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F A Karlsson - One of the best experts on this subject based on the ideXlab platform.
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retrospective evaluation of subtotal and total thyroidectomy in graves disease with and without Endocrine Ophthalmopathy
European Journal of Endocrinology, 1995Co-Authors: Brita Winsa, Jonas Rastad, Goran Akerstrom, H Johansson, Kerstin Westermark, F A KarlssonAbstract:: A retrospective analysis was performed in 173 consecutive patients with Graves' disease (GD) with the principal aim of evaluating the influences of subtotal (N = 157) and total (N = 19) thyroidectomy on postoperative recurrence rates, Endocrine Ophthalmopathy (EO) and thyrotropin receptor antibody (TSH-R-ab) titres. Postoperatively recurrent disease, identified by increased thyroid hormone levels, occurred in 32 patients (20%) who underwent subtotal resection. These recurrences were associated with over-representation of preoperative EO (p < 0.001) as well as high TSH-R-ab levels postoperatively (p < 0.05-0.01). Subtotal and total resections were followed by an aggravation of preoperative EO in nine (16%) and one (6%), and by a development of EO in two and none of the patients, respectively. Persistently elevated TSH-R-ab titers during thyrostatic therapy became close to normalized in seven (32%) and 15 (88%) of the patients undergoing subtotal or total thyroidectomies, respectively, which illustrates a thyroid tissue dependency of the autoantibody production. Among the total material of 173 patients, altogether 75 cases exhibited persistent or progressive EO and/or TSH-R-ab elevation after more than 1 year of preoperative thyrostatic treatment. In this group, recurrent GD or aggravated EO occurred in 23 (39%) of those operated with subtotal resection and in one (6%) of those undergoing total thyroidectomy (p < 0.05). The results thus indicate that EO, particularly at the time of surgery, and prevailing TSH-R-ab titers are associated with an increased risk of recurrent GD and suggest that patients exhibiting these characteristics should benefit from total rather than subtotal thyroidectomy.
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graves disease Endocrine Ophthalmopathy and smoking
European Journal of Endocrinology, 1993Co-Authors: Brita Winsa, A Mandahl, F A KarlssonAbstract:: We have evaluated the association between smoking, Graves' disease and Endocrine Ophthalmopathy in a case-control study of 208 patients with newly diagnosed Graves' disease and carried out a retrospective survey of 72 patients treated for Graves' disease and admitted to our ward because of Endocrine Ophthalmopathy. In the prospective study, patients with Graves' disease smoked significantly more than their healthy controls (41% vs 30%, p < 0.01 for current smokers, odds ratio 1.6, 95% confidence interval 1.1-2.3, and p < 0.05 for patients with a history of smoking, odds ratio: 1.4, 95% confidence interval 1.0-1.9). Among the patients with Endocrine Ophthalmopathy at diagnosis, there were slightly more patients with a history of smoking (p < 0.05, odds ratio 2.1, 95% confidence interval 1.1-3.9), but not more current smokers when compared with the remaining group. The patients with eye problems tended to have a more active disease with higher levels of thyroxine and TSH-receptor antibodies, but no difference was seen in thyrogastric autoantibodies. No effect of smoking on thyroid hormone and autoantibody levels could be detected. In the retrospective survey we found 64%, 71% and 87% smokers among patients with moderate, severe and malignant eye disease, respectively. In summary, the results show that smoking is associated with an increased risk of contracting Graves' disease and that it enhances the severity of the eye disease in cases that develop Endocrine Ophthalmopathy during the course of treatment.
Brita Winsa - One of the best experts on this subject based on the ideXlab platform.
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retrospective evaluation of subtotal and total thyroidectomy in graves disease with and without Endocrine Ophthalmopathy
European Journal of Endocrinology, 1995Co-Authors: Brita Winsa, Jonas Rastad, Goran Akerstrom, H Johansson, Kerstin Westermark, F A KarlssonAbstract:: A retrospective analysis was performed in 173 consecutive patients with Graves' disease (GD) with the principal aim of evaluating the influences of subtotal (N = 157) and total (N = 19) thyroidectomy on postoperative recurrence rates, Endocrine Ophthalmopathy (EO) and thyrotropin receptor antibody (TSH-R-ab) titres. Postoperatively recurrent disease, identified by increased thyroid hormone levels, occurred in 32 patients (20%) who underwent subtotal resection. These recurrences were associated with over-representation of preoperative EO (p < 0.001) as well as high TSH-R-ab levels postoperatively (p < 0.05-0.01). Subtotal and total resections were followed by an aggravation of preoperative EO in nine (16%) and one (6%), and by a development of EO in two and none of the patients, respectively. Persistently elevated TSH-R-ab titers during thyrostatic therapy became close to normalized in seven (32%) and 15 (88%) of the patients undergoing subtotal or total thyroidectomies, respectively, which illustrates a thyroid tissue dependency of the autoantibody production. Among the total material of 173 patients, altogether 75 cases exhibited persistent or progressive EO and/or TSH-R-ab elevation after more than 1 year of preoperative thyrostatic treatment. In this group, recurrent GD or aggravated EO occurred in 23 (39%) of those operated with subtotal resection and in one (6%) of those undergoing total thyroidectomy (p < 0.05). The results thus indicate that EO, particularly at the time of surgery, and prevailing TSH-R-ab titers are associated with an increased risk of recurrent GD and suggest that patients exhibiting these characteristics should benefit from total rather than subtotal thyroidectomy.
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Total thyroidectomy in therapy-resistant Graves' disease.
Surgery, 1994Co-Authors: Brita Winsa, Jonas Rastad, Kerstin Westermark, Eva Larsson, Agneta Mandahl, Henry Johansson, Claes Juhlin, Anders Karlsson, Goran AkerstromAbstract:BACKGROUND: Influences of total thyroidectomy have not been evaluated in patients with severe Graves' disease who might respond less satisfactorily to subtotal thyroid resection. METHODS: Thirty-three patients with Graves' disease underwent total thyroidectomy because of persistent Endocrine Ophthalmopathy (n = 28) or elevated thyrotrophin receptor antibody titers (n = 25) despite a mean of 2 years of thyrostatic therapy. Moreover, six and four patients had undergone radioiodine treatment and subtotal thyroid resection, respectively. Perioperative findings and complications have been investigated, as have influences on Endocrine Ophthalmopathy and thyrotrophin receptor antibody titers during a mean of 2.5 postoperative years. RESULTS: Total thyroidectomy substantiated mean thyroid weights of 17 gm, 2.3 hours of operating time, and total blood loss of 264 cc. Vocal cord paralysis and vitamin D-treated hypocalcemia occurred in two and three patients, respectively, and invariably persisted less than 6 months. Normalization of elevated thyrotrophin receptor antibody titers occurred in 86% of patients without radioiodine exposure, and stable or improved signs of Endocrine Ophthalmopathy were found in 96% of patients examined 6 or more months after the operation. CONCLUSIONS: Total thyroidectomy seems to be a surgically safe procedure in complicated Graves' disease and to provide normalization of therapy-resistant thyrotrophin receptor antibody titers. Because favorable influences might also encompass severe Endocrine Ophthalmopathy, prospective analysis on its efficiency is warranted.
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graves disease Endocrine Ophthalmopathy and smoking
European Journal of Endocrinology, 1993Co-Authors: Brita Winsa, A Mandahl, F A KarlssonAbstract:: We have evaluated the association between smoking, Graves' disease and Endocrine Ophthalmopathy in a case-control study of 208 patients with newly diagnosed Graves' disease and carried out a retrospective survey of 72 patients treated for Graves' disease and admitted to our ward because of Endocrine Ophthalmopathy. In the prospective study, patients with Graves' disease smoked significantly more than their healthy controls (41% vs 30%, p < 0.01 for current smokers, odds ratio 1.6, 95% confidence interval 1.1-2.3, and p < 0.05 for patients with a history of smoking, odds ratio: 1.4, 95% confidence interval 1.0-1.9). Among the patients with Endocrine Ophthalmopathy at diagnosis, there were slightly more patients with a history of smoking (p < 0.05, odds ratio 2.1, 95% confidence interval 1.1-3.9), but not more current smokers when compared with the remaining group. The patients with eye problems tended to have a more active disease with higher levels of thyroxine and TSH-receptor antibodies, but no difference was seen in thyrogastric autoantibodies. No effect of smoking on thyroid hormone and autoantibody levels could be detected. In the retrospective survey we found 64%, 71% and 87% smokers among patients with moderate, severe and malignant eye disease, respectively. In summary, the results show that smoking is associated with an increased risk of contracting Graves' disease and that it enhances the severity of the eye disease in cases that develop Endocrine Ophthalmopathy during the course of treatment.
H D Roher - One of the best experts on this subject based on the ideXlab platform.
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the influence of surgery on Endocrine Ophthalmopathy
World Journal of Surgery, 1990Co-Authors: A Frilling, P E Goretzki, M Grussendorf, M Erbsloh, H D RoherAbstract:Since the pathogenesis of Endocrine Ophthalmopathy is unclear, there has been little agreement on the treatment of the disease. The influence of thyroid surgery on Endocrine Ophthalmopathy is controversial. To evaluate the effect of thyroid surgery on the course of the disease, we developed a special Ophthalmopathy index. As a standard procedure, subtotal thyroidectomy with thyroid remnants of 3–5 g was performed. A total of 176 patients with Graves' disease underwent the above treatment between 1986 and 1988. In 78 patients suffering from concomitant Endocrine Ophthalmopathy, ocular status was examined prior to operation and postoperatively. The history of Endocrine Ophthalmopathy had been present less than 2 years preoperatively in 74% of the patients. Follow-up ranged from 6 to 36 months. Postoperatively, 54 (69%) patients showed a marked improvement of their eye symptoms. In 18 (23%), there was no change and, in 6 (8%) patients, the severity of the eye symptoms increased after the operation. As a result of these data, a cautious and preliminary conclusion may be justified—that subtotal thyroidectomy may have a positive effect on Endocrine Ophthalmopathy.
George J Kahaly - One of the best experts on this subject based on the ideXlab platform.
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autoimmune Endocrine Ophthalmopathy and retrobulbar antigens
Hormone and Metabolic Research, 1995Co-Authors: E Otto, J Beyer, C Hansen, K Ochs, E Leyendecker, A Gentsch, George J KahalyAbstract:: Endocrine Ophthalmopathy (EO) is based on autoimmune processes that lead to lymphocyte infiltration of the retrobulbar space. In this study, antigenic character of retrobulbar adipose, connective and muscle tissue as well as of cultured fibroblasts and myoblasts were examined. Samples were obtained from EO patients (n = 13, 8 fem., age 26-82 years, median 47 years) undergoing orbital decompression surgery. Retrobulbar and abdominal tissue from 7 controls (4 fem., 48 - 74 y) was investigated, too. Tissues were homogenized and the proteins were separated by SDS-PAGE according to molecular weight. In order to recover the separated proteins in soluble form, an electroelution technique was employed. Twenty-two separated soluble protein fractions were used as antigenic stimuli for autologous peripheral blood mononuclear cells (PBMC) separated by Ficoll gradient centrifugation. Subsequently, the proliferation of T cells was measured by [3H]-thymidine uptake. A marked T cell response to protein fractions with molecular weight of 6 - 10 kD and 19 - 26 kD was detected (p < 0.001). These autoantigens were found readily reproducible in adipose tissue in 8 out of 9 EO patients, stimulation index (SI) to antigen 6 - 10 kD 29 +/- 4.6 (mean +/- SEM); 19 - 26 kD 5 +/- 1.4 and in 3 out of 4 patients using retrobulbar eye muscle tissue (SI: 6 - 10 kD 23 +/- 4.2; 19 - 26 kD 6 +/- 2). Using the proteins of cultured fibroblasts as antigen, the autologous PBMC from 2 out of 4 tested EO-patients also responded (SI: 7 +/- 2; 4 +/- 1.4). Testing cultured retrobulbar myoblasts of an EO patient, a response to the 19 - 26 kD antigen was found only (SI: 8.0). In response to retrobulbar or muscle proteins, PBMC of 2 controls showed also a higher proliferation rate (SI: 16 +/- 3.5; 13 +/- 2.8), whereas, a response to abdominal adipose or muscle proteins (4 controls) was never found. Thus, two orbital antigens reacting with autologous T cells could be demonstrated and may play an important role in the immunopathogenesis of EO. According to these findings, retrobulbar fibroblast antigens are most likely the main T cell targets.
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glycosaminoglycan antibodies in Endocrine Ophthalmopathy
Hormone and Metabolic Research, 1993Co-Authors: George J Kahaly, Cordula M Stover, J Beyer, C Hansen, E OttoAbstract:: An increased accumulation of glycosaminoglycans (GAG) in the orbita has been reported in Endocrine Ophthalmopathy (EO). In this study we investigated whether antibodies directed against GAG are present in the sera of 52 EO patients and 47 healthy controls. Three out of 52 patients exhibited low titers of antinuclear antibodies and all patients were negative for antibodies against extractable nuclear antigens. Isotype IgG antibodies were detected by means of an ELISA using hyaluronic acid and dermatan sulfate as antigens. Values were expressed as optical density at 405 nm. In comparison to the control group (0.445, 0.364, 0.588; median, 25th, 75th percentile) significantly (p < 0.001) higher hyaluronic acid antibody levels were found in EO patients (0.626, 0.473, 0.801). Untreated patients had significantly higher hyaluronic acid antibody values compared to controls (0.770 vs 0.437, median, p < 0.005). Thyroid status or antithyroid treatment did not influence binding of hyaluronic acid antibodies. When screening for dermatan sulfate antibodies no such difference could be observed between patients and controls. Thus, the detection of GAG antibodies in EO patients emphasizes the important role of glycosaminoglycans in the pathogenesis of thyroid eye disease.
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in vitro synthesis of glycosaminoglycans in Endocrine Ophthalmopathy
European Journal of Endocrinology, 1992Co-Authors: George J Kahaly, Cordula M Stover, J Beyer, E OttoAbstract:: The effects of humoral and cell-mediated immunity on the glycosaminoglycan synthesis of retrobulbar fibroblasts was evaluated in patients with Endocrine Ophthalmopathy. After incubation with IgG and sera, secreted glycosaminoglycans, radiolabeled with D-6-3H-glucosamine and 35sulfate, were precipitated with cetylpyridinium chloride and ethanol. Hyaluronic acid synthesis of human retrobulbar fibroblasts after incubation with sera and IgG and after co-culture with lymphocytes was assessed by means of a radiometric test. Patients' IgG, compared to controls', accounted for a higher secretory stimulation of porcine retrobulbar fibroblasts (as measured by cetylpyridinium chloride precipitation) after 24 and 48 h. Contrasting with 24 h incubation time, glycosaminoglycan values after 48 h were increased two to threefold. Patients' and controls' sera caused earlier and stronger, yet indistinguishable glycosaminoglycan production. Non-sulfated hyaluronic acid was the preponderant glycosaminoglycan secreted into the media by retrobulbar fibroblasts. As assessed with the radiometric test, incubation with patients' and controls' sera and IgG did not reveal a significant difference in stimulating the hyaluronic synthesis of patients' and controls' retrobulbar fibroblasts. When measuring the hyaluronic acid synthesis of controls' and patients' retrobulbar fibroblasts after co-cultivation of lymphocytes, however, patients' lymphocytes had a marked ability to increase the hyaluronic acid concentration compared to controls' lymphocytes. The hyaluronic acid concentration after incubation of a patient's retrobulbar fibroblasts with autologous lymphocytes was markedly more elevated than the intrinsic hyaluronic acid production of retrobulbar fibroblasts.(ABSTRACT TRUNCATED AT 250 WORDS)
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humoral immunity and retrobulbar fibroblasts in Endocrine Ophthalmopathy
European Journal of Endocrinology, 1992Co-Authors: Cordula M Stover, E Otto, J Beyer, George J KahalyAbstract:: The exact role of retrobulbar fibroblasts in the immunopathogenesis of Endocrine Ophthalmopathy still remains to be elucidated. To evaluate the in vitro influence of humoral immunity on retrobulbar fibroblasts, the effects of immunoglobulin G as well as of the sera of 50 euthyroid patients with Endocrine Ophthalmopathy and 30 controls on both porcine and human (patients' and controls') retrobulbar fibroblasts were measured by means of several assays: a colorimetric test involving a heterocyclic chemical, a tetrazolium bromide, was applied to quantify the activity of mitochondrial dehydrogenases; the incorporation of 3H-thymidine was determined as a sensitive parameter for cell proliferation, and an enzyme-linked immunosorbent assay was to reveal specific binding of antibodies to the cells. There was consistently no significant difference between patients' (untreated or treated) and controls' IgG to bind to, to activate or to stimulate the proliferation of porcine and human (patients and controls) retrobulbar fibroblasts. The effects of patients' heat-inactivated and non-inactivated sera were indistinguishable from those of the controls. Incubation of autologous sera, however, led to an activation of retrobulbar fibroblasts which was both higher than the median caused by the patients' group and that engendered by incubation of autologous IgG. Yet, a significant role that humoral immunity might play directly on retrobulbar fibroblasts could not be detected in the experiments conducted in this study.
A Frilling - One of the best experts on this subject based on the ideXlab platform.
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the influence of surgery on Endocrine Ophthalmopathy
World Journal of Surgery, 1990Co-Authors: A Frilling, P E Goretzki, M Grussendorf, M Erbsloh, H D RoherAbstract:Since the pathogenesis of Endocrine Ophthalmopathy is unclear, there has been little agreement on the treatment of the disease. The influence of thyroid surgery on Endocrine Ophthalmopathy is controversial. To evaluate the effect of thyroid surgery on the course of the disease, we developed a special Ophthalmopathy index. As a standard procedure, subtotal thyroidectomy with thyroid remnants of 3–5 g was performed. A total of 176 patients with Graves' disease underwent the above treatment between 1986 and 1988. In 78 patients suffering from concomitant Endocrine Ophthalmopathy, ocular status was examined prior to operation and postoperatively. The history of Endocrine Ophthalmopathy had been present less than 2 years preoperatively in 74% of the patients. Follow-up ranged from 6 to 36 months. Postoperatively, 54 (69%) patients showed a marked improvement of their eye symptoms. In 18 (23%), there was no change and, in 6 (8%) patients, the severity of the eye symptoms increased after the operation. As a result of these data, a cautious and preliminary conclusion may be justified—that subtotal thyroidectomy may have a positive effect on Endocrine Ophthalmopathy.