an endocrine gland disease or dysfunction with resulting hormonal abnormali ties that can variably affect the patient's wellbeing, quality of life, and life expectancy. These guidelines provide consensus recommendations for diagnosis and treatment of four canine and feline endocrinopathies commonly encountered in clini cal practice: canine hypothyroidism, canine hypercortisolism (Cushing's syndrome), canine hypoadrenocorticism (Addi son's disease), and feline hyperthyroidism. To aid the general practitioner in navigating these common diseases, a stepwise diagnosis and treatment algorithm and relevant background information is provided for managing each of these diseases. The guidelines also describe, in lesser detail, the diagnosis and treatment of three relatively less common endo crinopathies of cats: feline hyperaldosteronism, feline hypothyroidism, and feline hyperadrenocorticism. Additionally, the guidelines present tips on effective veterinary team utilization and client communication when discussing endocrine cases.

Thyroid hormone manipulation influences development of endothermy and hatching in white leghorn chickens (Gallus gallus)

Chickens experience rapid change in their physiology and metabolism during hatching. We propose that thyroid hormones play a major role in regulating the developmental changes associated with attaining endothermy. To better understand the role thyroid hormones play in hatch timing and development of thermogenic capacity and metabolic rate we manipulated plasma thyroid hormone levels in chicken embryos beginning at 80% development (day 17 of a 21-day incubation) with either a single dose of triiodo-L-thyronine (T3) or the thyroperoxidase inhibitor methimazole (MMI). Manipulation of thyroid hormones altered the timing of hatching, accelerating hatching under hyperthyroid conditions, and prolonging hatching with hypothyroid conditions. Effect sizes comparisons of morphological variables between treatment groups revealed larger heart and body masses in hyperthyroid 1-day post hatch animals. Thyroid hormone manipulation influenced the thermal neutral zone for O2 consumption and body temperature during gradual cooling from 35 to 15 °C of externally pipped embryos and 1-day post hatch chicks. Hyperthyroid EP animals had a wider thermal neutral zone during cooling when compared to control animals. At the temperatures tested, the hypothyroid animals did not exhibit a thermal neutral zone. Similar differences between treatments in the breadth of the thermal neutral zone carried through to 1-day post hatch chickens. These findings suggest that thyroid manipulations influence the timing and development of the animal’s thermogenic response to cooling.

Abstract #1402994: Unilateral Exophthalmos in A Patient with Hashitoxicosis: Case Report and Review of the Literature

Hashitoxicosis is a transient period of hyperthyroid state in a patient with Hashimoto thyroiditis. Ii is not common condition. Exophthalmos is usually bilateral disease commonly associated with Graves's hyperthyroidism. It rarely occurs in Hashimoto thyroiditis or hashitoxicosis. Unilateral exophthalmos is a less common presentation of Graves's ophthalmopathy. So, we present this case of a male with Hashimoto thyroiditis, who presented with unilateral exophthalmos and Hashitoxicosis. A 41-year-old male presented with protrusion of his right eye. He was diagnosed 9 months ago with Hashimoto thyroiditis based on clinical ground, laboratory tests and thyroid scan. His TSH was 18.5 (N 0.4- 4) and FT4 was 0.023 (N12-22). TPO was positive (Thyroid Peroxidase anti-bodies). Thyroid scan showed diffused homogeneous reduced uptake. He was started on Thyroxine 100ug/day. Six months later his thyroid function test on follows up showed features of subclinical hyperthyroidism. His Thyroxine was reduced gradually till it was stopped. Three months later, he developed palpitations, weight loss and noticed changes in his right eye. On examination he was toxic his pulse 100 bpm, right eye there is exophthalmos, lid retraction and lid lag. He has small goiter and no bruit. No pretibial myxedema or proximal myopathy. Laboratory tests showed suppressed THS 0,013 and high FT4 26.8. We diagnosed him as having Hashitoxicosis and started on Propranolol 20 mg three times daily. He did not improve and repeated TSH was 0.006 and FT4 was 46.3(12-22). Neomercazole was started at a dose of 30 mg/day, Over the next 6 months Neomercazole was tapered until the patient become hypothyroid and thyroxine was restarted. Currently he is on thyroxine 100ug and is doing well. However, the exophthalmos did not resolve completely. Hashimoto thyroiditis is the most common cause of hypothyroidism in Iodine sufficient areas. It is characterized by elevated levels of thyroid anti-bodies (Anti TPO antibodies are present in 90% of cases). Hashitoxicosis is the hyperthyroid phase in chronic autoimmune thyroiditis. it occurs due to the release of preformed thyroid hormones from the inflamed thyroid gland. The exact duration of the disease is not well described, in average it last less than 8 months. The term Hshitoxicosis sometimes used to describe an autoimmune thyroid disease overlap syndrome of Graves's disease and Hashimoto disease. The presentation of our patient was consistent with Hashitoxicosis. But due to his severe symptoms and development of exophthalmos we suspect overlap syndrome, so we started antithyroid medication. Wasniewska et al. investigated the outcome of Hashitoxicosis in 14 children. Due to more severe presentation, four patients required antithyroid medications as in our patient. A definitive resolution of hyperthyroidism was recorded 8.3- 6.3 months after the diagnosis, as in our patient who recovered over a period of 6 months. Graves's orbitopathy (GO) usually associated with Graves's hyperthyroidism, rarely occurs in hypo- or euthyroid state, unlike our patient who developed unilateral exophthalmos in hypothyroidism.

Multiple Cranial Neuropathies with Orbital Myositis as an Initial Presentation of Lyme Disease (P9-10.002)

<h3>Objective:</h3> To report a case of Lyme disease presenting with subacute multiple cranial neuropathies and orbital myositis. <h3>Background:</h3> Lyme disease can present with multiple cranial neuropathies. Orbital myositis is not well described as one of the rare complications of Lyme disease. Here, we describe a patient with multiple cranial neuropathies and orbital myositis as an initial manifestation of Lyme disease. <h3>Design/Methods:</h3> A 69-year-old male with a history of hyperthyroidism status post thyroidectomy, presented with a new onset headache, double vision, numbness of the face, and dysphagia. On examination, he had left lower motor neuron facial weakness, left eye proptosis, and findings suggestive of III and VI nerve palsies. Brain MRI with contrast revealed abnormal enhancement along the left V2 and V3 nerves and enhancement of the bilateral III cranial nerve. Abnormal enhancement was also seen at the left orbital apex in addition to enhancement along the left retro-orbital optic nerve. MRI of the orbit showed asymmetric enlargement and subtle enhancement of the left extra orbital muscles with mild orbital fat infiltration, compatible with orbital myositis. Lyme IgG/IgM antibody screen was positive which was confirmed by Lyme immunoblot assay which was also positive for Lyme IgG (5 bands) and IgM (3 bands) antibodies. B2 Glycoprotein IgM was elevated. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis and elevated protein. CSF cytology and flow cytometry were negative for malignant cells. TSH, thyroxin, and anti-thyroid peroxidase antibodies were unremarkable. Sarcoidosis, IgG4-related disease, autoimmune, and infectious workups were unrevealing. The patient received IV ceftriaxone with significant improvement and with near resolution of the symptoms and clinical findings after 1 month. <h3>Results:</h3> NA <h3>Conclusions:</h3> Orbital myositis is a rare complication of Lyme disease. <b>Disclosure:</b> Dr. Biso has nothing to disclose. Dr. Philip has nothing to disclose. Dr. Chevula has nothing to disclose. Dr. El-Dokla has nothing to disclose.

Outcome and Evaluation of the Patient Thyroidectomy with Hyperthyroidism: A Case-Control Study

Introduction: According to reports, pediatric patients with hypothyroidism have a higher risk of complications following surgery than adults. Specifically, this Study's aimed to evaluate how complete thyroidectomy is in youth (18 years) and adults. Materials and Methods: A retrospective case-control study of all (n=100) complete thyroidectomies was performed on 32 pediatric and 68 adult patients who were consecutive from were compared at the Department of ENT, Head &amp; Neck Surgery, Islami Bank Medical College and multicentral base hospital, Rajshahi, Bangladesh, from July 2018 to June 2021. Results: The average patient age in children was 9.7 years (range 3.4-17.9 years) against 44.9 years (range 18.4-84.2 years) in adults. Compared to adults, surgical procedures on children took an average of (2.18 ± 0.08 hrs.) longer to complete in adults (1.66 ± 0.03 hrs) (p = 0.003). The average weight of a thyroid specimen was 48.0 ± 6.4 grams in adults and 38.6.0 ± 8.9 grams in children (range, 6.6-203 grams; p = 0.34). Children had a higher ratio of thyroid weight to body weight (0.94 ± 0.11 gm/kg) than adults (0.67 ± 0.8 gm/kg; p = 0.05). After surgery, the hyperthyroid condition improved in every patient. There were no operational deaths, recurrences, or long-term hypoparathyroidism. Conclusion: It is clear that the technical difficulties associated with treating Graves' disease surgically in children and adults result in longer operational periods. There was no difference in the chances of long-term consequences, including recurrent laryngeal nerve damage or neck hematoma. Medicine Today 2023 Vol.35(1): 40-43

GRAVES DISEASE

Graves' disease is one of the most common autoimmune diseases. The disease is named after the scientist Robert James Graves, who first described it in the 19th century as a syndrome with an enlarged and overactive thyroid gland (hyperthyroidism due to circulating autoantibodies), rapid heart rate, and eye abnormalities. graves’ disease is the most common cause of hyperthyroidism and affects more women than men. Graves’ disease can appear at any age, but it most commonly appears for the first time between the ages of 20 and 40. Factor is a predisposition that is more dominant than environmental factors. There are circulating autoantibodies produced by B lymphocytes induced by autoreactive T lymphocytes that recognize thyrotropin-stimulating hormone (TSH) receptors in thyroid tissue as self-antigens. These autoantibodies are also known as TSH receptor antibodies (TSH-R Ab), thyrotropin stimulating antibodies (TSI), or thyrotropin receptor antibodies (TRAb). TRAb acts like TSH to cause thyroid hyperplasia (diffuse goitre), increased synthesis, and excessive and uncontrolled secretion of thyroid hormones (T4: tetraiodothyronine T4 and T3: triiodothyronine T3). Investigations to confirm Graves’ disease show elevated thyroid hormones (T4 and T3) with very low TSH and increased TRAb. On thyroid ultrasound, the majority of patients have a hypervascular and hypoechoic diffusely enlarged thyroid gland. The treatment for graves’ disease is to reduce the synthesis of thyroid hormones using anti-thyroid drugs, or to reduce the amount of thyroid tissue with radioactive iodine (RAI) or total thyroidectomy. Methimazole is the first-choice antithyroid drug with good effectiveness and safety. Although the recurrence rate after stopping the drug is still quite high

Graves' Ophthalmopathy: A Comprehensive Review of Current Evidence and Management Approaches

Thyroid ophthalmopathy, also known as Graves' ophthalmopathy or thyroid eye disease, is an autoimmune condition that affects the eyes and is often associated with hyperthyroidism, an overactive thyroid gland. It is characterized by inflammation, swelling, and tissue changes in the muscles and tissues around the eyes, leading to a range of symptoms including bulging eyes, double vision, eye pain, redness, and sensitivity to light. The treatment of thyroid ophthalmopathy typically involves managing the underlying thyroid condition, relieving symptoms, and preventing complications. Corticosteroids, such as prednisone, are commonly used to reduce inflammation and swelling in the eye tissues. They can be administered orally or locally through eye drops or injections. Orbital radiotherapy, a form of radiation therapy, may also be used to reduce inflammation in the eye tissues, particularly in cases where corticosteroids are not effective or not well tolerated. In addition to medical treatments, eye protection measures are important in managing thyroid ophthalmopathy. This may include wearing sunglasses to protect the eyes from exposure to sunlight and using lubricating eye ointments at night to alleviate dryness. If eyelid retraction or swelling is present, eyelid management techniques such as lubricating ointments, taping the eyelids closed during sleep, or using moisture chamber glasses may be recommended to protect the cornea and relieve symptoms. Managing the underlying thyroid condition is also crucial in the treatment of thyroid ophthalmopathy. This may involve medications to regulate thyroid hormone levels, radioactive iodine therapy, or surgery to remove the thyroid gland, depending on the individual case. Surgical intervention may also be necessary in severe cases of eye-related complications, such as double vision or optic nerve compression. Surgical options may include decompression surgery, eyelid surgery, or strabismus surgery to realign the eyes. It's important to note that the management of thyroid ophthalmopathy is typically tailored to the specific needs of each patient and may involve a multidisciplinary approach involving endocrinologists, ophthalmologists, and sometimes surgeons. Regular follow-up and monitoring are necessary to assess the effectiveness of the treatment plan and make any necessary adjustments. In conclusion, thyroid ophthalmopathy is an autoimmune condition that affects the eyes and is often associated with hyperthyroidism. Treatment typically involves managing the underlying thyroid condition, relieving symptoms, and preventing complications. Corticosteroids, orbital radiotherapy, eye protection measures, and surgical intervention may be used as part of the management plan. It's important to work closely with a healthcare professional to determine the most appropriate treatment approach for each individual case.&#x0D; &#x0D; Received: 14 January 2023 / Accepted: 26 February 2023 / Published: 20 March 2023

Outcomes of Radioactive Iodine Versus Surgery for the Treatment of Graves’ Disease: a Systematic Review and Meta-analysis

Abstract Graves’ disease (GD) is a systemic autoimmune disorder mainly affecting the thyroid gland. During GD management, the principal target is to control the hyperthyroid state. There have been three rather similarly effective modalities: medical therapy with antithyroid drugs (ATD), radioactive iodine (RAI), or surgical excision of the thyroid tissue (thyroidectomy). Defining the relative risks and benefits of each of the two potential definitive treatment options (RAI or thyroidectomy) is crucial for creating evidence-based therapy algorithms. This systematic review and meta-analysis aimed to compare the outcomes of these two treatment options. This is a systematic review and meta-analysis that analyzed the studies comparing RAI and thyroidectomy to treat GD. Studies were obtained by searching on Scopus, the Cochrane Central Register of Controlled Trials, and PubMed central database. The surgically treated group showed significantly lower failure rates, non-significantly lower cardiovascular morbidities, non-significantly higher complication rates, and significantly lower mortality rates. The RAI-related complications were mostly the development or worsening of Graves’ ophthalmopathy. This review and meta-analysis comparing surgery and radioactive iodine for the treatment of Grave’s disease from 16 well-conducted trials has shown that although surgery viz., total thyroidectomy was less frequently utilized for the treatment of Grave’s disease, it controlled the symptoms with greater success and without any worsening of Grave’s ophthalmopathy.

Management of Hyperthyroidism during Pregnancy: A Systematic Literature Review

In pregnancy, several physiological changes affect maternal circulating thyroid hormone levels. The most common causes of hyperthyroidism in pregnancy are Graves' disease and hCG-mediated hyperthyroidism. Therefore, evaluating and managing thyroid dysfunction in women during pregnancy should ensure favorable maternal and fetal outcomes. Currently, there is no consensus regarding an optimal method to treat hyperthyroidism in pregnancy. The term "hyperthyroidism in pregnancy" was searched in the PubMed and Google Scholar databases to identify relevant articles published between 1 January 2010 and 31 December 2021. All of the resulting abstracts that met the inclusion period were evaluated. Antithyroid drugs are the main therapeutic form administered in pregnant women. Treatment initiation aims to achieve a subclinical hyperthyroidism state, and a multidisciplinary approach can facilitate this process. Other treatment options, such as radioactive iodine therapy, are contraindicated during pregnancy, and thyroidectomy should be limited to severe non-responsive thyroid dysfunction pregnant patients. In light of this events, even in the absence of guidelines certifying screening, it is recommended that all pregnant and childbearing women should be screened for thyroid conditions.

Hyperthyroidism and depression: a clinical case of atypical thyrotoxicosis manifestation.

The relationship between psychiatric symptoms and thyroid function has been well known and studied since antiquity. The common view is that clinical hypothyroidism is associated with depressive symptoms, whereas the psychiatric manifestations of hyperthyroidism are agitation, emotional lability, hyperexcitability, occasionally accompanied by angry outbursts, and euphoria. The case here reported overturns this conventional medical knowledge. A 73-year-old Italian woman experienced a severe major depressive episode with psychotic and melancholic features during laboratory thyrotoxicosis. No classical clinical signs and symptoms of thyrotoxicosis were present. Psychiatric symptoms improved together with the resolution of the hyperthyroid state. Historically, different cases of so-called 'apathetic hyperthyroidism' have been described. Recent neuroimaging and animal studies provided possible neurobiological explanations, showing how the excess thyroid hormones could affect brain structures involved in the regulation of mood, leading to depression. A direct link between hyperthyroidism and depression seems to be likely. This insight may be relevant in facilitating early diagnosis of thyroid disease and the planning of therapeutic strategies.

Myasthenia gravis in current status: epidemiology, types, etiology, pathophysiology, symptoms, diagnostic tests, prevention, treatment, and complications - correspondence.

Myasthenia gravis in current status: epidemiology, types, etiology, pathophysiology, symptoms, diagnostic tests, prevention, treatment, and complications - correspondence.

Successful Treatment with Radioiodine for Antithyroid Drug-Induced Agranulocytosis in Graves' Disease

Background: Graves’ disease (GD) is an autoimmune disorder and the leading cause of hyperthyroidism. Antithyroid drugs (ATDs) are available treatment option. Agranulocytosis is a rare but potentially fatal complication of ATD in hyperthyroidism management. The study's objectives include clinical symptoms of ATD-induced agranulocytosis in Graves' illness and the difficulties in clinical care in addition to radioactive iodine therapy (RAIT). Methods: Twelve patients with ATD induced agranulocytosis referred to NINMAS between 2021to 2022 for RAIT therapy were included in this study. All the patients with hyperthyroidism and agranulocytosis or leukopenia were taken in this study. Results: The age of the 12 patients (female: male = 10:3) was 26 to 56 years (mean SD: 38.41±13.9 years). Among the twelve patients 10 were treated with carbimazole and two with PTU for Graves’ disease. Initial dose of ATD was 15-30 mg daily. The most common clinical manifestations were fever (100%), sore throat (41.6%), oral ulcer (16%), rash (41.66%), loose motion (16.66%) and atrial fibrillation (8.33%) with deep vein thrombosis (DVT). Agranulocytosis developed between 7th and 547th days after initiation of ATD; all of them developed early onset except one who developed agranulocytosis after 1.5 years of initiation of ATD. All 12 patients were treated immediately after diagnosis of agranulocytosis following prompt discontinuation of ATD, they were treated with antibiotic with 12 cases, G CSF in one case, KI in one case, glucocorticoid in two cases, and beta blocker in all cases. After intensive and supportive treatment in hospital, all the patients recovered with absolute neutrophil counts of more than 500/mm3 in 5 to 15 days (mean SD: 7.6 3.4 days). Nine patients were treated with lithium carbonate supplement to reduce FT3 level. Average dose of lithium carbonate was 600 mg. After that patients were referred for RAIT. TRAb were positive in seven patients and average were 4.2 U/L. Plasmapheresis was done in three patients and one patient in two times due to high FT4 level before RAIT. Lithium carbonate supplementation reduce thyroid hormone level but not to the optimum level. All the 12 patients were treated with RAIT. Average dose RAI 10.9 mCi, average follow up period 2.3 years. Two patients required second dose of RAIT due to persistent hyperthyroidism. Six patients became hypothyroid, two were in hyperthyroid state (on plan for second therapy), four patients are euthyroid at present and they are on follow up. No fatal condition was found in this study. Conclusion: The most cost-effective method of managing agranulocytosis induced by thionamide-derived ATD is that all patients with thyrotoxicosis must be informed that their white blood cells and differential counts should be checked immediately whenever the “common cold” symptoms occur during treatment, especially within the first three months of medication. Contraindication to ATDs; RAI is a safe and effective alternative. Bangladesh J. Nuclear Med. 26(1): 39-43, 2023

Marked method differences in the measurement of thyroid function tests support the need for standardisation

Background: Thyroid function tests (TFT) are used to diagnose and monitor thyroid dysfunction and disease. Though method differences are recognised in the euthyroid range, variation across the biochemical spectrum of disease is under-appreciated. Aim: This study compared TFT measurement in euthyroid, hypothyroid and hyperthyroid patients using five automated methods. Methods: TSH, free T4 and free T3 were measured on the Roche Cobas, Abbott Architect, Siemens Atellica, Beckman DxI and Ortho Vitros platforms. Method comparison was by Passing & Bablok linear regression and concordance analysis was performed using the manufacturer’s reference intervals. Results: Five-way TFT method comparison was available for 94 samples. Differences in TFT, particularly free T4, were subtle in the hypothyroid range and most marked in the hyperthyroid range. Method specific reference intervals did not fully accommodate measurement differences, leading to discordance in biochemical diagnosis of hypothyroidism, hyperthyroidism, and sub-clinical states across methods. Discussion: Correlation between TFT methods differs across the dynamic range. For free T4, correlation was closest in the hypothyroid range and most marked in the hyperthyroid range. This has important implications for monitoring, as method differences can masquerade as biochemical worsening or improvement of disease. Our data supports the IFCC call for standardisation of TFT.

Case report on a switch from hypothyroidism to hyperthyroidism

Abstract Introduction Hashimoto's thyroiditis and Graves’ disease are the most common autoimmune thyroid conditions and are more common in women than in men. Thyrotropin receptor (TSHR) antibodies that stimulate the thyroid (TSAb) cause Graves’ hyperthyroidism and TSHR antibodies which block thyrotropin action (TBAb) are occasionally responsible for hypothyroidism. Unusual patients switch from TSAb to TBAb (or vice versa) with concomitant thyroid function changes. The most common scenario is the evolution from Graves’ disease (GD) to Hashimoto's thyroiditis (HT), whereas the switch from HT into GD seems to be less common. Clinical Case 53-year-old woman presented with a several month's history of tiredness, cold intolerance and hoarseness in October 2020. She was diagnosed with autoimmune hypothyroidism and achieved euthyroid status following treatment with Tbl. Levothyroxine a 50 mcg S. 1×1. This almost stable status was interestingly interrupted after 9 months (January 2021) when the patient on a regular checkup got laboratory results that showed suppressed TSH levels and a high fT4. The substitution therapy was discontinued immediately. The ultrasound of the thyroid gland showed nonspecific changes: hypoechoic, inhomogeneous gland without any markable pathological formations. The patient was feeling tired, she had palpitations, sweating that is not connected to a physical activity, shaking of the hands and uncontrolled movements of the extremities and neck. Her hair started to fall rapidly in the past few months. She was given Tbl. Metoprolol a 100 mg S.1×1 and Tbl ASA a 100 mg S. 1X1. In October 2021, the new laboratory results showed TSH &amp;lt;0.005 mU/l; fT4 =33.36, aTP-O= 22.77 iU/ml thyroglobulin =46,62, Calcitonin=2.99, Vit. D3=27.3, TSH receptor antibodies= 15.40. Antithyroid therapy was required, and she was given Tbl Thiamazole, Tbl. Propronalol because of the developed clinically and laboratory confirmed hyperthyroidism. There were oscillations in the thyroid status in the first months after the switch to hyperthyroidism, and in December 2021 there was a discontinuation of the Thiamazole treatment for one month because of the unstable TSH level, but afterwards from January 2022 the therapy is administered again and the patient is so far clinically stable under regular control. The patient is feeling good. Conclusion This rare switch from a state of hypothyroidism to a state of hyperthyroidism is not very common in the clinical endocrinology practice, but should not be missed or misdiagnosed. Suspicion should be raised in the very first moment of tapering the levothyroxine doses in any patient with diagnosed HT during a regular follow up. Our recommendation is doing the TRABs (if available) at the moment of lowering the levothyroxine doses along with the regular laboratory tests of fT4, TSH, ATP-O. If there are any TRABs elevated, the leading way is to think and manage the possible and probable onset of hyperthyroidism.

Delayed Presentation of Functioning Metastasis in a Patient with Follicular Thyroid Carcinoma.

Functioning metastases from differentiated thyroid carcinoma are rare and present a great therapeutic challenge. Here, we present an unusual case of a patient with metastatic thyroid carcinoma who developed a hyperthyroid state a few years after the diagnosis due to functioning metastases. Radioiodine treatment was effective in controlling the hyperthyroidism; however, it had no effect on tumor burden. By sharing our experience with this case, we hope to raise awareness for this rare condition and the ways to manage it.

Thyroid storm in a polytrauma patient

Thyroid storm is a potentially life-threatening endocrinologic emergency characterized by an exacerbation of a hyperthyroid state. Several inciting factors can instigate the conversion of thyrotoxicosis to thyroid storm; trauma is one such trigger, but it is rare. Here we describe a case of thyroid storm in a young man that was alleged in a motor vehicle accident where his thyroid storm exhibited symptoms similar to traumatic hypovolemic shock.

Thyrotoxic periodic paralysis together with thyrotoxic heart disease in a Ghanaian man: case report and literature review

&lt;abstract&gt; &lt;p&gt;Thyrotoxic periodic paralysis (TPP) is an uncommon symmetrical paralysis usually affecting proximal muscles, which occurs in the hyperthyroid state with associated hypokalemia. It is more prevalent in East Asian males and extremely rare in blacks. Data on TPP is scarce in Africa and no report has been made in Ghana. We report a case of a middle-aged Ghanaian man who had three episodes of paralysis in all four limbs occurring at night with the second and third episodes requiring hospital visit. He had no clinical signs of hyperthyroidism during his first hospital visit but had developed clinical and biochemical evidence of hyperthyroidism on the second visit with serum potassium levels of 1.9 mmol/l; and he was eventually diagnosed with TPP. His paralysis resolved with correction of the hypokalemia. It is important to evaluate patients presenting with paralysis comprehensively. Less common differential diagnosis such as TPP may also be considered in such patients to ensure early diagnosis and treatment which can prevent complications.&lt;/p&gt; &lt;/abstract&gt;

Clinico-cytomorphological features and thyroid function tests of different thyroid lesions – A hospital-based cross-sectional study

Background: Thyroid gland is an endocrine organ. The non-neoplastic and neoplastic conditions affecting the gland can manifest as the swelling of the gland with thyroid dysfunction. Based on cytology, the diseases can be categorized into non-neoplastic, benign neoplastic, and malignant neoplastic conditions and according to hormone status, the lesions of thyroid can be categorized in hypothyroid, euthyroid, or hyperthyroid condition. Aims and Objectives: Our study was done to find out the various cytomorphological spectrum of thyroid diseases and to record their common clinical presentation along with hormonal status in a tertiary care hospital in Northern Odisha. Materials and Methods: A total of 220 cases of thyroid disorder were taken for analysis over a period of 2 years. Patients demographic data, brief clinical features, finding on FNAC (cytomorphology), and thyroid function status were analyzed with appropriate statistical method. Results: The predominant age group affected was 21–40 years and total female to male patient ratio was 5.5:1. Most common presentations were heat intolerance (22.27%), cold intolerance (28.63%), and tachycardia (27.72%) apart from thyroid enlargement. Most common non-neoplastic lesion were multinodular and colloid goiter constituting 38.18% of total cases and most common neoplastic lesion was papillary carcinoma constituting 14.55% of total cases. Thyroid function test showed predominantly euthyroid states for all conditions. Conclusion: As the rest part of India, this part of Odisha also showed that thyroid disorders are more common in females and the most affected age group is 21–40 years. Multinodular and colloid goiter are the most common thyroid lesions. Most of the cases present with euthyroid state.