Sadaki Sakane

The relationship of psychological factors to the prognosis of hyperthyroidism in antithyroid drug‐treated patients with Graves’ disease

objective The relationship between emotional stress and the onset of hyperthyroidism has been well investigated, but the relationship between psychological factors and prognosis of antithyroid drug‐treated hyperthyroidism is not well known. This study has examined not only emotional stresses but also patients’ personality traits using specific tests.

DEVELOPMENT OF HYPERTHYROIDISM FOLLOWING PRIMARY HYPOTHYROIDISM: A CASE REPORT WITH CHANGES IN THYROID‐RELATED ANTIBODIES

We report a 48‐year‐old woman who developed hyperthyroidism following primary hypothyroidism. The serum T4 level was initially low and serum TSH level was high with clinical signs of hypothyroidism. The thyroid gland was not enlarged. Therapy with L‐T4 was started. Three years later she developed hyperthyroidism; serum free T4 increased to 29–1 pmol/l after cessation of L‐T4 therapy. The 123I thyroid uptake was increased with no suppression by exogenous T3. When she was hypothyroid, the activity of thyroid stimulating antibodies (TSAb) in serum measured by cyclic AMP production in cultured porcine thyroid cells were negative at 93.4% (normal < 140%), while thyroid stimulation‐blocking antibodies (TSBAb) determined by inhibition of TSH‐induced cyclic AMP increase were positive at 96.1% (normal < 40%). When hyperthyroidism subsequently occurred, TSBAb became negative (30.%), while TSAb became positive (163.3%). The findings indicate that hypothyroidism due to the potent TSBAb activity is not always persistent, but can be changed when various types of thyroid‐relating antibodies change in the course of the disease.

Isolated adrenocorticotropic hormone deficiency with transient thyroiditis inducing an adrenal crisis.

Objective: It was the aim of this study to describe a patient with isolated adrenocorticotropic hormone deficiency presenting with a variety of involuntary movements who developed an adrenal crisis due to transient thyroiditis. Clinical Presentation and Intervention: A 61-year-old man was hospitalized with a variety of involuntary movements that were suspected manifestations of metabolic encephalopathy. After admission, his general status rapidly deteriorated to a life-threatening condition that included a degree of hyponatremia. The hyponatremia and metabolic encephalopathy provided clues toward a definitive diagnosis. After corticosteroid and sodium supplementation improved the status of the patient, endocrinological examinations revealed that he suffered from isolated adrenocorticotropic hormone deficiency followed by transient thyroiditis that induced an adrenal crisis. Conclusion: This case emphasizes the importance of considering hypoadrenalism when encountering hyponatremia or metabolic encephalopathy of unknown etiology.

Serial MRI findings in a relapsing-remitting form of neuro-Behcet's disease A case report

We describe a case of neuro-Behcets disease (NBD) characterized by recurrent attacks of neurologic deficit. T2-weighted images showed a high signal intensity lesion with extensive edema in the right thalamolenticular region, midbrain, and pons as well as the cerebral white matter. After a relapse of the disease, MRI demonstrated a high signal intensity in the left thalamus, internal capsule, and midbrain. These MRI abnormalities showed marked resolution with steroid treatment. We observed sequential MRI findings in a patient with a relapsing-remitting form of NBD who had parenchymal CNS involvement, and we examined the correlation among the MRI findings and clinical features during the clinical course.

Acute and early effects of triiodothyronine administration on serum markers of bone and mineral metabolism

There have been few studies on acute changes of bone metabolism in humans by thyroid hormone. This study aimed to examine the effects of triiodothyronine on serum markers of bone and mineral metabolism during a 7-d course of daily 75 μg therapy in 14 normal volunteers by drawing blood on 1, 2, 3, 5, and 7 d of therapy.Serum calcium concentrations did not significantly change during the course of therapy, while serum phosphorus concentrations were significantly (p<0.05) decreased from 3.21±0.43 mg/dL (mean±SD) to 2.85±0.46 mg/dL on the 7th d. Serum PTH concentrations were significantly decreased from 339±116 pg/mL to 316±29 pg/mL. Serum concentrations of alkali-phosphatase and bone-specific alkali-phosphatase were not significantly changed, but serum osteocalcin concentrations were significantly increased from 5.71±1.98 mg/dL to 6.73±2.24 mg/dL. Serum carboxy-terminal propeptide of type I collagen concentrations were significantly decreased from 137.8±33.7 μg/L to 119.2±33.6 μg/L. Serum pyridinoline cross-linked telopeptide domain of type I collagen concentrations, a bone resorption marker, were significantly increased from 3.40±0.77 to 3.87±1.05 μg/L, and such significant increase was obtained from the 3rd day. The results indicate that some of bone and mineral markers change rapidly in response to triiodothyronine-induced acute thyrotoxicosis, but the manner of change is not the same as that of chronic thyrotoxicosis.

Acute Cerebellar Ataxia with an MRI Abnormality: A Sequential Imaging Study

Introduction Acute cerebellar ataxia (ACA), or acute cerebellitis, is a benign disease occurring with or after a nonspecific viral infection and generally has a good prognosis [1, 2]. ACA occurs most commonly in young children, and in the majority of cases, cerebrospinal fluid (CSF) and neuroimaging analysis are normal. Serial MRI findings have been reported in single-case studies in children [3, 4]. We report a sequential study of MRI in adult with ACA.

Insulin-dependent diabetes mellitus in which glycemic control was improved during pregnancy but deteriorated after delivery with the occurrence of postpartum thyrotoxicosis: a case report

We report a patient, a twin, with diabetes mellitus whose hyperglycemic state fluctuated during the course of the pregnancy and the subsequent delivery. She was diagnosed as having slowly progressive IDDM because of her clinical course and the findings of serum positive ICA/CF, positive HLA-DR4 and disconcordance of diabetes mellitus with her identical twin. Insulin therapy was not initially needed in the first two years because the endogenous insulin secretion was not completely reduced. After two years of insulin therapy the patient became pregnant. Her glycemic control was remarkably improved without changes in dietary intake and insulin dosage. After delivery glycemic control deteriorated after delivery with the occurrence of postpartum thyroiditis. Urinary excretion of CPR was increased during pregnancy but decreased after delivery. ICA/CF in serum were persistently detected in the whole observation period. It seems that the improved glycemic control during pregnancy was caused by the reduction in the autoimmune reaction and the deterioration in glycemic control during the postpartum period was induced by the acceleration of the autoimmune reaction by the same mechanism of postpartum autoimmune thyroiditis.