• Tuberculosis and Respiratory Diseases
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• v.62 no.5
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• pp.417-420
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• 2007

Sarcoidosis is a multisystemic granulomatous disease with an of unknown etiology, involving bilateral hilar lymphadenopathy, pulmonary, skin and eye lesions. However, involvement of the endocrine system in sarcoidosis is quite rare, and the coexistence of both diseases is extremely unusual. We describe a 60-year-old woman presenting with sarcoidosis and Graves' disease. She was admitted for evaluation of dry cough, dyspnea, palpitation and general weakness. Both thyroid glands were enlarged diffusely. The thyroid function tests showed suppressed serum thyrotropin and an increased thyroid hormone level. The levels of the TSH receptor antibody, anti-thyroglobulin antibody and anti-microsomal antibody were higher than normal. The radionuclide scan($^{131}I$) showed increased iodine uptake. The chest X-ray revealed pulmonary hilar enlargement and high resolution CT showed both hilar lymph nodes enlargement and tiny parenchymal nodules. The transbronchial lung biopsy showed a noncaseating granuloma without necrosis. We report this case of pulmonary sarcoidosis plus Graves' disease with a review of the relevant literatures.

• 대한핵의학회:학술대회논문집
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• 1976.06a
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• pp.70.1-70.1
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• 1976

• The Korean Journal of Nuclear Medicine
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• v.30 no.1
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• pp.65-76
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• 1996

In order to evaluate the significance of thyrotropin-binding inhibiting immunoglobulin (TBII) in the patients with autoimmune thyroid diseases, the authors investigated 402 cases of Graves' disease and 230 cases of Hashimoto's thyroiditis comparing 30 cases of normal healthy adult at Kyung Pook University Hospital from February 1993 to August 1994. The TBII was tested by radioimmunoassay and assesed on the dynamic change with the disease course, thyroid functional parameters, and other thyroid autoantibodies : antithyroglobulin antibody (ATAb) and antimicrosomal antibody (AMAb) including thyroglobulin. The serum level of TBII was $40.82{\pm}21.651(mean{\pm}SD)%$ in hyperthyroid Graves' disease and $8.89{\pm}14.522%$ in Hashimoto's thyroiditis and both were significant different from normal control of which was $3.21{\pm}2.571%$. The frequency of abnormally increased TBII level was 92.2% in hyperthyroid Graves' disease, 46.7% in euthyroid Graves' disease or remission state of hyperthyroidism, and 23.9% in Hashimoto's thyroiditis. The serum levels of increased TBII in Graves' disease were positively correlated with RAIU, serum T3, T4, and FT4, but negatively correlated with serum TSH(each P<0.001). The TBII in Graves' disease had significant positive correlation with serum thyroglobulin and AMAb, but no significant correlation with ATAb. In the Hashimoto's thyroiditis, the serum levels of TBII were positively correlated with RAIU, serum T3, TSH and AMAb, but not significantly correlated with serum T4, FT4, thyroglobulin and ATAb. Therefore serum level of TBII seemed to be a useful mean of assessing the degree of hyperthyroidism in Graves' disease and correlated well with thyroidal stimulation. The serum level of TBII in Hashimoto's thyroiditis is meaningful for the degree of both functional abnormality reflecting either hyperfunction or hypofunction and the immune logic abnormality.

• Journal of Yeungnam Medical Science
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• v.31 no.2
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• pp.148-151
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• 2014

Radioactive iodine (RAI) therapy is widely used for the treatment of Graves disease. After RAI therapy, 44% become hypothyroid and up to 28% remain hyperthyroid. The development of thyrotoxicosis after RAI therapy is believed to be mediated by 2 different mechanisms: a transient increased release of thyroid hormone due to radiation thyroiditis and the rare development of Graves disease due to the formation of antibodies to the thyroid-associated antigens released from the damaged follicular cells. A 55-year-old woman was hospitalized with severe headache, weight loss, and palpitation. She received a dose of 7 mCi of RAI (I-131) about 6 weeks earlier. Thyroid function test showed 7.98 ng/dL free T4, >8 ng/mL T3, < $0.08{\mu}IU/L$ thyroid stimulating hormone, and high titer thyroid stimulating immunoglobulin (TSI) (85.8 IU/L). She improved with propylthiouracil, propranolol, and steroid treatment. The TSI, however, was persistently elevated for 11 months.

• The Journal of Internal Korean Medicine
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• v.26 no.2
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• pp.398-408
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• 2005

Objective: Graves' disease encompasses hyperthyroidism and diffused goiter associated with auto-antibodies to the thyroid stimulating hormone(TSH) receptors. In clinical environment, treatments of Graves' disease have many side effects such as recurrence and hypothyroidism. We've studied the effects of Sipyukmiyukieum on DNA synthesis, cAMP synthesis, and MHC-class II expression of FRTL-5 thyroid cells were studied. Methods: DNA synthesis was investigated by using BrdU staining and cAMP synthesis by ELISA kit, and expression of $interferon-{\gamma}$ activated MHC class II by Flow cytometer. Results: After introduction of Sipyukmiyukieum, significant inhibition of DNA synthesis. cAMP synthesis, and expression of $interferon-{\gamma}$ activated MHC class II of FRTL-5 thyroid cells was observed. Conclusions: Judging from these results, Sipyukmiyukieum has potential as a potent herbal treatment for inhibiting the enlargement of goiter, synthesis of abnormal thyroidal hormones, and autoimmuine responses of Graves' disease.

• Journal of Yeungnam Medical Science
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• v.40 no.1
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• pp.12-22
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• 2023

Graves disease (GD) is the most common cause of hyperthyroidism, accounting for more than 90% of cases in Korea. Patients with GD are treated with any of the following: antithyroid drugs (ATDs), radioactive iodine (RAI) therapy, or thyroidectomy. Most patients begin treatment with ATDs, and clinical guidelines suggest that the appropriate treatment period is 12 to 18 months. While RAI treatment and surgery manage thyrotoxicosis by destroying or removing thyroid tissue, ATDs control thyrotoxicosis by inhibiting thyroid hormone synthesis and preserving the thyroid gland. Although ATDs efficiently control thyrotoxicosis symptoms, they do not correct the main etiology of GD; therefore, frequent relapses can follow. Recently, a large amount of data has been collected on long-term ATDs for GD, and low-dose methimazole (MMZ) is expected to be a good option for remission. For the long-term management of recurrent GD, it is important to induce remission by evaluating the patient's drug response, stopping ATDs at an appropriate time, and actively switching to surgery or RAI therapy, if indicated. Continuing drug treatment for an extended time is now encouraged in patients with a high possibility of remission with low-dose MMZ. It is also important to pay attention to the quality of life of the patients. This review aimed to summarize the appropriate treatment methods and timing of treatment transition in patients who relapsed several times while receiving treatment for GD.

• The Korean Journal of Nuclear Medicine
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• v.16 no.2
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• pp.1-24
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• 1982

Several recent advances in our knowledge of thyroid physiology have broad application to the diagnosis and management of thyroid disorders. For in the thyroid, more than other endocrine organs, pathophysiology can be translated directly into the diagnosis and management of thyroid disease. Graves' disease is a syndrome including goiter with hyperthyroidism, exophthalmos and dermopathy. The pathogenesis of Graves' disease is not yet clearly identified, but various autoantibodies to the thyroid gland and immunopathologic studies indicate that autoimmune processes are involved in the pathogenesis of the disease. The diagnosis and management of Graves' disease are largely dependent on radionuclide techniques as radioimmunoassay, radioactive iodine therapy and so on. Several laboratory tests are also developed to determine the remission of this disase including TRH stimulation test, $T_3$ suppression test and detection of thyroid stimulating immunoglobulins. Autoimmune thyroiditis is almost certainly a primary immunologic disease and the incidence tends to increase recently, mainly due to the application of biopsy technique in thyroid diseases. Thyroid nodules have been a great challenge to physicians because of the possibility of malignancy. But recently, cytologic examination of thyroid aspirate provides a very simple and also reliable diagnostic method in patients with thyroid nodules. In 163 patients with thyroid nodules, only 19.3% was revealed to be malignant. Therefore cytologic examination of thyroid aspirate and thyroid biopsy should be included in the diagnosis of nodular patients prior to surgical intervention. In this paper, a comprehensive review is presented on the pathogenesis, clinical features, laboratory findings and therapeutic modalities of various thyroid diseases on the basis of over 80 researches performed during the past 20 years at radioisotope clinic, Seoul National University Hospital.

• The Korean Journal of Nuclear Medicine
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• v.22 no.1
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• pp.21-26
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• 1988

Serum TBII measured by radioreceptor assay using $^{125}I-bovine$ TSH and porcine thyroid well membrane was checked before, 6 months and 12 months after initiation of thionamide regimens in 63 Graves' disease patients and was related with their remission state. 1) A significant difference (p < 0.01) in pre-treatment TBII was noted between the remitted [N = 45, TBII $40.9{\pm}18.2%$ $(mean{\pm}S.D)$] and the unremitted (N = 18, TBII $64.1{\pm}15.3%$) groups. 2) After 6 months of therapy, TBII were significantly decreased in both groups (to $20.2{\pm}10.3%$ and to $45.2{\pm}16.3%$, p<0.05 for each group) 3) At 12th month, TBII activities were not significantly decreased compared to the 6th month levels in both groups. 4) 3 of the 58 patients who were initially TBII positive (over 15%) converted negative. All the 3 belonged to the remitted group. 5) No significant differences were seen in initial and posttreatment TBII levels between propylthiouracil treated (N = 36) and methimazole treated (N = 27) cases. with above mentioned results, we observed that the TBII decreased significantly with 6 months of thionamide therapy and concluded that the pretreatment measurement of serum TBII may be clinically useful in predicting the response to thionamide regimen in the treatment of Graves' disease.

• Korean Journal of Head & Neck Oncology
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• v.18 no.1
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• pp.60-64
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• 2002

Objectives: Three classic treatment modalities have been used to treat Graves' disease: antithyroid medication, radioiodine ablation, and subtotal thyroidectomy. Postoperative thyroid functions were studied in patients with Graves' disease treated by subtotal thyroidectomy to evaluate the superiority of surgical treatment. Materials and Methods: One hundred fourty patients of Graves' disease were analysed retrospectively in follow-up for more than three years following subtotal thyroidectomy. Postoperative serum levels of $T_3,\;T_4, TSH, TSH-R Ab, free $T_4$, were evaluated to watch hypo- or hyperthyroidsm. Results: In the evaluation of preop- and postoperative thyroid function after three years of subtotal thyroidectomy, $T_3$ was changed from $464.10{\pm}196.16ng/dl$ to $140.41{\pm}76.56ng/dl$ in mean value, $T_4$ was changed from $20.76{\pm}7.98{\mu}g/dl$ to $9.54{\pm}4.02{\mu}g/dl$, $TSHT_3$ was changed from $0.55{\pm}4.42{\mu}u/ml$ to $4.96{\pm}7.20{\mu}u/ml$, TSH-R Ab was changed from $41.6{\pm}28.27%$ to $28.7{\pm}28.79%$ and free $T_4$ was changed from $4.45{\pm}2.33ng/dl$ to $1.44{\pm}0.69ng/dl$ in mean value. Euthyroidism was noted in 118 patients(84.3%), overt hyperthyroidism in 6 patiens(4.3%), latent hyperthyroidism in 8 patients(5.7%), overt hypothyroidism in 2 patint(1.4%), and latent hypothyroidism in 6 patients(4.3%). Of surgical complications, permanant hypoparathyroidism was found in one patient, recurrent laryngeal nerve injury in two patients, postoprative bleeding with reoperation in two patients, and death in one patient. Conclusion: The thyroid function after subtotal thyroidectomy in diffuse toxic goiter is normal level (euthyroidism) in 84.3% and low recurrence rate of hyperthyroidism is showed with rare surgical complication. Therefore, subtotal thyroidectomy in diffuse toxic goiter is more effective and safe than RI or longterm ATD treatment, if the operation is performed by skillful surgeon.

• Clinical and Experimental Pediatrics
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• v.52 no.9
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• pp.1021-1028
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• 2009

Purpose:Medical therapy is the initial treatment for children with Graves disease to avoid complications of other treatments. However, optimal treatment for childhood Graves disease is controversial because most patients require relatively long periods of medical therapy and relapse is common after medication discontinuation. Therefore, this study aimed to search clinical or biochemical characteristics that could be used as remission predictors in Graves disease. Methods:We retrospectively studied children diagnosed with Graves disease, treated with anti-thyroid agents, and observed for at least 3 years. Patients were categorized into remission and non-remission groups, and the groups were compared to determine the variables that were predictive of achieving remission. Results:Sixty-four patients were enrolled, of which 37 (57.8%) achieved remission and 27 (42.2%) could not achieve remission until the last visit. Normalization of thyroid-stimulating hormone-binding inhibitory immunoglobulin (TBII) after treatment was faster in the remission group than in the non-remission group (remission group, $15.5{\pm}12.07$ vs. non-remission group, $41.69{\pm}35.70$ months). Thyrotropin-releasing hormone (TRH) stimulation tests were performed in 28 patients. Only 2 (8.3%) of 26 patients who showed normal or hyper-response in TRH stimulation test relapsed. Binary logistic regression analysis identified rapid achievement of TBII normalization after treatment as a significant predictor of remission. Six percent of patients achieved remission within 3 years and 55.8% achieved it within 6 years. Conclusion:Rapid achievement of TBII normalization can be a predictor of remission in childhood Graves disease. The TRH stimulation test can be a predictor of maintenance of remission.