No description available.

Thesis (M.S.M.E.)--University of Massachusetts Amherst, 2009. / Open access. "This protocol is the basis of an ongoing pilot study in conjunction with Cooley Dickinson Hospital, Northampton, MA."--P. vii. Includes bibliographical references (p. 118-121).

by Gary Wing-Kin Wong. / "July 1999." / Thesis (M.D.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (p. 174-198). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Thesis (M.S.)--Ohio University, March, 2010. / Title from PDF t.p. Release of full electronic text on OhioLINK has been delayed until October 1, 2010. Includes bibliographical references.

O hipertireoidismo da doença de Graves é a forma mais comum de hipertireoidismo em pacientes entre 20-50 anos. Três abordagens terapêuticas são atualmente utilizadas, drogas antitireoidiana, cirurgia e iodo radioativo (131I). O iodo radioativo tem sido cada vez mais aceito como primeira escolha terapêutica, porque é um tratamento seguro, definitivo e de fácil administração. O risco de piora do quadro de tireotoxicose após administração do 131I, os fatores prognósticos de falência e o cálculo da dose administrada têm sido alguns dos aspectos discutidos na literatura recentemente, e constituem o foco desta artigo. Em pacientes com bócios pequenos (<30g), crianças e adolescentes, e em situações especiais como na gravidez, as drogas antitireoidianas ainda é a primeira escolha no tratamento para a maioria dos autores. O tratamento cirúrgico é, atualmente, quase um tratamento de exceção, com indicação restrita para os casos em que as terapias anteriores não possam ser utilizadas. / Graves’ disease is the most frequent cause of hyperthyroidism and current treatment options are antithyroid drugs, radioiodine (131I) and surgery. Radioactive iodine is increasingly being used as definitive therapy, because it long has proven to be a safe, cheap and effective treatment. The risk of exacerbation of hyperthyroidism after 131I administration, factors that may predict the response to radioiodine and the dose to be administrated have been discussed in the literature and we comment the controversies in this review. In patients with mild disease, small goiters, children, adolescents and in special situations, as pregnancy, antityhyroid drugs are still the first choice of treatment for most authors. Surgery is rarely employed, and it is indicated only in cases where antithyroid drugs have not been effective and radioiodine is contraindicated or not acceptable by the patients.

O hipertireoidismo da doença de Graves é a forma mais comum de hipertireoidismo em pacientes entre 20-50 anos. Três abordagens terapêuticas são atualmente utilizadas, drogas antitireoidiana, cirurgia e iodo radioativo (131I). O iodo radioativo tem sido cada vez mais aceito como primeira escolha terapêutica, porque é um tratamento seguro, definitivo e de fácil administração. O risco de piora do quadro de tireotoxicose após administração do 131I, os fatores prognósticos de falência e o cálculo da dose administrada têm sido alguns dos aspectos discutidos na literatura recentemente, e constituem o foco desta artigo. Em pacientes com bócios pequenos (<30g), crianças e adolescentes, e em situações especiais como na gravidez, as drogas antitireoidianas ainda é a primeira escolha no tratamento para a maioria dos autores. O tratamento cirúrgico é, atualmente, quase um tratamento de exceção, com indicação restrita para os casos em que as terapias anteriores não possam ser utilizadas. / Graves’ disease is the most frequent cause of hyperthyroidism and current treatment options are antithyroid drugs, radioiodine (131I) and surgery. Radioactive iodine is increasingly being used as definitive therapy, because it long has proven to be a safe, cheap and effective treatment. The risk of exacerbation of hyperthyroidism after 131I administration, factors that may predict the response to radioiodine and the dose to be administrated have been discussed in the literature and we comment the controversies in this review. In patients with mild disease, small goiters, children, adolescents and in special situations, as pregnancy, antityhyroid drugs are still the first choice of treatment for most authors. Surgery is rarely employed, and it is indicated only in cases where antithyroid drugs have not been effective and radioiodine is contraindicated or not acceptable by the patients.

O hipertireoidismo da doença de Graves é a forma mais comum de hipertireoidismo em pacientes entre 20-50 anos. Três abordagens terapêuticas são atualmente utilizadas, drogas antitireoidiana, cirurgia e iodo radioativo (131I). O iodo radioativo tem sido cada vez mais aceito como primeira escolha terapêutica, porque é um tratamento seguro, definitivo e de fácil administração. O risco de piora do quadro de tireotoxicose após administração do 131I, os fatores prognósticos de falência e o cálculo da dose administrada têm sido alguns dos aspectos discutidos na literatura recentemente, e constituem o foco desta artigo. Em pacientes com bócios pequenos (<30g), crianças e adolescentes, e em situações especiais como na gravidez, as drogas antitireoidianas ainda é a primeira escolha no tratamento para a maioria dos autores. O tratamento cirúrgico é, atualmente, quase um tratamento de exceção, com indicação restrita para os casos em que as terapias anteriores não possam ser utilizadas. / Graves’ disease is the most frequent cause of hyperthyroidism and current treatment options are antithyroid drugs, radioiodine (131I) and surgery. Radioactive iodine is increasingly being used as definitive therapy, because it long has proven to be a safe, cheap and effective treatment. The risk of exacerbation of hyperthyroidism after 131I administration, factors that may predict the response to radioiodine and the dose to be administrated have been discussed in the literature and we comment the controversies in this review. In patients with mild disease, small goiters, children, adolescents and in special situations, as pregnancy, antityhyroid drugs are still the first choice of treatment for most authors. Surgery is rarely employed, and it is indicated only in cases where antithyroid drugs have not been effective and radioiodine is contraindicated or not acceptable by the patients.

The thyroid gland secretes hormones that help to govern metabolism and energy expenditure within the body [1]; these hormones also affect growth and development. As a result, the regulation of thyroid hormones is vital for maintaining an individual's well being. Graves' disease is an autoimmune disorder and is a major cause of hyperthyroidism or an overproduction of thyroid hormones. Radioactive iodine (RAI) therapy has become the preferred treatment with typical RAI protocols being based on the Marinelli-Quimby equation to compute the dose; however, up to 90 % of subjects become hypothyroid within the first year after therapy. In this thesis we focus on the development of a new computational protocol for the calculation of RAI in the treatment of Graves' hyperthyroidism. The new protocol implements a two-compartment model to describe RAI kinetics in the body, which accounts for the conversion between different RAI isotopes used in diagnostic and therapeutic applications. Thus, by using the measured response of the subject's thyroid to a test dose of 123I, the model predicts what amount of RAI (131I) will be needed to reduce, through ablation, the functional, thyroid volume/mass to an amount that would result in a normal metabolic balance. A detailed uncertainty analysis was performed using both a standard propagation of error method as well as a simulation method. The simulation method consisted of both parametric and nonparametric bootstrapping techniques. Using clinical data consisting of activity kinetics and mass dynamics of 17 subjects and measured final mass values of 7 of the 17 subjects, we were able to validate the protocol as well as quantify the uncertainty analysis. This protocol is the basis of an ongoing pilot study in conjunction with Cooley Dickinson hospital, Northampton, MA.

Graves’ Disease is an autoimmune disorder represented by the overproduction of thyroid hormones (hyperthyroidism). Graves’ Disease is more common among women of reproductive age, and genetic, endogenous, and environmental factors influence the pathogenesis of Graves’ Disease. Graves’ Disease presents with many clinical manifestations, such as tachycardia, fatigue, heat intolerance, palpitations, weight loss, muscle weakness, alterations in menstrual cycles, insomnia, hair loss, goiter, and others. Currently, there are three main treatment routes for Graves’ Disease: antithyroid drugs, radioactive iodine therapy, and thyroidectomy. Antithyroid drug therapy has a high relapse rate. At the same time, both radioactive iodine and thyroidectomy eradicate or surgically remove the tissue of the thyroid and lead to the consequence of developing another disease, hyperthyroidism, that requires a life-long supplementation of the thyroid replacement hormone, levothyroxine. Presently, investigations are focused on finding new therapeutics that can supplement existing treatments as a combination therapy that can lengthen the remission period after cessation of ATDs or conduction of RAI therapy. Future research is exploring treatment options that target different components of the immune system response pathway, the thyroid stimulating hormone receptor or thyrotropin receptor autoantibodies, that have the potential to cure Graves’ Disease.

Patients with Graves´ Disease (GD) have a higher risk of developing more severe and prolonged hypocalcaemia after total thyroidectomy (TT) than patients who undergo surgery for benign atoxic goitre. Since TT is the most effective treatment for GD, it is crucial to identify mechanisms for postoperative hypocalcaemia. The aim of this thesis was to study the mechanisms of calcium metabolism in patients with GD. It is safe to operate on GD patients with TT. Results in Paper I showed fewer recurrences and equal complication rates compared to patients who underwent subtotal thyroidectomy (ST). The transient lowering of PTH seen in the hypocalcaemic patients was fully restored one month after surgery (Papers II and V). The calcium-sensing receptor (CaSR) is crucial for maintaining plasma calcium, and single nucleotide polymorphisms (SNPs) in the gene may alter the sensing function. Thus, we analysed SNPs in CaSR in GD patients (Paper II) and showed that they had a more left-shifted calcium-PTH set-point compared to controls, implicating higher sensitivity. This is also supported by the results in the group of postoperatively hypocalcaemic patients. They already had lower plasma calcium preoperatively (Papers II, IV and V) and lacked the T/G G/A G/C, a haplotype shown in Paper III to have a close relationship to higher p-calcium levels. Moreover, a lack of the T allele in rs1801725 was seen in the group of patients needing permanent treatment with calcium and vitamin D, i.e. &gt; 12 months, (paper V). Patients who became hypocalcaemic (p-calcium &lt; 2.00 mmol/L) on day one postoperatively, had lower preoperative levels of thyroid stimulating hormone (TSH) and higher levels of  T3, this was also applied to the patient groups requiring temporary or permanent postoperative treatment (Papers II and V). In addition, hypocalcaemic patients treated for less than six months with anti-thyroid drugs had higher levels of bone metabolism markers CTX and P1NP than normocalcaemic patients (Paper V). In conclusion, the postoperative period of hypocalcaemia seen in patients with GD is a complex medical condition, caused by a combination of surgical trauma, different SNPs in CaSR, and high bone metabolism related to preoperative thyroid metabolism.