Thyrotoxicosis: Muller AF

Muller AF, Berghout A, Wiersinga WM, Kooy A, Smits JW, Hermus AR, Anonymous00181. · Diakonessenhuis Utrecht, Utrecht, the Netherlands. · Neth J Med. · Pubmed #18349473 links to  free full text

Abstract: Thyroid function disorders are common with a female to male ratio of 4 to 1. In adult women primary hypothyroidism and thyrotoxicosis have a prevalence of 3.5/1000 and 0.8/1000, respectively. This guideline is aimed at secondary care providers especially internists, but also contains relevant information for interested general practitioners and gynaecologists. A multidisciplinary working group, containing delegates of professional and patient organisations, prepared the guideline. According to principles of 'evidence-based medicine' available literature was studied and discussed. Considering the availability and quality of published studies a practical advice was formulated. For a full overview of the literature and considerations the reader is referred to the original version of the guideline (accessible through NIV-net). In this manuscript we have aimed to provide the practicing internist with practical and 'as evidence-based as possible' treatment guidelines with respect to thyroid function disorders.

Muller AF, Berghout A. · Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands. · Minerva Endocrinol. · Pubmed #14605606 No free full text.

Abstract: Autoimmune thyroiditis has important consequences for fertility, the occurrence of pregnancy complications, pregnancy outcome. Moreover autoimmune thyroiditis can aggravate during the postpartum period. Finally, the sequelae of autoimmune thyroiditis might have important consequences for the offspring. Several studies have shown an association between thyroid autoimmunity in earlyas opposed to beforepregnancy and subsequent "incidental" miscarriage. With respect to habitual abortion available data are more conflicting perhaps mild degrees of thyroid insufficiency - not detectable by routine thyroid testing - and not thyroid autoimmunity per se is causal in the association between the presence of thyroid antibodies and recurrent abortion. Autoimmune hypo- and hyperfunction during pregnancy are both related to obstetrical complications. It is important to note that treatment can - at least in part - reduce this excess risk associated with untreated hypo- or hyperthyroidism. Considering pregnancy outcome there are now data providing evidence that not only overt but also relatively mild and hitherto unrecognized states of thyroid failure are associated with persistent and significant impairment in neuropsychological performance of the offspring. Postpartum thyroiditis is clearly associated with the presence of TPO antibodies (i.e. autoimmune thyroiditis). Autoimmune thyroiditis is thus clearly associated with clinically relevant events, occurring before, during and after pregnancy. Screening should be considered; however further research is urgently needed.

de Ruijter SH, van Dalen T, Muller AF. · Diakonessenhuis Utrecht. · Ned Tijdschr Geneeskd. · Pubmed #16808361 No free full text.

Abstract: A man aged 80 and three women aged 66, 26, and 39 years respectively, underwent surgery for Graves' disease. The first woman had pneumonia and experienced thyrotoxic storm. Euthyroidism was restored with antithyroid drugs (ATD) and thyroidectomy was performed as ablative treatment for hyperthyroidism. The man presented with thyrotoxicosis and had severe Graves' ophthalmopathy. After euthyroidism was restored with ATD, he underwent subtotal thyroidectomy. The second woman presented with severe thyrotoxicosis but was allergic to ATD. She was treated with iodine and beta-blockers after which subtotal thyroidectomy was done as an ablative procedure. Medical treatment for hyperthyroidism failed in the last patient and, as she had experienced severe psychological disturbances during a previous relapse, she too chose surgery as a definitive treatment option. In two patients the postoperative course was complicated by early hypocalcaemia and one of these patients experienced temporary recurrent laryngeal nerve paralysis. Surgery has a limited role in the treatment of Graves' disease. In pregnant women with severe ATD-resistant thyrotoxicosis, surgery is the only treatment option, while in patients with Graves' orbitopathy surgery may be preferable because of its neutral and perhaps even beneficial effects on eye symptoms. Large goitre size and thyroid nodules are concomitant reasons for choosing surgery, as are allergy to ATD and patients' preference. Lastly, in patients who have suffered from severe thyrotoxicosis, surgery provides rapid and definitive treatment. Early morbidity following surgery is common and should be discussed with the patient.

Walraven M, Wilmink HJ, de Boer LM, Muller AF. · Afd. Interne Geneeskunde, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht. · Ned Tijdschr Geneeskd. · Pubmed #15141644 No free full text.

Abstract: In three patients gynaecomastia was diagnosed: a 22-year-old man with concomitant thyrotoxicosis due to an extensively metastasized extragonadal choriocarcinoma, a 53-year-old man with hypogonadism due to Klinefelter's syndrome that was biochemically obscured due to medications leading to elevated prolactin levels, and a 62-year-old man with acromegaly and secondary hypogonadism due to a mixed prolactin and growth hormone secreting pituitary adenoma. Gynaecomastia calls for thorough evaluation.