Sheldon S. Stoffer

Addison's disease: How to improve patients' quality of life

Modern adrenal function studies can facilitate both diagnosis and management in patients with chronic adrenal insufficiency. These tests are readily available at commercial laboratories and can be conveniently carried out in the physicians office during working hours. As use of these adrenal function studies becomes more common, patients with chronic adrenal insufficiency can expect to have a great improvement in quality of life.

Hyperparathyroidism and thyroid disease

The incidence of hyperparathyroidism was prospectively evaluated in a group of patients with thyroid disease, and the incidence of thyroid disease was retrospectively evaluated in a group of patients specifically referred for evaluation of hyperparathyroidism. Hyperparathyroidism was ten times more frequent in thyroid patients than expected in a general medical population and was especially prevalent in patients with nodular goiter. The incidence of thyroid disease in patients with hyperparathyroidism was 38.8%. Although radiation therapy was shown to be a factor in these associations, it alone could not explain the observed frequency.

Loss of bladder control in hyperthyroidism.

Urinary urgency and frequency and even enuresis may be manifestations of augmented adrenergic activity in hyperthyroidism, as are sweating, tremor, and tachycardia. Because patients rarely volunteer problems with urgency, frequency, and enuresis, it is worthwhile for the physician to inquire about such symptoms in patients with moderate to severe hyperthyroidism. Symptoms generally cease after treatment of the hyperthyroidism.

Is Thyroid Imaging an Overutilized Diagnostic Procedure

The technique for thyroid imaging has improved dramatically over the past 30 years so that modern images are remarkably clear and may provide striking pictures of abnormal thyroid structure. Also the patient radiation burden has been reduced by a factor of 100. However, advanced technology carries a correspondingly advanced price tag. As physicians are being held increasingly accountable for the rising cost of health care it becomes incumbent upon us to consider the cost effectiveness of thyroid imaging in relation to the indications for its use. This issue is particularly pertinent now because of improvement in the sensitivity and reliability of in vitro thyroid function testing. Also, needle biopsy is gaining favor as the procedure of choice for the diagnosis of the thyroid nodule.1

Thyroid cancer following higher dose radiation therapy

PreviewTherapeutic irradiation has long been recognized as a possible cause of cancer. Most studies linking thyroid cancer to previous irradiation have identified low-dose therapy to the head and neck as the cause. In this article, the authors point out that higher dose irradiation is also a potential cause of thyroid cancer. Two case reports, along with several cases from the literature, illustrate this relationship.

Thyroid disease in the elderly. How is it different than in other age-groups?

PreviewSome elderly patients (and even some physicians) think it is natural to feel tired, depressed, or anxious as they age. However, as shown by the authors in their illustrative case reports, these symptoms may be caused by hyperthyroidism or hypothyroidism. Drs Stoffer and Szpunar describe, through examples taken from their practice, the special challenges of diagnosing thyroid disease in elderly patients.

Reversible infertility in iatrogenic thyrotoxicosis.

Two patients with iatrogenic thyrotoxicosis and infertility were studied. Restoring the euthyroid state promptly reversed the infertility in both cases. Since it is so easy to treat, iatrogenic thyrotoxicosis should be considered in all patients taking thyroid hormone who request infertility evaluation.

The painful thyroid. A three-step diagnostic approach.

A three-step diagnostic approach can help to determine whether neck pain is related to a thyroid condition: Thyroid pain is almost always short-lived (less than 3 months); patients with thyroid-related neck pain usually point to the thyroid gland as the site of the most intense discomfort; patients with a painful thyroid always have abnormal findings on palpation. The vast majority of painful thyroid conditions are benign and can be managed with very little medication and a lot of reassurance.

Screening for minimal hypothyroidism. How sensitive is the free thyroxine assay

The free thyroxine index (FTI) and a free thyroxine (FT4) assay were compared with the thyrotropin-releasing hormone stimulation test in 98 consecutive patients to determine whether the FT4 assay is more sensitive than the FTI in screening patients for minimal hypothyroidism. FTI and FT4 values did not agree with the clinical evaluation in 20% (3/15) of the patients with a transitional thyroid-stimulating hormone (TSH) response (21 to 35 microU/ml) and in 64.3% (9/14) of the patients with an augmented TSH response (greater than 35 microU/ml). From these results we conclude that the FT4 assay is no more sensitive than the FTI in detection of such minimal thyroid dysfunction.

How does levothyroxine therapy affect thyroid function studies

Are thyroid function test results affected by the timing of the previous levothyroxine dose? To answer this question, the authors asked 101 consecutive patients when they took the last dose and then correlated the time elapsed with the results of thyroid assays. Their findings are discussed in this article.