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Biomedical subjects

N Tokimitsu

Publications and source records attributed to N Tokimitsu.

At least 19 recordsLinked to original sources
PubMed1993

Case report: silent thyroiditis developed during alpha-interferon therapy.

Alpha-interferon (IFN-alpha) was used for the treatment of chronic active hepatitis C in a 30-year-old woman who was euthyroid but had low titers of antithyroid antibodies before treatment. Two months after the initiation of IFN-alpha therapy she became thyrotoxic. She had nontender diffuse goiter. A laboratory examination revealed elevated levels of serum free thyroid hormones and a suppressed concentration of serum thyrotropin. Titers of antimicrosomal antibodies increased. The anti-thyrotropin receptor antibody was negative. A 99mTcO- scintigram of the thyroid showed reduced uptake. During the IFN therapy free thyroid-hormone levels started to decline. The IFN-alpha therapy was completed 1 month after the onset of thyrotoxicosis. Two months after the completion of the therapy the patient became euthyroid and 99mTcO- uptake was normalized. It is likely that preexisting chronic thyroiditis was exacerbated to cause silent thyroiditis during IFN-alpha therapy. None of the other 11 patients with chronic hepatitis C who had had no anti-thyroid antibodies and were treated with IFN-alpha showed anti-thyroid antibodies and thyroid dysfunction after the therapy. It is advisable to assess anti-thyroid antibodies and thyroid function in patients who are going to receive IFN-alpha treatment.

Adult↗
PubMed1993

Autoimmune hepatitis and hypothyroidism associated with anti-thyroid hormone autoantibodies.

A 40-year-old hypothyroid female who had been treated with synthetic thyroxine was admitted to our hospital in October 1988 due to abnormal liver function tests. She had low serum free triiodothyronine (T3; 2.3 pg/ml) and high serum thyrotropin (TSH; 20.8 microU/ml) concentrations. On the other hand, the serum free thyroxine (FT4) level was inappropriately high, being 2.46 ng/dl. Immune precipitation of radiolabeled thyroid hormones with her serum disclosed the binding of 125I-T3 and 125I-T4 to the extent of 9.5% and 11.3%, respectively (normal ranges for 125I-T3 and 125I-T4 binding are less than 6.3% and 5.9%, respectively). 125I-T4 binding to the patient's serum gamma globulin was completely displaced with the addition of unlabeled T4. Further examination disclosed that anti-T4 antibodies in her serum belong to IgG kappa class immunoglobulin.

Adult↗
PubMed1992

A case of rheumatoid arthritis associated with silent thyroiditis.

A 41-year-old female with rheumatoid arthritis had nontender enlarged thyroid gland. Thyroid function tests revealed increased concentrations of serum free T3 (FT3, 10.8 pmol/L) and free T4 (FT4, 31.1 pmol/L) with suppressed concentration of thyrotropin (TSH, lower than 0.1 mU/L) and low 24-hour thyroidal radioactive iodine uptake (1.6%). Serum thyrotropin receptor antibody (TRAb) was negative (0%) and she had positive anti-thyroglobulin and anti-microsomal antibodies. A diagnosis of silent thyroiditis was made based on laboratory findings. Serum concentrations of FT3 and FT4 normalized one month later without treatment. The causal relationship between the two diseases is discussed.

Adult↗
PubMed1992

Thyrotropin-secreting pituitary adenoma: a case report.

We report a 44-year-old male with a thyrotropin (TSH)-secreting pituitary adenoma. Based serum free triiodothyronine (FT3, 12.1 pmol/l) and free thyroxine (FT4, 28 pmol/l) were increased with normal basal TSH (3.1 mU/l). There was impaired TSH response to thyrotropin releasing hormone (TRH) test. Serum TSH was suppressed to 59% of the basal level after oral administration of 1.4 mg 3,3'-5-triiodothyroacetic acid (triac), whereas no suppression was observed after 75 micrograms daily administration of triiodothyronine (T3). Serum concentrations of alpha-subunit of TSH (TSH-alpha) and TSH-alpha/TSH molar ratio were high, being 1.95 micrograms/l, and 4.4, respectively. Pituitary CT and MRI scan showed the presence of a macroadenoma in the anterior lobe of the pituitary gland. Histopathology of the excised pituitary confirmed the diagnosis of a TSH-producing adenoma. A positive correlation between TSH and FT3 (r = 0.66, P less than 0.01) or FT4 (r = 0.54, P less than 0.01) was observed in serial sera obtained before and after operation.

Adult↗
PubMed1990

Two cases of Graves' disease with antithyroid hormone antibodies: implication on the role of thyroglobulin as an antigen.

We have experienced two cases of Graves' disease with antithyroid hormone autoantibodies (Case 1: anti-T4; Case 2: anti-T3) who finally underwent subtotal thyroidectomy after antithyroid drug treatment. Using serial sera obtained before and after operation, the correlation between titers of antithyroglobulin (anti-Tg) and anti-T4 or anti-T3 autoantibodies was examined in each case. There was a significant positive correlation between titers of anti-T4 (Case 1, r = 0.90, p less than 0.05), or anti-T3 (Case 2, r = 0.64, p less than 0.01) and anti-Tg antibodies. Using the homogenate of the thyroid tissue, it was found that the sole iodoprotein in the thyroid gland in each patient was 660 KDa Tg. In addition, Tg purified from the thyroid gland from Case 2 showed different immunological activity with normal Tg in two out of four murine monoclonal anti-Tg antibodies tested. On the other hand, Tg from Case 1 had identical immunological activity with normal Tg in every four monoclonal antibodies. These results are consistent with the view that the antigen responsible for the development of antithyroid hormone autoantibodies is Tg, at least in our two cases. The reason for the persistence of anti-T3 autoantibodies in Case 2, despite the subtotal thyroidectomy, could be due to some unidentified structural abnormalities of Tg which was detected only by the monoclonal anti-Tg antibodies.

Adenoma↗
PubMed1989

[Two cases of Graves' disease with anti-thyroid hormone autoantibodies: the effect of subtotal thyroidectomy on the titers of anti-thyroid hormone autoantibodies and anti-Tg antibodies].

We experienced two cases of Graves' disease associated with anti-thyroid hormone autoantibodies (Case 1: anti-T4, Case 2: anti-T3). Both cases underwent subtotal thyroidectomy, and titers of anti-thyroid hormone antibodies and anti-Tg antibodies were compared before and after operation. In case 1, titers of both anti-T4 and anti-Tg antibodies decreased after operation, whereas in Case 2, titers of both anti-T3 and anti-Tg were unchanged before and after operation. There was a significant positive correlation between titers of anti-T4 and anti-Tg antibodies in Case 1 (r = 0.90, P less than 0.01), and anti-T3 and anti-Tg antibodies in Case 2 (r = 0.64, P less than 0.01). These results strengthen the possibility that the antigen of anti-thyroid hormone autoantibodies in both cases is the Tg molecule.

Autoantibodies↗
PubMed1989

Simultaneous occurrence of medullary and follicular carcinoma in the same thyroid lobe.

A rare case of the simultaneous development of medullary and follicular carcinoma of the thyroid gland in a 51-year-old Japanese woman is examined. A preoperative diagnosis was made by needle aspiration cytology. Neoplastic cells of the medullary carcinoma were positive for calcitonin and carcinoembryonic antigen, whereas the tumor cells of the follicular carcinoma were negative for these substances. This case presents evidence that, in rare cases, two malignant epithelial neoplasms of different origins can occur in the same lobe of the thyroid.

Adenocarcinoma↗
PubMed1989

[An autopsy revealing hepatocellular carcinoma with solitary metastatic gastric cancer].

This case concerns a 61-year-old man who had been determined as having rt-hypochondrialgia. The plasma AFP was found to have increased and an abdominal-CT revealed multiple low density areas in the liver. Endoscopic examination of the stomach revealed a Borrmann type III cancer and the specimens taken by punch biopsy demonstrated a tubular adenocarcinoma. Therefore, he had been diagnosed as having a gastric cancer with a metastatic liver cancer, or double cancer. Histologically, liver tumor proved to be a hepatocellular carcinoma (Edmondson: Gr III), and the histological findings of the gastric tumor was found to be identical with that of the liver tumor. The fact that this case has esophageal varices during the course of the disease suggested that metastasis to the stomach has likely occurred through the portal vein system.

Biopsy, Needle↗
PubMed1988

A case of silent thyroiditis associated with idiopathic thrombocytopenic purpura.

A 51-year-old woman had symptoms of thyrotoxicosis which disappeared spontaneously within two months. She was diagnosed as a case of silent thyroiditis on the basis of both the clinical course and the laboratory data such as low uptake of radioactive iodine and technesium. She also had petechiae in her arms which were diagnosed as an idiopathic thrombocytopenic purpura (I.T.P.). This case would seem to expand the spectrum of the coexistence of autoimmune thyroid diseases and I.T.P. which is believed to be an autoimmune disease.

Autoantibodies↗
PubMed1987

[An autopsy case of mucin-producing pancreatic cancer].

A 85-year-old woman with a mucin-producing pancreatic cancer is reported. The patient, who had been diabetic for 2 years, was admitted in March of 1984 to our hospital because of a fever and cough. On admission, a hard tumor was found on the right hypochondric region. Ultrasonogram and computed tomography revealed a cystic pancreas head tumor containing mucin and a dilated pancreatic duct. During an ERCP examination, Vater's papilla was found to be enlarged and a biopsy showed papillary adenocarcinoma. Also, the levels of CEA and CA 19-9 were elevated 11.3 ng/ml and 1300 U/ml, respectively. On Feb. 13, 1985, she died due to panperitonitis that resulted from a perforated duodenal ulcer. Microscopic examination of the pancreas showed a papillary adenocarcinoma producing mucin, a dilated pancreatic duct and atrophy of the islets. No metastatic lesion was found. The pathogenesis and the clinical characteristics of the mucin-producing pancreatic cancer are discussed.

Adenocarcinoma, Mucinous↗
PubMed1986

Familiar hypercholinesterasemia. A case report.

A 58-year-old female who had a serum cholinesterase activity four times higher than normal is described. Investigation of her family revealed that five out of seven tested had high level of serum cholinesterase activity. The family distribution of the increased cholinesterase suggests that the inheritance is transmitted in a autosomal dominant manner. Analysis of the isoenzyme of serum cholinesterase of five cases including the patient showed that none of them had extracomponent (C5) of the cholinesterase. Examination of anti-cholinesterase antibodies in her serum was negative. Molecular weight of her serum cholinesterase by HPLC analysis was not different from that of a healthy subject. It was speculated that the overproduction of usual components (C1, C2, C3, C4), decreased clearance of cholinesterase by a certain mechanism(s), and/or the presence of cholinesterase which has more active catalysis could be responsible for her and her family's hypercholinesterasemia.

Cholinesterases↗
PubMed1985

A case of Graves' disease with anti-triiodothyronine antibodies.

A case of Graves' disease with high serum thyroxine (T4) and low triiodothyronine (T3) levels which was therefore initially diagnosed as a T4-thyrotoxicosis is reported. Examination of the serum from the patient showed the presence of unusual protein which bound T3. It was later confirmed as IgG class anti-T3 antibodies. In addition to treatment with methylmercaptoimidazole (MMI), the patient was treated with prednisolone for 30 days (total amount 500 mg). Titers of anti-T3 antibodies in the sera were unchanged before and after prednisolone treatment. Our present case indicates that it is clinically important to bear the presence of autoantibodies in mind to account for a possible error in measuring T3 and T4 by radioimmunoassay (RIA). In the case that RIA determination gives an unexpectedly high or low T3 and/or T4 value, the presence of autoantibodies to them should be considered and a test for them is recommended.

Antibodies, Anti-Idiotypic↗