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3-1772
DiS Caetston OF FF a Conmterd. ~795. 077
Medical Research Center
Brookhaven
;
National
Reprinted from
REPOSITORY
THE JOURNAL OF
CLINICAL ENDOCRINOLOGY AND
Labo owtery7, No. 12, December, 1907,
Upton, L. L, New York
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Printed in the US -bes oy No. MENS
—
Two Panel Discussions on HyperthyroidismER
Ie p) ' fice
NOY
Em.
i
Sidney C. Werner, Moderator
- II. Etiology and Treatmentof Hyperthyroidism in the Adult
antithyroid medication and finally arrived
at the hospital hyperthyroid and with
evident joint involvement.
DR. SIDNEY C. WERNER, Department
of Medicine, Columbia University College
of Physicians and Surgeons, New York,
Moderator: The second panel on hyperthyroidism is composed of the following
members: Doctors Robert Conard, Carl R.
Feind, Ernest Gould, David Hsia, Sidney
H. Ingbar, Joseph P. Kriss, Stuart Lindsay,
Farahe Maloof, J. Maxwell McKenzie,
Louis Sokoloff and Kenneth Sterling.
Following the pattern of the first panel
(1), we shall present a patient. But the
subsequent discussion will open with two
ifferent problems: 1) the mechanism of
ics of thyroid hormone, and 2) the
etiology of toxic diffuse goiter.
The patient was a 16}-year-old girl who
arrived at the hospital with obvious hyperthyroidism of three years’ duration. She
also had had joint pains and fever for these
three years. The hyperthyroidism had been
moreorless controlled with methimazole or
with propylthiouracil given by various
physicians. There were persistent efforts
to make the diagnosis of rheumatic disease
or of disseminated lupus erythematosus,
but a numberof rheumatologists could find
no tangible evidence of either.
She had had a sore throat a few months
before admission and received penicillin.
After this, her joints had a flare-up of
activity. She was irregular in taking her
Received April 7, 1967; accepted August 2.
1 Sponsored by The American Thyroid Associa-
tion, Inc., as part of the annual program, October
13, 1966, Chicago,Il.
* Address reprint requests to Dr. Sidney C.
Werner, Department of Medicine, Columbia Uni-
versity College of Physicians and Surgeons, 630
West 168th Street, New York, N. Y. 10032.
>The first of these two articles appeared in the
Jovember 1967 issue of The Journal of Clinical
Endocrinology and Metabolism.
IO 5094
For the month prior to admission, her
joint involvement had become worse; she
had developed periumbilical pain associated with periods of fever to 103 F, A 24
hour radioactive iodine uptake three days
after stopping the small amountof propylthiouracil she was taking was 75%.
The admission findings were as follows:
She was evidently hyperthyroid, looked
sick, but had no eye signs. The joints, as
well as the other systems, were negative to
physical examination, except for a moderate-sized rather soft diffuse goiter with a
bruit. She had a fever, 103 F.
In the laboratory, 24 hour '!*'I uptake was
55%, PBI 9 uwg/100 ml. The erythrocyte
sedimentation rate was 48 mm at one hour;
a disseminated lupus erythematosus preparation was negative; and the antistreptolysin titer was negative.
It was concluded that she had toxic diffuse goiter; and since the usual surveys for
connective tissue or rheumatic disease were
essentially negative, it was considered
likely that the articular and other manifestations were due to a reaction to antithyroid drugs. This view was probably
correct, inasmuch as she became well when
propylthiouracil therapy was terminated.
The arthralgia and fever subsided.
At this point, it seemed reasonable to
administer sodium iodide in preparation
for surgery. Since she was 163 years old,
18\T therapy was eliminated from consideration. Sodium iodide was started, 0.1 g
daily. However, within 24 hours, she developed a fever of 102 F, her joints became red
and swollen, and she developed a vesicular
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