In three separate studies, members of the American Thyroid Association (ATA), the European Thyroid Association (ETA), and the Japan Thyroid Association (JTA) were surveyed by questionnaire on their management of Graves' disease. The aim was to determine how expert clinical thyroidologists employ diagnostic procedures and the three different therapies that are available for this disorder. In this report, we identify, summarize, compare, and contrast similarities and differences in the results of these surveys in these three different regions of the world. In general, ATA members used fewer diagnostic tests than did their European or Japanese colleagues. For the index patient, radioiodine was the therapy of choice for 69% of ATA respondents but only 22% and 11% of ETA and JTA respondents, respectively. In contrast, only 30.5% of ATA respondents chose antithyroid drugs as first-line therapy compared to 77% of ETA and 88% of JTA respondents. There was consensus on the relative lack of a role for thyroidectomy except for narrow indications. The implications of these differing approaches for the diagnosis and treatment of hyperthyroidism due to Graves' disease are discussed.
12 of 17, a significant frequency (71%), of untreated Graves' disease patients with no clinical ophthalmopathy showed extraocular muscle (EOM) enlargement by Magnetic Resonance Imaging (MRI). Enlargement was bilateral in 41% and unilateral in 29% in these patients. Apparent enlargements of EOM were also detected, by MRI, in all of 11 Graves' disease patients with clinical ophthalmopathy, bilateral in 73% and unilateral in 27% of patients in this group. Both group showed the inferior rectus muscle as the most frequently involved (56% and 77% respectively). In 16 patients without autoimmune thyroid disorders or ophthalmopathy who served as normal controls, only 2 of these patients (12%) demonstrated mild EOM enlargement. The severity and patterns of EOM enlargement revealed no correlation with abnormalities in serum thyroid function tests or serum thyroidal autoantibodies. In conclusion, a high frequency of Graves' disease patients without clinical eye signs or symptoms harbor EOM abnormalities, as demonstrated by MRI. This suggests that present clinical examination methods are insufficient to diagnose varying degrees of ophthalmopathy in patients with autoimmune thyroid disorders who do not initially present with clinical ophthalmopathy.
Abstract. It has been reported that cytokines, especially interleukin 1 and interferon-γ, inhibit the thyroid hormone secretion and the gene expression of human thyroid peroxidase and thyroglobulin. Interleukin 6 has recently been found to be an important cytokine for the regulation of immunoendocrine interaction and intrathyroidal production of interleukin 6 has been reported. Therefore, we investigated the regulation of thyroid hormone secretion and thyroid peroxidase messenger RNA by interleukin 6 in human thyrocytes to clarify further the functional role of interleukin 6 in thyroid glands. Thyrocytes dispersed from Graves' thyroid tissues were incubated with TSH with or without interleukin 6. TSH (5 U/l stimulated the expression of thyroid peroxidase mRNA transcripts (4.0, 3.2, 2.1, and 1.7 kb, respectively), although unstimulated thyrocytes contained the low level of 3.2 kb thyroid peroxidase mRNA transcript. Interleukin 6 (104-105 U/l) inhibited TSH-induced thyroid peroxidase mRNA in a dose-dependent manner, although the basal level of thyroid peroxidase mRNA expression was not suppressed by interleukin 6. Interleukin 6 also inhibited 8-bromo-cyclic adenosine monophosphate-induced thyroid peroxidase mRNA levels. In contrast, the γ-action mRNA hybridization signal was not altered in control or treated cells. Subsequently, interleukin 6 inhibited TSH-induced T3 secretion in a dose-dependent manner after 72 h treatment. However, interleukin 6 did not affect DNA synthesis. Pretreatment with specific antibody against interleukin 6 selectively restored the inhibitory effect of interleukin 6 on thyroid peroxidase gene expression. Our results suggest that interleukin 6 plays an inhibitory role in the thyroid gland, in addition to interleukin 1 and interferon γ.
The management of hyperthyroidism
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