Prevalence of enuresis and other bladder symptoms in patients with active Graves’ disease

Abstract

Objective To determine the prevalence of bladder symptoms in patients with Graves’ disease and assess their abnormalities on urodynamic studies. Patients and methods The study comprised 30 consecutive patients (13 female, 17 male, mean age 31 years, sd 10) with active Graves’ disease. Before and after attaining euthyroidism with carbimazole, their bladder symptoms were assessed using a questionnaire adapted from the American Urologic Association voiding symptom score, the serum levels of total triiodo‐l‐thyronine (T3), serum thyroxine (T4) and thyroid‐stimulating hormone (TSH) were measured by radioimmunoassay, and uroflowmetry, cystometry and perineal muscle electromyography were performed. Results Twelve of the 30 patients (40%) had the onset of bladder symptoms 1–6 months after the onset of symptoms of Graves’ disease; four of the 12 patients had enuresis. Urodynamic studies were possible in five patients and showed reduced flow rates in all, a significant post‐void residual volume in four, and enlarged bladder capacity and increased perineal muscle electromyographic activity during the voiding phase in three. Voiding disturbances and urodynamic abnormalities resolved after attaining euthyroidism. Conclusion Significant bladder symptoms can occur in about 40% of patients with active Graves’ disease but resolve on euthyroidism; in some patients, urodynamic studies show significant abnormalities which are also reversible.

Frequency of Lower Urinary Tract Symptoms and Effects on Quality of Life in Women with Rheumatoid Arthritis

“…This study indicates an increased prevalence of LUTS among women with RA when compared with the healthy control population, and the current data is in accordance with the previous studies that report increased prevalence of LUTS among individuals with other autoimmune diseases (4)(5)(6)(7)(8). The presence of LUTS is associated with lower QoL in affected individuals.…”

“…Micturition pathophysiology has not been clearly defined in these autoimmune diseases; however, autoantibody mediated autonomic nerve pathway of the bladder is believed to play an important role in this process (4,8,9). Peeker et al (15) have reported there was interstitial cystitis (IS) in 13% of the patients with RA.…”

“…AUASI questionnaire includes seven questions to query the presence of a possible irritative (frequency, urgency, and nocturia) and obstructive (incomplete emptying, decrease in flow rate, and straining) urinary symptoms. A scoring system was utilized to classify the degree of the symptoms as mild (0-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), or severe (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). The final item of the AUASI form investigates the impact of urinary symptoms on QoL, and this entity is scored between 0 and 6 (10).…”

“…Lower urinary tract symptoms (LUTS) can be observed in both males and females throughout lifetime and are particularly common in the elderly population. Beside this, there is a higher prevalence of severe LUTS in the patients with autoimmune diseases than that in the healthy individuals (3)(4)(5)(6)(7)(8)(9). Although the etiology of LUTS that is observed in autoimmune diseases is poorly understood, some pathophysiological mechanisms involving the autoantibody-mediated bladder reflexes and autonomic nerve pathways have been postulated (3,9).…”

Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves' disease and their reversibility with carbimazole therapy

“…In an earlier study, we have described dyssynergia of the detrusor muscle as the cause of urinary bladder dysfunction in patients with thyrotoxicosis, which reversed on treatment (8). It is possible that dyssynergia of the thoracic diaphragm muscle might have contributed to poor diaphragmatic muscle pressure and its movement during deep respiration.…”