PubMed · 10320137
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V Jay. 1999. Dr Robert James Graves.. https://doi.org/10.5858/1999-123-0284-drjg
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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.
Administration of radioactive iodine (131I) is an effective treatment for hyperthyroidism due to Graves' disease. Recently several investigators have shown that the success of this therapy may depend on the absorbed dose to the thyroid. Thyroid dose varies inversely with the mass of the gland. Much experimental evidence demonstrates that a reduction of the thyroid volume (mass) may occur after radioiodine therapy. In this work we evaluate the influence of the volume reduction on the calculation of the absorbed dose to the thyroid. A mathematical model of thyroid mass reduction after 131I therapy is presented, based on masses evaluated with ultrasonography of ten patients treated in the endocrinology department of our hospital. This model was applied to the general formula for calculation of the thyroid doses in these patients. The dose values obtained considering a reduction of thyroid mass after the treatment are often quite different from those obtained without considering change in mass (from 9% to 30% greater). We conclude that the consideration of thyroid mass reduction is important for an accurate estimation of the calculated dose.
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