RESUMO
OBJECTIVE: The objective of this study was to compare the clinical utility of a new bioassay for thyrotropin (TSH) receptor antibodies (Abs) with the conventional radioreceptor assay and with measurement of thyroid peroxidase Abs in the diagnosis of Graves disease in childhood. STUDY DESIGN: Serum samples obtained from 22 children and adolescents with Graves disease (19 hyperthyroid, 3 in remission), 13 children and adolescents with chronic lymphocytic thyroiditis, and 17 normal children in a control group were evaluated. RESULTS: TSH receptor Abs were detected by bioassay in 10 (91%) of 11 patients with active Graves disease but in 0 of 2 patients in remission, 0 of 13 normal members of the control group, and 0 of 11 patients with chronic lymphocytic thyroiditis including 1 with thyrotoxicosis. The sensitivity and specificity of TSH receptor Abs detected by radioreceptor assay studied in the same 11 patients and in an additional 11 patients was similar to bioassay. In contrast, thyroid peroxidase Abs were detected in only 12 (71%) of 17 patients with Graves disease but in 11 of 11 patients with chronic lymphocytic thyroiditis and in 0 of 17 members of the control group. CONCLUSION: Bioassay of TSH receptor Abs is both sensitive and specific for the diagnosis of active Graves disease in the young. When cost and simplicity are considered, however, bioassay offers no advantage over radioreceptor assay for initial diagnostic screening. Rather, bioassay for TSH receptor Abs may be useful in thyrotoxic patients who are negative initially in the radioreceptor assay or in treated patients whose clinical picture is discordant with results in the radioreceptor assay.
Assuntos
Autoanticorpos/análise , Doença de Graves/diagnóstico , Receptores da Tireotropina/imunologia , Adolescente , Animais , Bioensaio , Células CHO , Estudos de Casos e Controles , Criança , Pré-Escolar , Cricetinae , Feminino , Humanos , Iodeto Peroxidase/imunologia , Masculino , Radioimunoensaio , Ensaio Radioligante , Sensibilidade e Especificidade , Tireoidite Autoimune/diagnóstico , TransfecçãoRESUMO
We report a toddler with massive thyroid hormone poisoning in whom the addition of iopanoic acid to the treatment regimen (propylthiouracil and propranolol) resulted in a dramatic clinical and biochemical improvement. Iopanoic acid is a safe and effective drug in the treatment of massive thyroid hormone poisoning in children.
Assuntos
Meios de Contraste/uso terapêutico , Ácido Iopanoico/uso terapêutico , Tiroxina/intoxicação , Pré-Escolar , Humanos , Masculino , Intoxicação/sangue , Intoxicação/tratamento farmacológico , Hormônios Tireóideos/sangueRESUMO
A woman receiving thyroxine substitution therapy for acquired hypothyroidism caused by autoimmune thyroiditis gave birth to three babies who had transient primary hypothyroidism. All three babies had elevated thyrotropin levels on neonatal screening, but one had normal thyroxine values. Thyrotropin receptor-blocking antibodies were present in maternal serum and in the three neonates. Each baby also had a different congenital malformation. The neurodevelopmental outcome of the children appeared related in part to maternal thyroxine levels, which suggests that transplacental transfer of thyroxine may protect the fetal brain.
Assuntos
Hipotireoidismo Congênito , Complicações na Gravidez/tratamento farmacológico , Tireoidite Autoimune/tratamento farmacológico , Tiroxina/sangue , Tiroxina/uso terapêutico , Adulto , Pré-Escolar , Feminino , Seguimentos , Cardiopatias Congênitas/epidemiologia , Hérnia Umbilical/epidemiologia , Humanos , Hipotireoidismo/epidemiologia , Recém-Nascido , Rim/anormalidades , Masculino , Gravidez , Complicações na Gravidez/sangue , Tireoidite Autoimune/sangue , Tireoidite Autoimune/complicações , Tireotropina/sangue , Fatores de TempoRESUMO
In a 12-year-old girl, hyperglycemia and an elevated glycohemoglobin concentration developed after therapy with growth hormone for familial short stature. Both clinical and biochemical abnormalities disappeared after therapy was discontinued. The insulin response to an oral glucose tolerance test was abnormal 3 months after discontinuation of growth hormone; 18 months later, it remained delayed but was normal quantitatively.
Assuntos
Diabetes Mellitus Tipo 2/induzido quimicamente , Transtornos do Crescimento/tratamento farmacológico , Hormônio do Crescimento/efeitos adversos , Estatura , Criança , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Teste de Tolerância a Glucose , Transtornos do Crescimento/genética , Hormônio do Crescimento/uso terapêutico , Humanos , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêuticoRESUMO
Recognition of the syndrome of OF MMN can identify individuals at risk for the early appearance of MTC. Three such patients are described. Each had the characteristic neuromas and facies, present since infancy. In each, MTC was found in childhood. In the last two patients, the diagnosis was made because of elevated serum CT concentrations. Venous drainage from the tumor, as well as tumor tissue itself, contained high levels of CT. Prompt recognition of persons with MMN is essential for proper investigation and treatment of the associated MTC.