Thyroid : official journal of the American Thyroid Association
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Case Reports
Graves' dermopathy: does octreotide scintigraphy predict the response to octreotide treatment?
We report on three patients with severe Graves' dermopathy who were treated with octreotide despite a negative octreotide scintigraphy. One patient showed a complete recovery while two others had a partial response. In contrast to active Graves' ophthalmopathy, an octreotide scintigraphy appears not to be useful for pretreatment identification of patients with Graves' dermopathy who are likely to respond to octreotide treatment.
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Comparative Study Clinical Trial
A comparison of direct, indirect, and fiberoptic laryngoscopy to evaluate vocal cord paralysis after thyroid surgery.
After thyroidectomy, the anesthesiologist usually performs a laryngoscopy to detect laryngeal edema and nerve palsies. The goal of this study was to compare three different methods of laryngeal examination after tracheal extubation of the patients. For that purpose, between 1990 and 1995, a prospective series of 1608 patients operated for thyroidectomy has been studied. ⋯ Finally, variations in monitored cardiovascular parameters were significantly lower with flexible and indirect laryngoscopies than with direct laryngoscopy. These mild variations induced by flexible laryngoscopy were well tolerated by patients with known cardiovascular diseases. Flexible laryngoscopy is the best method for an immediate laryngoscopic examination after thyroidectomy.
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The pathogenesis of the extrathyroidal manifestations of Graves' disease-ophthalmopathy and pretibial myxedema (Graves' dermopathy)-involves fibroblast activation and increased mucin (glycosaminoglycan) production. It is nuclear why fibroblasts are activated at these sites and evidence for site-specific and generalized fibroblast activation is conflicting. One previous report has demonstrated an increase in glycosaminoglycan deposition in the forearm skin of patients with Graves' disease but without pretibial myxedema. ⋯ Only 1 of 8 UG patients had multiple CR3/43 staining cells present in the dermis: 3 of 8 TG and 1 of 8 controls had a few CR3/43 stained cells. Overall we found no evidence of dermal mucin deposition in the forearms of 16 patients with Graves' disease and a similar GAG distribution to normal controls. HLA-DR expression by fibroblast-like cells in the dermis suggests activation of these cells in the dermis of the PTM specimens, but no evidence of widespread fibroblast activation was found in the forearms of patients with Graves' disease.
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Case Reports
Rectal administration of iodide and propylthiouracil in the treatment of thyroid storm.
We administered potassium iodide and propylthiouracil per rectum, in conjunction with intravenous dexamethasone and propranolol, for emergent treatment of a patient in thyroid storm with small bowel obstruction. Shortly after initiation of this treatment, the patient successfully underwent two emergent surgical procedures for resection of an intestinal volvulus with advanced peritonitis. ⋯ Parenteral iodide preparations have been unavailable in the past, and continue to be difficult to obtain emergently. Rectal administration of inorganic iodide is an effective, readily available and less expensive alternative to parenteral sodium iodide for patients in thyroid storm with upper gastrointestinal tract dysfunction.
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Comparative Study
Analysis of fibroblast-stimulating activity in IgG from patients with Graves' dermopathy.
Conflicting results have been reported on the effect of IgGs from patients with Graves' dermopathy on dermal fibroblast function. We have analyzed 14 dermopathy IgGs prepared by protein G affinity chromatography. These caused FRTL-5 thyroid cells to synthesize significantly greater amounts of glycosaminoglycans (GAG) and protein than IgGs from normal controls (p < 0.05). [3H]Thymidine incorporation was also significantly increased (p < 0.05) and there was a significant correlation between all three parameters and the ability of these IgGs to stimulate iodide incorporation (p < 0.001). ⋯ Conditioned medium from thyroid cells treated with dermopathy or control IgGs caused a greater increase in GAG production than the IgGs alone, but again there was no difference between the two sources of IgG. Neither control nor dermopathy IgG affected fibroblast protein synthesis or [3H]thymidine incorporation. Our results argue against a role for circulating IgGs in mediating Graves' dermopathy and make it unlikely that the TSH receptor antibodies are acting directly on a functional receptor expressed by dermal fibroblasts in this disorder.