1,721,091 research outputs found
What should patients with Graves’ orbitopathy without functional deficit should expect from decompression surgery.
No full textEpidemiology and prevention of Graves' ophthalmopathy
No full textGraves' ophthalmopathy is clinically relevant in approximately 50% of patients with Graves' disease, severe forms affecting 3%-5% of patients. Two age peaks of incidence are observed in the fifth and seventh decades of life, with slight differences between women and men. The disease is more frequent in women than in men, although the female-to-male ratio is only 1:4 in severe forms of eye disease. The natural history of Graves' ophthalmopathy is incompletely defined, but in many instances, especially in mild forms, the disease may remit or improve spontaneously. The onset of the ophthalmopathy is in most cases concomitant with the onset of hyperthyroidism, but eye disease may precede or follow hyperthyroidism. Cigarette smoking plays an important role in the occurrence of the ophthalmopathy, and is also associated with a higher degree of disease severity and a lower effectiveness of its medical treatment. Primary prevention (i.e., avoidance of the occurrence of the ophthalmopathy) is presently not feasible, but smoking withdrawal in relatives of patients with Graves' disease might be important. In terms of secondary prevention (i.e., avoidance of progression of subclinical eye disease into overt and severe ophthalmopathy) in addition to refraining from smoking, early and accurate control of thyroid dysfunction (both hyperthyroidism. and hypothyroidism), as well as early diagnosis and treatment of mild eye disease are important. As to the role that management of hyperthyroidism may play in the course of Graves' ophthalmopathy, while antithyroid drugs and thyroidectomy are not disease-modifying treatments, radioiodine therapy causes a progression of the ophthalmopathy in approximately 15% of patients, especially high-risk patients, who smoke, have severe hyperthyroidism or uncontrolled hypothyroidism, high levels of thyrotropin (TSH)-receptor antibody, or preexisting eye disease. However, the risk of radioiodine-associated progression of the opthalmopathy can be eliminated by concomitant treatment with middle-dose glucocorticoids. In terms of tertiary prevention (i.e., avoidance of deterioration and complications of overt disease) early immunosuppressive treatment or orbital decompression, as appropriate, are essential tools. Smoking withdrawal may increase the effectiveness of immunosuppressive treatmen
Cosa aspettarsi dalla chirurgia decompressiva a tre pareti in caso di orbitopatia distiroidea non complicata da diplopia pre operatoria: Uno studio retrospettivo su 134 pazienti. (What is to be expected by three wall decompression surgery performed on patients affected by dysthyroid orbitopathy without pre operative double vision).
No full text
Effectiveness of early versus late orbital decompression in thyroid related orbitopathy.
No full textDoes orbital radiotherapy influence the effect of orbital decompression in Graves’ orbitopathy.
No full textTSH-R expression and cytokine profile in orbital tissue of active vs. inactive Graves' ophthalmopathy patients.
No full textDiagnosi e terapia della tireotossicosi indotta da amiodarone (AIT): risultati di una indagine condotta tra i membri della European Thyroid Association (ETA)
No full textGraves’ orbitopathy in a patient with adrenoleukodystrophy after bone marrow transplantation
No full textObjective: For many years, the treatment of X-linked childhood cerebral adrenoleukodystrophy (XALD)
consisted of hydrocortisone replacement and a mixture of short chain-fatty acids, known as ‘Lorenzo’s
oil’. Recently, bone marrow transplantation (BMT) has also been used.
Case report: We report the case of a patient affected by XALD who developed Graves’ hyperthyroidism
(GH) and Graves’ orbitopathy (GO) after BMT and who we could follow-up for 6.5 years afterwards.
Evidence synthesis: A boyaffected by XALD was treated at the age of 6 years, with awhole BMT from his
sister. One year after BMT, the transplanted patient presented TSH at the lower normal value and
3 years later he developed thyrotoxicosis. After a further 2 years, the patient developed GO, which
showed clinical evidence of reactivation 5 years after its onset as a consequence of an attempt to treat
thyrotoxicosis by means of I131 (300 MBq). Seven years after BMT, the donor showed alterations of
thyroid autoimmunity and 1 year thereafter she developed GH. She never presented GO during a
subsequent 5 year follow-up.
Conclusions: This case illustrates that autoimmunity originating from a pre-symptomatic donor can be
transferred into the host during allogeneic stem cell transplantation. In cases where autoimmune
phenomena are recognized in the donor prior to donation, alternative donors or T-cell manipulation of
the graft might be considered.
For many years, the treatment of X-linked childhood cerebral adrenoleukodystrophy (XALD) consisted of hydrocortisone replacement and a mixture of short chain-fatty acids, known as 'Lorenzo's oil'. Recently, bone marrow transplantation (BMT) has also been used.
CASE REPORT:
We report the case of a patient affected by XALD who developed Graves' hyperthyroidism (GH) and Graves' orbitopathy (GO) after BMT and who we could follow-up for 6.5 years afterwards.
EVIDENCE SYNTHESIS:
A boy affected by XALD was treated at the age of 6 years, with a whole BMT from his sister. One year after BMT, the transplanted patient presented TSH at the lower normal value and 3 years later he developed thyrotoxicosis. After a further 2 years, the patient developed GO, which showed clinical evidence of reactivation 5 years after its onset as a consequence of an attempt to treat thyrotoxicosis by means of I(131) (300 MBq). Seven years after BMT, the donor showed alterations of thyroid autoimmunity and 1 year thereafter she developed GH. She never presented GO during a subsequent 5 year follow-up.
CONCLUSIONS:
This case illustrates that autoimmunity originating from a pre-symptomatic donor can be transferred into the host during allogeneic stem cell transplantation. In cases where autoimmune phenomena are recognized in the donor prior to donation, alternative donors or T-cell manipulation of the graft might be considered
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