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S J Bonnema

Publications and source records attributed to S J Bonnema.

17 recordsLinked to original sources
PubMed2004

Propylthiouracil before 131I therapy of hyperthyroid diseases: effect on cure rate evaluated by a randomized clinical trial.

A randomized clinical trial was performed to clarify whether pretreatment with propylthiouracil (PTU) before radioiodine ((131)I) therapy influences the final outcome of this therapy, as has been indicated by retrospective studies. Untreated consecutive hyperthyroid patients with Graves' disease (n = 23) or a toxic nodular goiter (n = 57) were randomized to either PTU (+PTU; n = 39) or no pretreatment (-PTU; n = 41) before compensated (131)I therapy. The median PTU dose was 100 mg, which was discontinued 4 d before treatment. The median (131)I activity was 302 MBq (range, 87-600 MBq). After (131)I therapy, the serum free T(4) index increased in the +PTU group from 97.7 +/- 47.5(+/-sd) nmol/liter at the time of therapy to 152.3 +/- 77.6 nmol/liter at 3 wk (P < 0.001) and 140.4 +/- 75.9 nmol/liter at 6 wk (P < 0.001). In the -PTU group, the serum free T(4) index, which was initially 254.3 +/- 145.7 nmol/liter, decreased significantly to 212.0 +/- 113.0 nmol/liter at 3 wk (P < 0.05) and 165.8 +/- 110.0 nmol/liter at 6 wk (P < 0.005). After 1 yr of follow-up, the treatment failure rate in patients with a toxic nodular goiter was four times higher in the +PTU group than in the -PTU group (nine of 20 vs. three of 25 patients; P = 0.06), whereas the difference among patients with Graves' disease was less obvious (four of six vs. four of nine; P = 0.81). Patients in the +PTU group who were cured had higher serum TSH (s-TSH) levels at the time of (131)I therapy than those who were not cured. By adjusting for a possible interfactorial relationship through a regression analysis, including the s-TSH level and type of disease, only PTU pretreatment had a significant adverse effect on the cure rate (P = 0.03). In conclusion, this randomized trial demonstrates that PTU pretreatment reduces the cure rate of (131)I therapy in hyperthyroid diseases, although this adverse effect seems to be attenuated by the concomitant rise in s-TSH.

Adult↗
PubMed2003

Differences between endocrine surgeons and endocrinologists in the management of non-toxic multinodular goitre.

BACKGROUND: It is not known whether the management of multinodular goitre differs between endocrinologists and endocrine surgeons. METHODS: A questionnaire containing a hypothetical case (a 42-year-old euthyroid woman with a 50-80-g multinodular goitre) and 11 variations on the case was sent to endocrinologists and endocrine surgeons in Australia. RESULTS: The response rate was 55 per cent, including 45 endocrine surgeons and 127 endocrinologists. For the index case, serum thyroid-stimulating hormone (TSH), fine-needle aspiration biopsy and ultrasonography were widely used by both groups. Thyroid antibodies and scintigraphy were ordered by a greater proportion of endocrinologists than surgeons, and computed tomography more frequently by surgeons than endocrinologists. Treatment recommendations differed significantly between specialties for the index case (endocrinologists: no treatment 65 per cent, thyroxine 22 per cent, surgery 10 per cent, radioiodine 3 per cent; surgeons: no treatment 67 per cent, thyroxine 2 per cent, surgery 31 per cent; P < 0.001) and for seven of the variations. In particular, for a patient with suppressed TSH, most endocrinologists (60 per cent) recommended radioiodine treatment, whereas there was no consensus among surgeons (surgery 40 per cent, no treatment 36 per cent, radioiodine 21 per cent). For a patient with a partly intrathoracic goitre, most surgeons (88 per cent) recommended surgery, whereas there was no consensus among endocrinologists (surgery 45 per cent, no treatment 34 per cent, thyroxine treatment 13 per cent, radioiodine 8 per cent). CONCLUSION: There are clinically significant differences between endocrine surgeons and endocrinologists in the management of multinodular goitre.

Adult↗
PubMed2002

Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres.

In routine use for more than 50 years, radioiodine ((131)I) is generally considered safe and devoid of major side effects. Therefore, it is surprising that relatively many aspects of radioiodine therapy are controversial, as illustrated by recent international questionnaire studies. Our review aims at highlighting three of these areas - namely, the influence of (131)I on the course of Graves' ophthalmopathy, the possible radioprotective effects of antithyroid drugs, and the use of (131)I in large goitres. (131)I therapy carries a small (but definite) risk of causing progression of Graves' ophthalmopathy. Identification of risk factors (thyroid dysfunction, high level of thyroid-stimulating hormone (TSH) receptor antibodies, cigarette smoking) allows the identification of patients at risk and the institution of concomitant glucocorticoid treatment, thereby hindering progression of eye disease. On the basis, largely, of retrospective data, it appears that carbimazole (or methimazole), if stopped 3-5 days before treatment, does not influence the outcome of (131)I therapy. Simultaneous thyrostatic medication most probably reduces the efficacy of (131)I, as does restarting it within 7 days. Propylthiouracil seems to have a more prolonged radioprotective effect than carbimazole. Surgery is the treatment of first choice in patients with a large goitre. However, in the case of patient ineligibility or preference, (131)I therapy may be an option. The treatment has a favourable effect on tracheal compression and inspiratory capacity, but the reduction in thyroid volume is only 30-40%. Inpatient treatment, necessitated by the large doses, makes the treatment cumbersome. Controversy related to radioiodine therapy is mainly based on the lack of adequate prospective randomised studies comparing efficacy, side effects, cost and patient satisfaction.

Antithyroid Agents↗
PubMed2001

[Danish endocrinologists' examination and treatment of non-toxic multinodular goiter. A questionnaire study].

AIM: To assess the attitudes towards the management of the non-toxic multinodular goitre by means of a questionnaire concerning on case history, which was circulated to all Danish endocrinologists ("A 42-year-old woman with an irregular, non-tender, bilaterally enlarged thyroid of 50-80 g and no clinical suspicion of malignancy"). DESIGN: Eleven variations of the (basic) case report were proposed in order to evaluate the impact on the management of each alteration. In the index case, serum TSH was the routine choice of 100%, serum T4/free T4-index and T3/free T3-index were measured by 83% and 79%, serum TPOab and serum calcitonin by 49% and 4%, respectively. RESULTS: The median number of blood tests was three (range 1-7). Thyroid scintigraphy was used by 96% and ultrasound by 94%, both methods were employed by 90% with scintigraphy most often having the first priority. Fine-needle aspiration biopsy was not routinely used, unless a scintigraphically dominant "cold" area was present; 70% used ultrasound guidance. Radioiodine was the preferred treatment of 51%, surgery 7%, L-T4 4%, and no treatment 38%. DISCUSSION: In the case of young patients or factors predisposing to thyroid cancer, treatment preferences changed to surgery. The prevailing use of radioiodine in Denmark contrasts with the situation in most other European countries, but Danish endocrinologists also disagree about the optimum management of multinodular non-toxic goitre.

Adult↗
PubMed2000

Management of the nontoxic multinodular goitre: a European questionnaire study.

BACKGROUND AND OBJECTIVE: The optimum management strategy for the patient with a multinodular nontoxic goitre is still a matter of debate. Our aim was to assess the attitudes towards management of such patients throughout Europe by means of a questionnaire. DESIGN: The questionnaire was circulated to all clinician members of the European Thyroid Association (ETA). A case report was followed by diagnostic investigations and choice of therapy in the index case (a 42-year-old woman with an irregular nontender bilaterally enlarged thyroid of 50-80 g and no clinical suspicion of malignancy). Eleven variations of the basic case report were proposed in order to evaluate the impact on management of each alteration. SUBJECTS AND METHODS: One hundred and sixty-seven members replied to the letter, and 120 individuals from 22 countries completed the questionnaire (corresponding to approximately two-thirds of the clinical members of the ETA). RESULTS: Based on the index case, serum TSH was the routine choice of 100%, and serum free T4/T4-index was included by 74%. Serum TPO autoantibodies, Tg autoantibodies and calcitonin were measured by 65%, 49% and 32%, respectively. The median number of blood tests used was four (range 1-11). Considerable intercountry variations were seen in the preferred imaging methods. Ninety-one percent of the clinicians would use at least one imaging modality. Ultrasound (US) was used by 84%, thyroid scintigraphy by 76%, and both methods by 69%. US had first priority (53% vs. 19% for scintigraphy). If scintigraphy was performed, fine-needle aspiration cytology was routinely used by 17% (inhomogeneous uptake) and 95% (dominant 'cold' area), and 63% used US-guidance. L-T4 treatment was supported by 52% of the clinicians, iodine supplementation by 4%, radioiodine by 6% and surgery by 10%. In the case of a suppressed serum TSH, radioiodine treatment was preferred by 44%, while surgery was the favoured recommendation in four clinical variations with a large goitre or suspicion of malignancy. Marked differences between the countries were suggested by L-T4 therapy being the dominant treatment in Italy, France and Germany in contrast to the prevailing use of radioiodine in Denmark and a wait and see policy in the UK. CONCLUSIONS: Fundamental differences between European countries exist as regards diagnosis and treatment of the multinodular nontoxic goitre suggesting difficulties in reaching a consensus.

Biomarkers↗
PubMed1999

[Thyrotoxic periodic paralysis].

Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism mainly seen in patients of Oriental origin and is rarely encountered in Western countries. TPP clinically resembles familial periodic paralysis with recurrent episodes of weakness or flaccid paralysis of especially the legs. Transient hypokalaemia is regularly observed during attacks and remission can be achieved by administration of potassium salts. The definitive treatment of TPP is to restore euthyroidism. This case describes a thyrotoxic patient who initially presented with periodic paralysis.

Adult↗
PubMed1999

The feasibility of high dose iodine 131 treatment as an alternative to surgery in patients with a very large goiter: effect on thyroid function and size and pulmonary function.

Some patients with very large goiters (>150 mL) are not candidates for surgery. We evaluated the feasibility of high dose 131I in such patients. Twenty-three patients (2 men and 21 women; median age, 67 yr; range, 42-86 yr) with very large goiter (8 toxic) were treated with calculated high dose 131I [median, 2281 megabecquerels (61.6 mCi); range, 988-4620 megabecquerels (26.7-124.9 mCi)]. During the 12-month observation period, goiter reduction and tracheal anatomy were monitored by magnetic resonance imaging, and the respiratory capacity was monitored by pulmonary function tests. Five patients (22%) developed hypothyroidism. Thyroid volumes were at baseline, after 1 week, and after 1 yr [mean +/- SEM, 311 +/- 28, 314 +/- 26 (P = NS), and 215 +/- 26 (P < 0.01) mL]. The relative changes 1 week after therapy ranged from -14.1% to 15.3%. After 1 yr the mean size was reduced by 33.9% (range, 13.5-61.4%). Only the initial goiter size showed a significant negative correlation to the percent reduction. The smallest cross-sectional area of the trachea decreased 9.2% within 1 week after treatment, but eventually emerged with a 17.9% larger area [mean +/- SEM, 84.3 +/- 4.8, 75.5 +/- 5.1 (P < 0.01), and 98.2 +/- 6.0 (P < 0.01) mm2]. The inspiratory parameter, FIF50%, improved after an initial insignificant decline [baseline therapy, after 1 week, after 3 months, and after 1 yr (mean +/- SEM), 2.37 +/- 0.24, 2.20 +/- 0.21 (P = NS), 2.51 +/- 0.23 (P = NS), and 2.76 +/- 0.25 (P = 0.01) L/s]. FIF50% correlated significantly with the smallest cross-sectional tracheal area (baseline, 1 week, and 1 yr: r = 0.74; P < 0.001, r = 0.63; P < 0.005, and r = 0.46; P < 0.05). Changes in tracheal anatomy did not correlate with changes in either lung dynamics or goiter size. In conclusion, very large goiters can be reduced by a third, on the average, with high dose 131I therapy without any initial clinically significant tracheal compression. Tracheal cross-sectional area as well as pulmonary inspiratory capacity improve. No serious adverse effects are seen.

Adult↗
PubMed1998

[Carpal tunnel syndrome and hand edema in temporal arteritis].

An 89 year-old male was admitted to hospital presenting oedema, reduced sensibility, paraesthesia and reduced mobility of both hands. EMG was in accordance with bilateral carpal tunnel syndrome. An elevated sedimentation rate was found and biopsy from the temporal artery showed arteritis. During glucocorticoid treatment the symptoms disappeared and the EMG and sedimentation rate returned to normal.

Aged↗
PubMed1996

[Guillain-Barre syndrome. Cytomegalovirus infections and pregnancy].

A case of Guillain-Barré syndrome during pregnancy is presented. The patient was 11 weeks' pregnant and developed tetraparesis over a few weeks. She did not require mechanical ventilation. Elevated liver enzymes and virocytosis in the peripheral blood were noted. Based on a positive IgM-antibody titre, a primary cytomegalovirus infection was diagnosed. The patient recovered completely and gave birth to a child of 43 weeks' gestation. Cytomegalovirus IgM-antibody was demonstrated in umbilical cord blood. The child appeared healthy without abnormalities at nine weeks of age.

Adult↗
PubMed1996

Sarcoidosis causes abnormal seasonal variation in 1,25-dihydroxy-cholecalciferol.

OBJECTIVES: The spontaneous seasonal variations in the calcium regulating hormones 1,25-dihydroxy-cholecalciferol (1,25-DHCC) and parathyroid hormone (PTH) were investigated in patients with sarcoidosis. DESIGN: Controlled, prospective observational study with measurements in the winter and summer seasons, respectively. SUBJECTS: Twelve patients (age: median 33, range 21-54 years) with biopsy-verified (n = 8) sarcoidosis were included as well as 11 age-matched healthy control subjects. MAIN OUTCOME MEASURES: Serum values of calcium, ionized calcium, phosphate, chloride, bicarbonate, creatinine, albumin, angiotensin-converting enzyme, alkaline phosphatase, 1,25-DHCC, and PTH. Also, 24-h whole body retention of 99mTc methylene-diphosphonate was assessed. RESULTS: The patient group showed an increased level of 1,25-DHCC in the summer season (w:146 +/- 67, s:198 +/- 73 pmol L-1; P < 0.01) in contrast to the opposite finding among controls (w:161 +/- 34, s:144 +/- 43 pmol L-1; P < 0.05). Comparing the individual seasonal changes between the two groups, the difference was marked (P < 0.001). Compared with controls, total serum calcium was elevated in the summer season in the patient group (P < 0.05), in which the same parameter correlated positively with 1,25-DHCC (r = 0.658; P < 0.01). PTH was increased two to three times above the control values throughout the year (patients: w:0.37 +/- 0.13, s:0.24 +/- 0.08 micrograms L-1; controls: w:0.14 +/- 0.09, s:0.10 +/- 0.04 micrograms L-1; P < 0.001); although, the level of this hormone was still found within the reference interval. 24-h whole body bone scintigraphy failed to show any seasonal variation in bone metabolism. In contrast, serum alkaline phosphatase was found to be increased during the summer season compared with the control group (P < 0.001). Angiotensin-converting enzyme showed no seasonal variation. CONCLUSIONS: In sarcoidosis, 1,25-DHCC is abnormally regulated throughout the year, with a significantly higher serum level in the summer season. Uncontrolled production of 1,25-DHCC in sarcoid pulmonary alveolary macrophages is possibly responsible for hypercalcaemic episodes, and this parameter should be used as a marker of disease activity.

Adult↗
PubMed1995

[Transesophageal atrial stimulation is useful in supraventricular arrhythmias].

The results of transoesophageal atrial stimulation (TAS) were retrospectively evaluated in 22 patients (13 women, nine men, mean age forty-five years), in whom the method was used in the process of diagnosing or specifying supraventricular arrhythmias. The patients were tested for corrected sinus node recovery time, the response to incremental stimulation and burst pacing. TAS resulted in a pathological outcome in 11 patients (50%). Among 14 patients suffering from unprovoked palpitations suspicious of tachyarrhythmias TAS was able to induce a pathological response in 10 patients (71%). In five of eight patients (63%) with inducible SVT, this arrhythmia had not previously been observed. TAS was able to induce atrial fibrillation in four of eight patients with an accessory pathway. Typical symptoms rather than a prior pathological electrocardiography (12-lead ECG, Holter-monitoring, exercise-ECG) was able to predict the outcome of TAS (p < 0.05). We conclude that TAS is a safe and suitable supplement in the evaluation of supraventricular arrhythmias; primarily among patients with characteristic symptoms.

Adolescent↗
PubMed1995

Effects of diabetes, insulin treatment, and osmolality on contractility of isolated rat resistance arteries.

The effects of osmolality, diabetes, and insulin-treatment on microvascular contractility were examined in mesenteric resistance arteries (internal diameter approximately 250 microns) isolated from streptozotocin-induced diabetic rats, streptozotocin-induced diabetic rats treated with 1-3 U insulin/day during the week before being killed, and age- and sex-matched control rats. Vessels were mounted in a microvascular myograph for isometric tension recording and responses were generated in physiological salt solutions with varying amounts of glucose or mannitol added. The passive response (expressed as the diameter the vessels would maintain if relaxed and exposed to a transmural pressure of 100 mmHg), the maximal response to noradrenaline, and the response produced by partial depolarization with 50 mmol/l potassium were not dependent on glucose or mannitol concentrations of the bathing medium; also, these responses were not dissimilar in vessels from the three groups of rats tested. The sensitivity to noradrenaline, however, was inversely related to the concentration of glucose (P < 0.01) and mannitol (P < 0.01) of the bathing medium without significant differences in slopes of regression lines between rat groups. Moreover, vessels from streptozotocin-induced diabetic rats were less sensitive to noradrenaline than were vessels from control rats; vessels from insulin-treated streptozotocin-induced diabetic animals had the lowest sensitivity to noradrenaline. These data suggest that osmolality, diabetes, and insulin-treatment independently affect microvascular sensitivity to the endogenous neurotransmitter, noradrenaline.

Aging↗
PubMed1993

[The combination of ACE inhibitor and thiazide may cause severe hyponatremia].

A case of a woman aged 79 years presenting severe hyponatraemia is described. The patient was not dehydrated and the urine was hypertonic. There was no history of renal, hepatic or cardiac disorders. Some weeks previously she had been treated with lisinopril and bendroflumethiazide on account of arterial hypertension. After withdrawal of the drugs and intensive therapy the patient recovered rapidly. The combination of an ACE-inhibitor and a thiazide drug may lead to serious disturbances in body fluid compartments and serum electrolytes. The need for frequent control of serum electrolytes is emphasized.

Aged↗
PubMed1992

[Juvenile renovascular hypertension of unusual origin].

The case history of a girl aged 10 years with renovascular hypertension is presented. The symptoms were atypical. The diagnosis was made on basis of positive captopril renography. Angiography showed delayed filling of the right main renal artery by a long collateral vessel. The right renal artery was found to be occluded proximally by intimal hyperplasia. Renal angioplasty was performed and resulted in normalized blood pressure and normalized right kidney function.

Angioplasty, Balloon↗
PubMed1991

[ST elevation in a patient with a healthy heart and acute appendicitis].

A male aged 57 years with acute appendicitis was found to have ST elevations in the EGG (precordial V1-V3 leads) suggesting acute myocardial infarction. The ECG returned to normal postoperatively. The patient showed no signs of ischaemic heart disease and the exercise test and myocardial scintigraphy were found to be normal.

Acute Disease↗