Ambulatory Radio Iodine Therapy in the Management of Hyperthyroidism in Africa: African Systematic Review and Perspectives in Burkina Faso

Introduction: In hyperthyroidism, selective irradiation of the thyroid gland with radioactive iodine is a radical treatment and an alternative to surgery. The aim of this review is to assess the medium-term efficacy of outpatient treatment of hyperthyroidism with iodine-131 in Africa. Methods: We identified the studies carried out in Africa on outpatient radiation therapy between 2016 and 2020. For each article included, we noted the country concerned and the year of publication, the numbers studied, the socio-demographic characteristics of the patients, the indications for radio iodine therapy, the dose administered, the results of the hormonal dosage 6 months after radiation. Results: 13 retrospective studies were included to constitute a total population of 925 patients. The average age was 40.77 years, the sex ratio of 1/5.4 with a clear female predominance. The 3 main etiologies of hyperthyroidism justifying outpatient radio iodine therapy were Graves’ disease (55.89%), toxic multinodular goiter (22.70%) and toxic adenoma (21.40%). The average dose of iodine 131 administered per course is 13.7 mCi. No short-and medium-term complications were reported. The radio iodine therapy was effective in 86.08% (n = 796) of the patients with extremes of 72% and 100%. Conclusion: Radio iodine therapy is effective in Africa. It is simple, inexpensive on an outpatient basis and well tolerated. The introduction of outpatient radio iodine therapy could improve the management of patients with hyperthyroidism in Burkina Faso.

Lithium carbonate-induced giant goiter and subclinical hyperthyroidism in a patient with schizophrenia:A case report and review of literature

BACKGROUND Lithium carbonate is used to manage various mood disorders,but it can cause thyroid abnormalities,including goiter,hypothyroidism,and hyperthyroidism.In rare cases,it can lead to giant goiter and subclinical hyperthyroidism,which may require surgical intervention in severe cases.CASE SUMMARY This case represents a rare development of giant goiter and subclinical hyperthyroidism in a schizophrenia patient who was subjected to prolonged lithium carbonate treatment.The enlarged thyroid gland caused pressure on the airway and recurrent laryngeal nerve,which led to respiratory distress,hoarseness,and dysphagia.The immediate danger of suffocation required urgent surgical intervention.In this report,we describe the case of a 41-year-old Chinese woman.This sheds light on the etiology and challenges associated with managing a giant goiter.The patient underwent a subtotal thyroidectomy to relieve airway compression and facilitate airway expansion.Prior to the procedure,the patient was given iodine to prepare.Concurrently,changes were made to the psychiatric medication regimen.Following surgery,the patient's respiratory function and vocal cord functionality improved significantly,and her mental state remained stable.CONCLUSION It is essential to monitor thyroid function,test thyroid antibody levels,and perform thyroid ultrasounds consistently in all patients undergoing long-term lithium carbonate treatment.This vigilance helps prevent severe and potentially life-threatening thyroid enlargement.

Left Ventricular Systolic Intraventricular Flow Field Assessment in Hyperthyroidism Patients Using Vector Flow Mapping

Summary： Intraventricular hydrodynamics is considered an important component of cardiac function assessment. Vector flow mapping （VFM） is a novel flow visualization method to describe cardiac pathophysiological condition. This study examined use of new VFM and flow field for assessment of left ventricular （LV） systolic hemodynamics in patients with simple hyperthyroidism （HT）. Thirty-seven simple HT patients were enrolled as HT group, and 38 gender- and age-matched healthy volunteers as control group. VFM model was used to analyze LV flow field at LV apical long-axis view. The follow- ing flow parameters were measured, including peak systolic velocity （Vs）, peak systolic flow （Fs）, total systolic negative flow （SQ） in LV basal, middle and apical level, velocity gradient from the apex to the aortic valve （AV）, and velocity according to half distance （V1/2）. The velocity vector in the LV cavity, stream line and vortex distribution in the two groups were observed. The results showed that there were no significant differences in the conventional parameters such as left ventricular ejection fraction （LVEF）, left ventricular end-diastolic diameter （LVEDD） and left atrium diameter （LAD） between HT group and control group （P〉0.05）. Compared with the control group, a brighter flow and more vortexes were detected in HT group. Non-uniform distribution occurred in the LV flow field, and the stream lines were discontinuous in HT group. The values of Vs and Fs in three levels, SQ in middle and basal levels, AV and V1/2 were higher in HT group than in control group （P〈0.01）. AV was positively correlated with serum free thyroxin （FT4） （r=0.48, P〈0.01）. Stepwise multiple regression analysis showed that LVEDD, FT4, and body surface area （BSA） were the influence factors of △V. The unstable left ventricular sys- tolic hydrodynamics increased in a compensatory manner in simple PIT patients. The present study in- dicated that VFM may be used for early detection of abnormal ventricle contraction in clinical settings.

Influence of serum levels of TSH receptor antibody in pregnant women with Graves disease on neonatal hyperthyroidism

Objective:To investigate the clinical significance of serum thyroid stimulating hormone(TSH) receptor antibody(TRAb) levels in pregnant women with Graves'disease,on neonatal hyperthyroidism. Methods:The clinical data of 68 pregnant women with Graves' disease and their newborns were retrospectively analyzed.Testing indicators included thyroid function tests and TRAb levels during pregnancy,at delivery,and within 2 weeks after birth.The serum TRAb and T_3,T_4,Free T_3,Free T_4,TSH levels were detected by radio receptor assay(RRA) and electrical chemiluminescence immunoassay(ECLIA),respectively. Results:The results showed that serum TRAb levels of the third trimester of pregnancy was positively correlated with that of the umbilical vein(n = 68,r= 0.8494,P<0.01),and that of the newborns(n = 68, r=0.8286,P<0.01).The incidence of neonatal hyperthyroidism was 11.8%(8/68).The serum TRAb levels in the 8 neonates with hyperthyroidism within 2 weeks after birth were 3 times higher than those in the normal neonates.Of these 8 neonates,2 had 15 times higher serum TRAb levels than those of normal neonates within 2 weeks after birth.The thyroid function and TRAb levels of these 2 neonates were still abnormal 6 months later. Conclusions:The risk of hyperthyroidism in newborn whose mother's TRAb levels were high in the third trimester of pregnancy was increased.This study suggests a significant correlation between TRAb levels in pregnant women with Graves' disease and the severity of neonatal hyperthyroidism.

Case report:pre tibial myxedema combined with hyperthyroidism and blastocystis hominis infection

The patient is a 37-year-old male with a right anterior tibial mass for more than one year and a left anterior tibial mass for more than one month.There was a history of hyperthyroidism.Histopathology of the lesions showed epidermal hyperkeratosis of the skin tissue,thickening of the spinous layer,extensive collagen fibrillation in the superficial dermis and reticular layer,and numerous linear and granular mucoprotein deposits in the lower and middle dermis.Blastocystis hominis was routinely detected in the stool.Diagnosis:1.Pretibial myxedema 2.intestinal parasitosis(Blastocystis hominis infection).

Hyperthyroidism-associated coronary spasm:A case of non-ST segment elevation myocardial infarction with thyrotoxicosis

Hyperthyroidism is associated with many heart diseases.Thyrotoxic state has a relationship with coronary spasm.We present a case of a non-menopausal woman with hyperthyroidism who complained of chest pain.The diagnosis of coronary spasm was confirmed by coronary angiography(CAG).She is treated well with anti-thyrotoxicosis and anti-anginal medication.We recommend not use CAG as the first diagnostic choice among the patients with medication-uncontrolled hyperthyroidism and chest pain.

Selective Pituitary Resistance to Thyroid Hormone: Clinical Hyperthyroidism with High TSH on Levothyroxine Administration in I-131 Ablated “Graves Disease”

Resistance to Thyroid Hormone (RTH) is a rare form of hormone resistance secondary to changes in the genes encoding thyroid hormone receptors. The two subtypes, Pituitary RTH (PRTH) and Generalized RTH (GRTH), cause clinically distinguishable patient presentations. In PRTH, typically only the pituitary gland is resistant to thyroid hormone (TH) while the rest of the body maintains sensitivity. Selective pituitary resistance to thyroid hormone results in dysregulation of thyroid hormone homeostasis with clinical presentation as either euthyroid or hyperthyroidism. PRTH is characterized by elevated thyroid hormone levels with an elevated or inappropriately normal TSH concentration. Herein we describe a case report of a 70-year-old woman who complained of weight loss of over 35 lbs., palpitations, jitters, hair loss, diarrhea, fatigue, muscle weakness, etc. over 6 months, thus, indicating the presence of iatrogenic hyperthyroidism while receiving levothyroxine 175 ug daily prescribed by her primary care provider because of a reported history of “Graves disease” treated by radioactive iodine ablation of the thyroid several years ago. The daily dose of levothyroxine had been increased gradually at an interval of 3 months over a year because of persistent elevation of serum TSH level. Laboratory tests revealed markedly elevated Free T4, Free T3 and TSH levels, along with low concentrations of all lipid fractions, serum creatinine and urea nitrogen levels, indicating TSH induced hyperthyroidism or PRTH. Further testing documented a mutation of thyroid hormone receptor beta gene 2 confirming presence of PRTH. We believe that the initial diagnosis of Graves Disease was erroneous and I-131 ablation further confounded and missed the diagnosis of PRTH. Thus, the purpose of this report is to report a patient with PRTH and describe potential pitfalls in diagnosis and management of this rare disorder.

Hyperthyroidism Due to Papillary Thyroid Carcinoma Associated with Ductal Breast Carcinoma

Thyroid tumors are usually associated with euthyroidism, and hyper functioning tumors are rare. There are few reports of carcinomas associated with hyperthyroidism. The aim of this study is to describe a case of hyper functioning papillary carcinoma associated with breast carcinoma. We present a 46-year-old woman that was referred for investigation of thyroid and breast nodules detected by routine ultrasound. She presented with hyperthyroidism and enlarged left thyroid lobe with fibroelastic consistency. Investigation demonstrated papillary carcinoma with follicular hyperactivity and invasive ductal carcinoma of the breast. The patient developed metastases 6 months later and died. This study demonstrates that hot thyroid nodules may harbor malignant tumors and should be punctured. The association with breast adenocarcinoma and the unfavorable outcome suggest higher aggressiveness of this tumor in the presence of hyperthyroidism.

Prediction of relapse after antithyroid drug therapy of hyperthyroidism through assessment of peak systolic velocity of superior thyroid artery

Objective:To explore whether assessment of peak systolic velocity of superior thyroid artery can predict relapse after anti-thyroid drug therapy of hyperthyroidism.Methods:Seventy patients with hyperthyroidism were recruited and treated with antithyroid drug according to the national guideline, the thyroid and superior thyroid artery were evaluated by color Doppler ultrasound, and the blood velocity was measured and analyzed. 30 people with euthyroid were selected as control.Results: Twenty-six of 70 patients with hyperthyroidism treated with anti-thyroid drug relapse six months after remission, accounting for 37.1%. There was no significant difference between relapse patients and patients without relapse for peak systolic velocity of pretreatment. The peak systolic velocities were significant difference between remissive and relapse patients. The MV1-MV2/MV1s was significant difference between remissive and relapse patients. Area under ROC curve of peak systolic velocities of the superior thyroid arteries of relapse patients and euthyroid subjects was 0.773, the cutoff point was 40.3 cm/s, and sensitivity and specificity were 84.6% and 65.0%, respectively. Area under ROC curve of MV1-MV2/MV1s of the superior thyroid arteries of remissive patients and relapse patients was 0.870, the cutoff point was 0.525, and sensitivity and specificity were 86.4% and 69.2%, respectively.Conclusion: The determination of peak systolic velocity of superior thyroid artery and relevant parameters can help predict relapse after anti-thyroid drug therapy of hyperthyroidism.

Therapeutic plasma exchange and continuous renal replacement therapy for severe hyperthyroidism and multi-organ failure:A case report

BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.

Alström syndrome with a novel mutation of ALMS1 and Graves’hyperthyroidism:A case report and review of the literature

BACKGROUND Alström syndrome(AS,OMIM ID 203800)is a rare disease involving multiple organs in children and is mostly reported in non-Chinese patients.In the Chinese population,there are few reports on the clinical manifestations and pathogenesis of AS.This is the first report on the association between AS and Graves’hyperthyroidism.CASE SUMMARY An 8-year-old Chinese girl was diagnosed with AS.Two years later,Graves’hyperthyroidism developed with progressive liver dysfunction.The patient’s clinical data were collected;DNA from peripheral blood of the proband,parents and sibling was collected for gene mutation detection using the second-generation sequencing method and gene panel for diabetes.The association between the patient’s genotype and clinical phenotype was analyzed.She carried the pathogenic compound heterozygous mutation of ALMS1(c.2296_2299del4 and c.11460C>A).These stop-gain mutations likely caused truncation of the ALMS1 protein.CONCLUSION The manifestation of hyperthyroidism may suggest rapid progression of AS.

Influencing factors of radioiodine therapy in hyperthyroidism in adults

The study was to evaluate factors affecting outcome of 131I therapy in hyperthyroidism for optimizing the method. Data from 213 patients who received 131I treatment from July 2003 to July 2005 in our department were retrospectively analyzed. Factors possibly contributing to the outcome of the 131I therapy were analyzed, including gen-der, age, history of antithyroid drug, thyroid volume, duration of disease and radioactive iodine uptake rate. Multivariate analysis was done. The rates of euthyroidism and hypothyroidism were 69% and 8.5%, respectively, after one time 131I therapy. Multivariate analysis of the patients showed no statistically significant factors affecting the outcome of 131I therapy. The study showed that 131I dose can be directly calculated, and this simplifies the dose-determined method and individualizes the therapy.

Changes of bone mineral density, bone metabolism indices and cell factors in patients with hyperthyroidism

Objective:To observe the changes of bone mineral density, bone metabolism indices and cell factor in patients with hyperthyroidismMethods:A total of 116 cases of hyperthyroidism patients from June 2015 to June 2016 in our hospital were selected. as the object of observation group. Then, 120 cases of healthy people were selected as the object of control group. Thyroid function indexes (TT3, TT4, FT3, FT4, TSH), bone mineral density (BMD), bone metabolism indexes (PTH, BGP, PINP) and cell factors (IL-2, IL-6) in both groups were detected and compared.Results:TT3, TT4, FT3, FT4, TSH in control group were (1.40±0.81) nmol/L, (94.36±32.10) nmol/L, (5.04±1.18) pmol/L, (15.37±4.60) pmol/L, (2.55±1.21) mU/L. TT3, TT4, FT3, FT4, TSH in observation group were (5.48±2.36) nmol/L, (405.55±71.48) nmol/L, (16.27±5.14) pmol/L, (46.83±12.66) pmol/L, (0.04±0.01) mU/L. TT3, TT4, FT3, FT4 in the observation group were higher than that in control group obviously. TSH in the observation group was lower than that in observation group obviously. The difference between two groups was considered statistically significant. BMD, PTH in observation group were (0.62±0.08) g/m2, (26.25±9.16) pg/mL, which were obviously lower than BMD (1.23±0.11) g/m2, PTH (37.13±8.05) pg/mL in control group. The difference between two groups was considered statistically significant. BGP, PINP in observation group were (14.51±6.25) ng/mL, (223.63±10.38) μg/L, which were obviously higher than BGP (5.97±1.98) ng/mL, PINP (33.18±6.15) μg/L in control group. The difference between two groups was considered statistically significant. IL-2 in observation group was (1.60±0.51) ng/L, which was obviously lower than IL-2 (4.72±1.29) ng/L, in control group. IL-6 in observation group was (1.98±0.34) pg/L, which was obviously higher than IL-6, (1.50±0.23) pg/L, in control group. The difference between two groups was considered statistically significant.Conclusion:Bone mineral density in patients with hyperthyroidism decreased and bone metabolism in patients with hyperthyroidism was active. The significant changes of IL-2, IL-6 also can be seen. In the clinical ,We should enhance the detection of these indexes, so as to take measures to prevent and cure the complications such as osteoporosis.

Hyperthyroidism and severe bradycardia:Report of three cases and review of the literature

BACKGROUND Hyperthyroidism often leads to tachycardia,but there are also sporadic reports of hyperthyroidism with severe bradycardia,such as sick sinus syndrome(SSS)and atrioventricular block.These disorders are a challenge for clinicians.CASE SUMMARY We describe three cases of hyperthyroidism with SSS and found 31 similar cases in a PubMed literature search.Through the analysis of these 34 cases,we found 21 cases of atrioventricular block and 13 cases of SSS,with 67.6%of the patients experiencing bradycardia symptoms.After drug treatment,temporary pacemaker implantation,or anti-hyperthyroidism treatment,the bradycardia of 27 patients(79.4%)was relieved,and the median recovery time was 5.5(2-8)d.Only 7 cases(20.6%)needed permanent pacemaker implantation.CONCLUSION Patients with hyperthyroidism should be aware of the risk of severe bradycardia.In most cases,drug treatment or temporary pacemaker placement is recommended for initial treatment.If the bradycardia does not improve after 1 wk,a permanent pacemaker should be implanted.

Acute coronary syndrome with severe atherosclerotic and hyperthyroidism: A case report

BACKGROUND Acute coronary syndrome(ACS)encompasses a spectrum of cardiovascular emergencies arising from the obstruction of coronary artery blood flow and acute myocardial ischemia.Recent studies have revealed that thyroid function is closely related to ACS.However,only a few reports of thyrotoxicosis-induced ACS with severe atherosclerosis have been reported.CASE SUMMARY A 33-year-old man,who had a history of hyperthyroidism without taking any antithyroid drugs and no history of coronary heart disease,experienced neck pain with occasional heart palpitations starting 3 mo prior that were aggravated after an activity.As the symptoms worsened at 21 d prior,he went to a hospital for treatment.The electrocardiogram examination showed a multilead ST segment elevation and pathological Q waves.Based on these findings and his symptoms,the patient was diagnosed with a suspected myocardial infarction and transferred to our hospital on July 2,2020.He was diagnosed with a rare case of ACS due to coronary artery atherosclerosis in the anterior descending artery complicated by hyperthyroidism.A paclitaxel-coated drug balloon was used for treatment to avoid the use of metal stents,thus reducing the time of antiplatelet therapy and facilitating the continued treatment of hyperthyroidism.The 9-mo follow-up showed favorable results.CONCLUSION This case highlights that atherosclerosis is a cause of ACS that cannot be ignored even in a patient with hyperthyroidism.

Novel compound heterozygous mutation of SLC12A3 in Gitelman syndrome co-existent with hyperthyroidism:A case report and literature review

BACKGROUND Gitelman syndrome(GS)is a rare inherited autosomal recessive tubulopathy,characterized clinically by hypokalemia,hypomagnesemia,hypocalciuria,and metabolic alkalosis,and is caused by an inactivating mutation in SLC12A3.GS is prone to misdiagnosis when occurring simultaneously with hyperthyroidism.It is important to consider the possibility of other diseases when hyperthyroidism is combined with hypokalemia,which is difficult to correct.CASE SUMMARY A female patient with hyperthyroidism complicated with limb weakness was diagnosed with thyrotoxic hypokalemic periodic paralysis for 4 mo.However,the patient’s serum potassium level remained low despite sufficient potassium replacement and remission of hyperthyroidism.GS was confirmed by whole exome and Sanger sequencing.Gene sequencing revealed compound heterozygous mutations of c.488C>T(p.Thr163Met),c.2612G>A(p.Arg871His),and c.1171_1178dupGCCACCAT(p.Ile393fs)in SLC12A3.Protein molecular modeling was performed to predict the effects of the identified missense mutations.All three mutations cause changes in protein structure and may result in abnormal protein function.All previously reported cases of GS coexisting with autoimmune thyroid disease are reviewed.CONCLUSION We have identified a novel compound heterozygous mutation in SLC12A3.The present study provides new genetic evidence for GS.

Alternating Hyperthyroidism and Hypothyroidism in Graves’ Disease: A Case Report and Literature Review

Background: Alternating thyroid function between hypo- and hyperthyroidism is a very rare phenomenon attributed to the switch between the types of thyroid stimulating hormone receptor autoantibodies;thyroid stimulating antibody and thyroid stimulating hormone blocking antibody. Case Presentation: We report an 18 years old male who presented with hyperthyroidism attributed to Graves’ disease. He was treated with antithyroid medication. During follow up, his thyroid function was switching between hyper- and hypothyroidism which was difficult to treat with antithyroid medication. His laboratory investigations revealed high thyroid stimulating immunoglobulin and TSH binding inhibitory immunoglobulin. Due to the difficultly of managing him with antithyroid medication, he was offered a definitive management for his Graves’ disease. Conclusion: This case demonstrates a rare challenging presentation of Graves’ disease. Patients presenting with fluctuation in thyroid function between hyper-and hypothyroidism need a definitive management for Graves’ disease.

One Case of Acute Fluid Pericarditis and Hyperthyroidism at Teaching Hospital of Bouake (Ivory Coast): Cause-Effect Relationship or Accidental Association?

Cardiovascular complications during hyperthyroidism are dominated by arrhythmias, heart failure and coronary heart disease. Pericardial effusion which is a common complication of hypothyroidism is extremely rare in hyperthyroidism. We report the case of a 45-year-old woman admitted for management of pleuro-pericarditis associated with atrial fibrillation in the context of cardiothyreosis. The treatment consisted of a pericardial puncture associated with synthetic anti-thyroid drugs and anti-tuberculosis drugs with positive clinical and echocardiographic outcomes.

Contribution of Radioiodine Thyroid Uptake and Scintigraphy to the Diagnosis of Hyperthyroidism

In total 184 studies, which included thyroid uptake and scintigraphy, were performed in 68 hyperthyroid patients: 67% female and 33% male to investigate their thyroid conditions. The aim of the present study was to illustrate the role of uptake and scintigraphy tests in determining the thyroid status of hyperthyroid patients. The uptake study was performed by oral administration of 100 - 200 &mu;Ci of 131I as sodium-iodide and counting the radioactivity at 2 and 24 hrs, whereas thyroid scintigraphy was performed 20 minutes after an intravenous injection of 2 - 4 mCi of 99mTc-pertechnetate. The present results of thyroid uptake and scintigraphy successfully identified the thyroid condition in different states. The present results were also compared with some reported data and found to be fair in good agreement.

Clinical observation of bone metabolism before and after131I treatment in premanopause adult female hyperthyroidism patients with low bone mass

Objective:To observe the bone metabolism before and after131I treatment in premanopause female hyperthyroidism patients with low bone mass patients of different age.Methods:A total of 78 premanopause female patients hyperthyroidism with low bone mass were divided into two different age groups: premanopause female patients less than 35 years old in group A (n=38). Patients above 35 in group B (n = 40). 78 healthy adults of same age were enrolled as the control group. The bone mineral density (BMD) and bone turnover markers including type I procollagen N-terminal propeptide (PINP),β-C-terminal telopeptides of type 1 collagen (β-CTx) of two groups were measured before and 6 months and 12 months after 131I treatment to observe the bone metabolism and the restorablility of BMD.Results: After prolonged treatment with131I, PINP andβ-CTX of group A decreased and BMD increased gradually in a time-dependence way. And there was no significant difference when compared to the normal after 12 months. PINP andβ-CTX of group B decreased gradually, after 12 months, BMD of group B restored when compared to the level of before treatment but lower than group A.Conclusions: In young female hyperthyroidism patients with low bone mass (<35 years), BMD can be restored to normal levels as reversing of high bone turnover after131I treatment. Short-term clinical observation showed that high bone turnover was reduced partly in premanopause female patients (>35 years) treated only with131I , but still at a high level, BMD can not restored completely.