[Ambulatory treatment of hyperthyroidism with radioiodine].
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Biomedical subjects
Publications and source records attributed to A Konrády.
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In a part of patients with thyrotoxicosis the serum triiodothyronine concentration increases only while free thyroxin level remains in the normal range (T3-thyrotoxicosis). This condition occurs in patients with untreated or treated thyrotoxicosis and in some other but rare thyroid disease, respectively. In this study occurrence and importance of T3-thyrotoxicosis were discussed. This form occurred in 11% of untreated thyrotoxicosis (53/480). The majority of patients suffering from T3-thyrotoxicosis have autonomous thyroid function (i.e. toxic uninodular and multinodular goiter: 45/53, 85%). In case of suppressed TSH and normal free thyroxin T3-thyrotoxicosis can be expected in 40% (53/140). The rate of free-triiodothyronin elevation is highest in Graves' disease with autoimmune origin. We consider the possibilities of development of triidothyronine increasing and the importance of iodine deficiency. Our patients are living in an area where mild iodine deficiency can be proved on the basis of decreased iodine excretion in urine. The results show the diagnostic importance of free-T3 determination.
UNLABELLED: Thyrostatic treatment of pregnant women with Graves' disease is a special problem. Observation of 46 pregnancies of 35 women suffering from Graves' disease has been summarized. The outcome was successful in 45 cases. Methimazole and propylthiouracil was administered to the patients without thyroxine. Therapy was needed for the two thirds of the mothers. At the end of the second trimester the thyrostatic agent could have been withdrawn in the 77% of the cases. Antithyroid treatment administered in low dose at the time of conception did not affect the outcome. Premature delivery rate and the number of neonates with low weight did not increased. Transient hyperthyrotropinaemia was observed in one case. Likewise, one infant suffered from neonatal thyrotoxicosis. 37% of the mothers had postpartal recurrence of hyperthyroidism. CONCLUSIONS: the free thyroxin level monitoring is essential during thyrostatic treatment. Thyrotropin receptor antibody investigation, having predictive value for neonatal thyrotoxicosis, should be done, too. Postpartal thyroid control is necessary for elucidate a hyperthyroid relapse, the rate of which was almost 40%.
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Author describes the history of a patient having primary hypothyroidism. After 7 year replacement therapy Graves' disease has been diagnosed. Author tries to give an explanation for this phenomenon by the changes occurred in thyroid directed immune response. As far as he knows this is the first reported case in the national literature.
Thyrotoxicosis most frequently is caused by Graves' disease and toxic adenoma. Author considers the difficulties of the diagnosis of these disorders. He established the prevalence and incidence of Graves' disease and toxic adenoma: 7.64% and 16.3/10(5)/year in the former and 2.34% and 4.1/10(5)/year in the later. The rate of the prevalence of these disorders in similar to that of iodine deficiency areas thus it refers indirectly to the deficiency of iodine in Hungary. The author suggests to determine correctly the nature of toxic multinodular goiter (autoimmune phenomenon or a variety of autonomous function) because it may have some importance in respect of therapy.
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