Lymphocytic Thyroiditis With Spontaneously Resolving Hyperthyroidism (Silent Thyroiditis)

Nikolai, Thomas F.

doi:10.1001/archinte.1980.00330160038023

Cited by 94 publications

(15 citation statements)

References 14 publications

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“…Difference from value for healthy subjects significant at P < 0.05. rotoxicosis from Graves' thyrotoxicosis, although there were some exceptional cases. Nikolai et al (16), however, could not confirm the usefulness of this index. In our study, patients receiving medication were strictly excluded by careful examination of case histories, since drug therapy, including treatment with antithyroid drugs, may change the T3 to T 4 ratio.…”

Section: Discussionmentioning

confidence: 87%

“…Recently, we found that the serum ratio of T3 to T 4 was helpful for differentiation of destruction-induced thyrotoxicosis from hyperthyroidism due to Graves' disease (13,14), but the usefulness of this index was not confirmed by Walfish (15) or Nikolai et al (16). The T 3 to T 4 ratio is modified by a change in the concentration of T 4 -binding globulin (TBG) (17).…”

mentioning

confidence: 99%

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Serum Ratio of Triiodothyronine to Thyroxine, and Thyroxine-Binding Globulin and Calcitonin Concentrations in Graves' Disease and Destruction- Induced Thyrotoxicosis*

Amino

Yabu

Miki

et al. 1981

The Journal of Clinical Endocrinology & Metabolism

120

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The serum ratios of T3 to T4, and T4-binding globulin (TBG) and calcitonin concentrations were studied in cases of thyrotoxic Graves' disease and destruction-induced thyrotoxicosis. In 272 patients with Graves' disease, 209 of 240 (87%) untreated patients without complications had high T3 to T4 ratios (nanograms per micrograms) of more than 20. Six of 32 (19%) patients with Graves' disease who had complications (15 with pregnancy, 14 with increased TBG, and 3 with conditions associated with a low T3 syndrome) had high T3 to T4 ratios. Eleven of 74 (15%) patients with destruction-induced thyrotoxicosis (24 with subacute thyroiditis, 39 with postpartum transient thyrotoxicosis, and 11 with spontaneous transient thyrotoxicosis) had high T3 to T4 ratios. Patients who had serum T4 levels of more than 30 micrograms/dl and/or T3 levels of more than 800 ng/dl had Graves' disease. There was no significant correlation between the T3 to T4 ratio and activities of thyroid-stimulating immunoglobulins in thyrotoxic patients with Graves' disease who had no complications. The average serum levels of TBG in destruction-induced thyrotoxicosis and thyrotoxic Graves' disease were 20.7 +/- 4.3 micrograms/ml (mean +/- SD; n = 22), and 19.9 +/- 4.0 (n = 41), respectively, which were significantly lower than that in healthy subjects (22.7 +/- 4.4 micrograms/ml; n = 165), but there was no difference between the values in the two groups of thyrotoxicosis patients. The average serum level of calcitonin in destruction-induced thyrotoxicosis patients was 96.7 +/- 66.7 pg/ml (n = 21), which was significantly (P less than 0.05) higher than the values in patients with thyrotoxic Graves' disease (62.0 +/- 44.7 pg/ml; n = 26) and in healthy subjects (63.9 +/- 31.2 pg/ml; n = 29), but the difference in values in the two groups of thyrotoxicosis was not clinically useful because of considerable overlap of individual values. The T3 to T4 ratio is a simple and helpful index for the differentiation of the two types of thyrotoxicosis. A T3 to T4 ratio less than 20 in thyrotoxic patients before therapy is a laboratory signal of destruction-induced thyrotoxicosis or Graves' disease with complications, but final differentiation should be confirmed by measuring radioactive iodine uptake.

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Section: Discussionmentioning

confidence: 87%

mentioning

confidence: 99%

Serum Ratio of Triiodothyronine to Thyroxine, and Thyroxine-Binding Globulin and Calcitonin Concentrations in Graves' Disease and Destruction- Induced Thyrotoxicosis*

Amino

Yabu

Miki

et al. 1981

The Journal of Clinical Endocrinology & Metabolism

120

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“…It is high (23%) in Wis¬ consin (19), but it is less than 5% in Brooklyn (20) and Rochester, NY (21), Portsmouth, VA (22), and Philadelphia, PA (23).…”

Section: Discussionmentioning

confidence: 99%

Postpartum thyroid dysfunction in Bangkok: A geographical variation in the prevalence

Rajatanavin¹,

Chailurkit²,

Tirarungsikul³

et al. 1990

Acta Endocrinologica

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To determine the prevalence of thyroid dysfunction in Thai postpartum women, we evaluated thyroid function and thyroid autoantibodies in 812 consecutive unselected women at 1.5 months post partum. At 3.5 months post partum 570 women without previous thyroid abnormality returned for a second set of thyroid function test. The prevalence of thyroid dysfunction was 1.1%, which was less than that reported from other countries. Various types of postpartum thyroid dysfunction, namely, transient thyrotoxicosis followed by transient hypothyroidism, transient thyrotoxicosis or hypothyroidism occurring alone or permanent hypothyroidism were encountered. Eight out of 9 patients with thyroid dysfunction had thyroid autoantibodies. Fine needle aspiration biopsy of the thyroid was done in 4 patients and all showed lymphocytic thyroiditis. Even though Bangkok is an iodine surfeit area, iodine intake is relatively lower than in other areas where the prevalence of postpartum thyroid dysfunction is much higher. The discrepancy in geographic prevalence of postpartum thyroid dysfunction may result from the interaction of immunogenetic heterogeneity of different ethnic background, environmental iodine intake, and other unidentified environmental factors.

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“…T HE ETIOLOGY of silent thyroiditis (painless thyroiditis) is uncertain, although the entity has been recognized over the past decade as a clinical syndrome manifested by spontaneously resolving thyrotoxicosis associated with a marked suppression of thyroid radioiodine uptake (1)(2)(3). TSH binding-inhibiting immunoglobulins (TBII) and thyroid-stimulating antibodies (TSAb) are not associated with most thyroid disorders, except for Graves' disease, euthyroid Graves' disease, and primary myxedema (4)(5)(6)(7)(8).…”

mentioning

confidence: 99%

The Occurrence of Thyrotropin Binding-Inhibiting Immunoglobulins and Thyroid-Stimulating Antibodies in Patients with Silent Thyroiditis

Morita

Tamai

Oshima

et al. 1990

The Journal of Clinical Endocrinology & Metabolism

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Silent (painless) thyroiditis has been recognized as a clinical entity for over a decade and is characterized by spontaneously resolving thyrotoxicosis. Its etiology is uncertain; however, a few reports have indicated the occurrence of TSH binding-inhibiting immunoglobulins (TBII) and thyroid-stimulating antibodies (TSAb) in some of the patients. The present study was undertaken to evaluate thyroid function and the occurrence of TBII and TSAb and thyroid autoantibodies (antithyroglobulin and antimicrosomal) in 53 patients with silent thyroiditis during the course of their disease. The patients were divided into 2 major groups: I) those who developed transient hypothyroidism and II) those who did not. All patients initially had significantly increased concentrations of serum T4, free T4, and free T3, suppressed TSH levels, and decreased thyroid radioiodine uptake. TBII and TSAb were initially positive in 8 (15.1%) and 10 patients (18.9%), respectively. Forty patients were available for follow-up. TBII was positive in 6 of 24 (25.0%), and TSAb was positive in 8 of 24 (33.3%) of the patients who developed transient hypothyroidism during the course of their disease. Among the patients who did not become hypothyroid at any time, TBII was positive in only 2 of 16 (12.5%), and none of the patients became TSAb positive. The findings indicate that increased TSAb and TBII activity may be detected in patients with silent thyroiditis and, when present, are associated with transient hypothyroidism during the course of the disease.

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Lymphocytic Thyroiditis With Spontaneously Resolving Hyperthyroidism (Silent Thyroiditis)

Cited by 94 publications

References 14 publications

Serum Ratio of Triiodothyronine to Thyroxine, and Thyroxine-Binding Globulin and Calcitonin Concentrations in Graves' Disease and Destruction- Induced Thyrotoxicosis*

Serum Ratio of Triiodothyronine to Thyroxine, and Thyroxine-Binding Globulin and Calcitonin Concentrations in Graves' Disease and Destruction- Induced Thyrotoxicosis*

Postpartum thyroid dysfunction in Bangkok: A geographical variation in the prevalence

The Occurrence of Thyrotropin Binding-Inhibiting Immunoglobulins and Thyroid-Stimulating Antibodies in Patients with Silent Thyroiditis

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