Amiodarone treatment is associated with the occurrence of thyroid dysfunction. The aim was to determine the incidence of amiodarone-induced thyroid dysfunctions and the influence of gender, age, ...treatment duration, goiter, thyroid antibodies, thyroid echogenicity and family history on their appearance. Of 248 consecutive patients, 144 males and 104 females, referred to thyroid status screening, 16% were with clinical dysfunction, 21% with sub-clinical dysfunction and 63% were euthyroid. The presence of goiter and thyroid peroxidase antibodies were the significant individual predictive factors for the occurrence of clinical dysfunction, and in the multivariate regression model, the presence of goiter was a significant predictive factor with the prognostic value of 80%. For sub-clinical dysfunction, the significant individual predictive factors were female gender and the presence of goiter, as well as in the multivariate regression model, with the prognostic value of 74.5% for female gender and 77.5 % for the presence of goiter. It is necessary to check the thyroid status both before and during amiodarone treatment. Administration of other anti-arrhythmic drugs and/or more frequent check-ups of the thyroid status should be taken into consideration in patients at higher risk, i.e. women with positive thyroid peroxidase antibodies and goiter.
Our aim was to analyze any changes during diastole in patients with normal left ventricular ejection fraction (LVEF), after pacemaker stimulation from the right ventricular outflow tract (RVOT) and ...right ventricular apex (RVA) lead position. This was a prospective, randomized, follow up study, which lasted for 12 months. Our research included 132 consecutive patients who were implanted with a permanent antibradycardiac pacemaker. Regarding the right ventricle lead position the patients were divided into two groups: The RVOT group--71 patients, with right ventricle outflow tract lead position and the RVA group--61 patients, with right ventricle apex lead position. We measured LVEF and diastolic parameters: peak filling ratio and time to peak filling ratio obtained by radionuclide ventriculography (RNV). The LVEF and various diastolic parameters and left atrial diameter were obtained by echocardiography. Based on the values of deceleration time of early diastolic filling (DTE), and other diastolic parameters like left atrial diameter, all the patients were classified into three degrees of diastolic dysfunction. Our results showed that there was no group difference in distribution of gender, age, body mass index (BMI), VVI to DDD pacemakers implantation ratio, RNV parameters (LVEF, peak filling rate (PFR), time to PFR (TPFR)) and echocardiography parameters: LVEF and parameters of diastolic dysfunction. After 12 months of pacemaker stimulation, LVEF by RNV remained the same in the RVOT group 51.31±15.80% (P=0.75), and also in the RVA group 53.83±6.57%, (P=0.19). In the RVOT group the PFR was highly lower and this finding was significant (P=0.01), while TPFR was also significantly lower (P=0.03). By dividing the patients according to the degree of diastolic dysfunction we found that most patients in both groups at enrollment had a second degree diastolic dysfunction. In both groups diastolic dysfunction increased, the number of patients with third degree diastolic dysfunction increased, and the number of patients with second degree diastolic dysfunction decreased, however, the worsening of diastolic function was significant only in the RVOT group. In conclusion, pacemaker stimulation from RVOT, but not in RVA, leads to progression of diastolic dysfunction in patients with preserved LVEF. This negative effect of pacemaker stimulation from RVOT on diastolic parameters was confirmed by two independent methods, RNV and echocardiography.
Antibodies to TSH receptors (TRAb) have great pathogenetic importance in the development and maintenance of hyperthyroidism in Graves' disease (GD). Measurement of their serum level could be of ...diagnostic and prognostic importance in autoimmune hyperthyroidism and in monitoring the efficiency of thyrosuppressive drug (TSD) treatment in GD. The aim of our study was to assess the sensitivity (SN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the TRAb assay in confirming the diagnosis and to define its prognostic value for remission duration in GD patients at the end of TSD treatment with thionamide derivatives, propylthiouracil or methimazole. We studied 99 patients, 65 female, 34 male, 18-76 years old; 52 GD patients and 47 as control group. We have studied frequency of relapses and remission duration in GD patients by a 2nd generation serum TRAb commercial kit. Our results showed that, the SN, SP, PPV and NPV of the TRAb test were 100%, 97%, 98% and 100%, respectively. Remission duration after TSD treatment was longer and relapses were fewer in GD patients with lower levels of TRAb before (P<0.01) and at the end of TSD treatment (P<0.05). In conclusion, our results suggest that serum TRAb is very sensitive and specific for confirming the diagnosis of GD. TRAb levels at the beginning of TSD treatment, above 5 IU/L gives 18% greater chance, and above 15 IU/L, 36% greater chance for remission, shorter than 6 months.
Graves' disease is autoimmune hyperthyroidism caused by pathological stimulation of thyroid-stimulation hormone-receptor antibodies. The decision on changing the therapy can be made on time by ...determining the prognostic factors of thyrosuppressive drug therapy outcome. The aim of the study was to determine the significance of thyroid-stimulation hormone-receptor antibodies level on the prediction of therapy outcome.
The study was prospective and involved 106 drug-treated patients with newly diagnosed Graves' disease. Thyroid-stimulation hormone-receptor antibodies level was measured at the beginning of therapy, during therapy and 12 months after it had been introduced.
No statistically significant difference in the level of thyroid-stimulation hormone-receptor antibodies was found at the beginning of disease and 12 months after the introduction of thyrosuppressive drug therapy among the patients who had been in remission and those who had not. Regardless of the outcome, thyroid-stimulation hormone-receptor antibodies level significantly decreased in all patients 12 months after the therapy had been introduced.
The level of thyroid-stimulation hormone-receptor antibodies at the beginning of disease and 12 months after the introduction of therapy cannot predict the outcome of thyrosuppressive drug therapy.
Background/Aim. Graves disease (GD) is defined as hyperthyroidism with diffuse goiter caused by immunogenic disturbances. Antibodies to the thyroid stimulating hormone (TSH) receptors of thyroid ...gland (TRAb) have crucial pathogenetic importance in the development and maintenance of autoimmune hyperthyroidism. The aim of this study was to identify sensitivity, specificity, positive an negative predictive value of TRAb level in sera of patients with GD as well as to estimate significance of TRAb level for remission and GD relapses occurrence. Methods. We studied prospectively and partly retrospectively 149 patients, 109 female and 40 male patients, 5-78 years old, in the period 1982-2007. There were 96 patients with GD. The control group consisted of 53 patients, 21 with hyperthyroidism of second etiology and 32 patients on amiodarone therapy, with or without thyroid dysfunction TRAb was measured by radioreceptor assay (TRAK Assay and DYNO Test TRAK Human Brahms Diagnostica GMBH). Results. According to the results the sensitivity (Sn) of TRAb test was 80%, specificity (Sp) 100%, positive predictive value (PP) 100% and negative predictive value (NP) 83%. Also, the Sn of hTRAb test was 94%, Sp 100%, PP 100% and NP 94%. Our results show that an increased level of TRAb/hTRAb at the beginning of the disease and the level at the end of medical therapy is associated with an increased number of GD relapses and a shorter remission duration. Conclusion. Detection and measurement of TRAb in serum is a very sensitive method for diagnosing GD and very highly specific in vitro method for differential diagnosis of various forms of hyperthyroidism. Clinical significance of differentiating various forms of hyperthyroidism, using this in vitro assay, lays in adequate therapeutic choice for these entities.
Uvod/Cilj. Grejsova (Graves) bolest (GB) definise se kao hipertireoidizam sa difuznom strumom nastalom zbog imunskih poremecaja. Antitela za TSH receptore stitaste zlezde (TRAb) imaju bitan patogenetski znacaj za razvoj i odrzavanje autoimunske hipertireoze. Cilj studije bio je utvrdjivanje specificnosti, senzitivnosti, pozitivne i negativne prediktivne vrednosti nivoa TRAb u serumu bolesnika obolelih od GB, kao i procena znacaja nivoa TRAb za prognozu nastupanja remisije i pojavu recidiva bolesti. Metode. U studiji je ispitano prospektivno i delom retrospektivno 149 bolesnika, 109 zenskog i 40 muskog pola, starosti od 5 do 78 godina, u periodu 1982-2007. Bilo je 96 bolesnika sa GB, a kontrolnu grupu cinilo je 53 bolesnika - 21 sa hipertiroidizmom druge etiologije i 32 bolesnika na terapiji amiodaronom, sa ili bez klinicke disfunkcije tireoidne zlezde. Nivo TRAb meren je radioreceptorskom metodom (TRAK Assay i DYNO Test TRAK Human Brahms Diagnostica GMBH). Rezultati. Dobijena senzitivnost (Sn) TRAb testa bila je 80%, specificnost (Sp) 100%, pozitivno prediktivna vrednost (PP) 100% i negativna prediktivna vrednost (NP) 83%. Dobijena Sn hTRAb testa bila je 94%, Sp 100%, PP 100% i NP 94%. Visi nivo TRAb/hTRAb na pocetku bolesti kao i nivo TRAb/hTRAb pri ukidanju terapije, bili su udruzeni sa vecim brojem recidiva GB i sa kracim trajanjem remisije. Zakljucak. Detekcija i merenje TRAb u serumu vrlo je senzitivan metod za potvrdu dijagnoze GB i jedini visoko specificni in vitro metod za diferencijalnu dijagnozu raznih vrsta hipertireoidizama. Klinicki znacaj razlikovanja raznih vrsta hipertireoidizama koriscenjem ovog in vitro testa ogleda se u izboru adekvatne terapije za ove entitete.
Autoimmune diseases of the thyroid gland (ADTG) which include, Graves' disease, Hashimoto thyroiditis, primary hypothyroidism with atrophic thyroiditis, postpartum thyroiditis and 'silent' ...thyroiditis, are characterized by the presence of serum thyroid autoantibodies (TAB). Thyroid autoantibodies are not rare even in the general population of all ages, and their presence in women is 5 times more than in men. The aim of our study was to define the prevalence of thyroid autoantibodies in patients on chronic treatment by amiodarone (AMD), an antiarrhythmic drug rich in iodine, with a potential cytotoxic effect. We have used a section study during a period of two years. Ninety six consecutive patients under AMD treatment were studied, 55 men and 41 women (mean age 62.2 years, range 26-82 years) who referred to us to study their thyroid function. Our results showed that antithyroid antibodies in patients under AMD treatment, with or without thyroid dysfunction, were in similar concentrations as in the general population. A statistically significant greater frequency of increased thyroid peroxidase antibodies (TPOAb) was present in female patients under AMD treatment. When AMD treatment lasted longer than 24 months, the TPOAb were statically higher as compared to those patients under AMD treatment for less than 24 months.
Graves disease (GD) is defined as hyperthyroidism with diffuse goiter caused by immunogenic disturbances. Antibodies to the thyroid stimulating hormone (TSH) receptors of thyroid gland (TRAb) have ...crucial pathogenetic importance in the development and maintenance of autoimmune hyperthyroidism. The aim of this study was to identify sensitivity, specificity, positive an negative predictive velue of TRAb level in sera of patients with GD as well as to estimate significance of TRAb level for remission and GD relapses occurrence.
We studied prospectively and partly retrospectively 149 patients, 109 female and 40 male patients, 5-78 years old, in the period 1982-2007. There were 96 patients with GD. The control group consisted of 53 patients, 21 with hyperthyroidism of second etiology and 32 patients on amiodarone therapy, with or without thyroid dysfunction TRAb was measured by radioreceptor assay (TRAK Assay and DYNO Test TRAK Human Brahms Diagnostica GMBH).
According to the results the sensitivity (Sn) of TRAb test was 80%, specificity (Sp) 100%, positive predictive value (PP) 100% and negative predictive value (NP) 83%. Also, the Sn of hTRAb test was 94%, Sp 100%, PP 100% and NP 94%. Our results show that an increased level of TRAb/hTRAb at the beginning of the disease and the level at the end of medical therapy is associated with an increased number of GD relapses and a shorter remission duration.
Detection and measurement of TRAb in serum is a very sensitive method for diagnosing GD and very highly specific in vitro method for differential diagnosis of various forms of hyperthyroidism. Clinical significance of differentiating various forms of hyperthyroidism, using this in vitro assay, lays in adequate therapeutic choice for these entities.
Mining is unsurprisingly considered a high-risk occupation because it involves continuous hard labour under highly demanding and stressful conditions. Many of these work stressors can impair ...individuals’ well-being in both a physiological and psychological sense. The aims of this study were to assess the prevalence of burnout and depressive symptoms and to evaluate aspects of proactive coping among underground coal miners in Serbia. The study involved 46 male underground coal miners. Burnout was measured with the Copenhagen Burnout Inventory, depression was assessed with the Patient Health Questionnaire-9, and level of proactive coping was measured with the Proactive Coping Inventory. The results showed a low level of burnout syndrome among the underground coal miners (12.46±4.879). Depression was slightly above the minimum (1.2±2.094), and the majority of the participants had no symptoms of depression (93.5%). Overall, the underground coal miners’ ability to proactively cope with work stress was very good (42.17±6.567). This is in contrast to the findings of the few previous international studies and is a good basis for further research using a larger sample in Serbia.
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