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.

Subacute Hyperthyroidism Induced by Treatment with Lithium Salts

Lithium treatment is usually indicated in bipolar disorder. It is associated with hypothyroidism and very rarely with hyperthyroidism. We report here the results of the exploration of a case of thyrotoxicosis occurring during treatment with lithium salts. This was a 16-year-old patient with ongoing lithium treatment for two and a half years who presented with a thyrotoxicosis syndrome without a context of iodine overload or an episode of anterior cervical pain that could suggest subacute thyroiditis or orthopathic sign. The assessment of the exploration of this patient reveals biological hyperthyroidism without anti-TSH receptor antibodies, a normal ultrasound, and white scintigraphy which makes it possible to evoke the diagnosis of subacute thyroiditis (absence of the context of iodine overload). Note the interest in a thyroid assessment before and during treatment with lithium salts. Moreover, scintigraphy occupies a place of choice in the exploration of hyperthyroidism, particularly in the context of normal thyroid ultrasound imaging.

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.

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.

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.

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.

Influencing factors and mechanism of iodine-induced stress corrosion cracking of zirconium alloy cladding:A review

Failure of the zirconium alloy claddings due to iodine-induced stress corrosion cracking(I-SCC)will increase the risk of fission product leakage.The progress of I-SCC has been comprehensively investigated in a massive amount of published literature.For a comprehensive understanding of I-SCC,this review focuses on summarizing the mechanisms and influencing factors of I-SCC.Results show that micropits are formed on the surface of zirconium alloys due to the reaction between iodine and zirconium,and then small pits gradually gather to form pit clusters.Cracks are easily generated in pit clusters and propagate along the grain boundary.After reaching a particular condition,the crack will transform into transgranular direction propagation.As the crack develops,it finally becomes a ductile fracture.We also summarize various factors that may affect I-SCC.The specific cracking conditions are linked to elements,such as iodine concentration,temperature,microstructure,and alloying elements.Nonetheless,the improvement of the I-SCC resistance of zirconium alloys needs to be further explored.More attention can be paid to material properties,such as alloying elements,microstructure,and surface treatment,to improve the I-SCC resistance of zirconium alloys.

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.

Study of the External Dose Rate and Retained Body Activity of Patients with Hyperthyroidism Who Are Receiving Ⅰ-131 Therapy

Hyperthyroidism refers to a clinical state that results from inappropriately hight hyroid hormone levels in the tissues;.Ⅰ-131 therapy plays a critical role and provides a remarkable curative effect in targeting thyroid diseases. Thyroid cells can take up isotope I-131, which emits not only beta rays but also

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.

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.

ACUPUNCTURE TREATMENT OF SUBACUTE THYROIDITIS WITH HYPERTHYROIDISM AT THE LATE STAGE

Causes inducing subacute thyroiditis have been unclear, but clinically it is treated mostlywith cortical hormones. In the present paper, it was reported that one case of subacute thyroiditis withhyperthyodism at the late stage was cured with acupuncture at Renying (ST 9), Fengchi (GB 20),Jiaji ponts on the neck and other points. In the treatment, differentiation of symptoms and signs wascombined with differentiation of disease, selection of proximal acupoints was combined with selectionof distal acupoints. The patient was treated in accordance with his physique. Therefore, the therapeu-tic effects were obtained rapidly.

COMPARISON ON THE CLINICAL EFFECT IN THE TREATMENT OF HYPERTHYROIDISM WITH DIFFERENT ACUPUNCTURE INTERVAL

Comparative observation was taken in 112 patients of hyperthyroidism. These patients were treated by both acupuncture and small dosage (10 mg once daily) of Methimazole. The acupuncture was given once weekly in group 1, twice in group 2, and thrice in group 3. The result shows that there is no significant difference in therapeutic effect beween group 2 and group 3 ( P > 0.05 ) . Further analysis discovered that two times' acupuncture given weekly is suitable to recrudescent patient, while in new patient the symptoms can be controlled by needling taken once in a week.

PROPRANOLOL IN THE SURGICAL TREATMENT OF HYPERTHYROIDISM

From July 1976 to Oct. 1993, propranolol war used to prepare 154 thyrotoxic patients including 95 severe cases. The initial dose of propranolol was gradually increased to 160 mg/d and Lngol's solution war added in for 10-14 days after the pulse rate had become stable. Just before operation another dose of propranolol was given, and propranolol intake war resumed within 6-8 hours after operation. The thyrotoxic symptonis were controlled The postoperative course in 144 cases was uneventful. High fever and tachycardia developed in 7 patients with severe thyrotoxicosis and were controlled by intravenous hydrocortisone and increased dosape of propranolol. Only one case developed hypaplycemia 12 hours after operation. Our study demonstrated that propranolol combined with iodine is a safe method for preoperative treatment in hyperthyroidism. Although there was no thyroid crisis, we do not recommend propranolol alone as the routine preparation for severe thyrotoxicosis. Preparation with antithyroid drugs is the method of choice if the patient can tolerate.

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.

Summary of Experience in Treating Hyperthyroidism with TCM Syndrome Differentiation

Syndrome differentiation is the characteristic and soul of Traditional Chinese Medicine (TCM), which has certain advantages in the treatment of hyperthyroidism. TCM mainly divides its syndrome differentiation into four types: exuberant liver fire type, yin deficiency and fire exuberant type, qi-yin deficiency type and phlegm stagnation type. This paper summarizes the treatment of hyperthyroidism by TCM syndrome differentiation, in order to provide some reference for the treatment of this disease.

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).

Clinical Implications and Management of Sub Clinical Hyperthyroidism: A Review

Sub clinical hyperthyroidism (SCH) is characterized by normal free thyroid hormone concentrations along with a low or undetectable serum TSH (thyrotropin) level. The increased use of TSH as a screening measure and improved assay sensitivity is contributing to the diagnosis of sub clinical hyperthyroidism more frequently than ever in our clinical practise leading to the increased prevalence of the disease. The significance of SCH remains uncertain for most patients as some will revert to normal thyroid status over time whereas others will either remain static or progress to overt thyroid disease in the future. The detrimental effects of a persistently suppressed TSH has now been extensively studied and its effect on the cardiovascular system, the skeleton, mood disturbance, quality of life is quite significant leading to considerable morbidity and mortality. Majority of the patients are asymptomatic and lack overt features but the relevance of treatment is more focussed in elderly patients where the risk of developing cardiac arrhythmia and loss of bone mineral density is much more than young people in whom a conservative approach is usually preferred. The issue is contentious, the situation is challenging and the benefits of treatment are debatable. The consensus for who, when and how to treat is growing but still hasn’t been universally accepted. We attempt to review the recent literature available for sub clinical hyperthyroidism and suggest an analytical approach to its investigations and management.

Lithium carbonate plus ¹³¹I in the treatment of Graves’ hyperthyroidism

Aims: Effectiveness of radioiodine for Graves’ hyperthyroidism (GD) depends on its intrathyroidal persistence, which could be enhanced by lithium by blocking the release of organic iodine and thyroid hormone from the thyroid gland. The present aim focused on the effect of the addition of lithium carbonate to 131I therapy in patients with GD. Methods: 100 consecutive patients with GD were randomly assigned to two groups: group (A) patients treated with 131I and group (B) patients treated with 131I plus lithium carbonate. Patients in B group were treated with a dose of 0.5 g per day (2 × 0.25 g) of lithium carbonate for half a month before and after the administration of 131I. Thyroid weight was estimated by ultrasonography and careful palpation of the thyroid. Radiation absorbed dose rate in the front of the neck was measured on days 1530 and 45 after the administration of 131I. Serum concentrations of thyroidstimulation hormone (TSH), fee tri-iodothyrosine (T3) and free thyroxine (T4) were tested on days 30, 45, 90, 180 before and after treatment. Results: After RIT, radiation absorbed dose rate in the front of neck gradually decreased as time went on (p 0.05), free T3 and free T4 values in both groups rose significantly one month after treatment (all p 0.05). Cure rate of hyperthyroidism was achieved in 36 of the 50 patients (72%) treated with 131I alone and in 38 of the 50 patients (76%) treated with 131I plus lithium. Conclusion: We suggest that for patients withdrawing of ATD and those with short effective half-time, as well as those intolerant or invalid, the short term addition of lithium to 131I allows for a better control of thyrotoxia and the completeness of treatment.