BACKGROUND & AIMS: :Graves' disease (GD) is the most common cause of hyperthyroidism in children. This review gives an overview and update of management of GD. Antithyroid drugs (ATD) are recommended as the initial treatment, but the major problem is the high relapse rate (30%) as remission is achieved after a first course of ATD. More prolonged medical treatment may increase the remission rate up to 50%. Alternative treatments, such as radioactive iodine or thyroidectomy, are considered in cases of relapse, lack of compliance, or ATD toxicity. Therefore, clinicians have sought prognostic indicators of remission. Relapse risk decreases with longer duration of the first course of ATD treatment, highlighting the positive impact of a long period of primary ATD treatment on outcome. The identification of other predictive factors such as severe biochemical hyperthyroidism at diagnosis, young age, and absence of other autoimmune conditions has made it possible to stratify patients according to the risk of relapse after ATD treatment, leading to improvement in patient management by facilitating the identification of patients requiring long-term ATD or early alternative therapy. Neonatal autoimmune hyperthyroidism is generally transient, occurring in only about 2% of the offspring of mothers with GD. Cardiac insufficiency, intrauterine growth retardation, craniostenosis, microcephaly and psychomotor disabilities are the major risks in these infants and highlight the importance of thyroid hormone receptor antibody determination throughout pregnancy in women with GD, as well as highlighting the need for early diagnosis and treatment of hyperthyroidism.

背景与目标： ：格雷夫斯病（GD）是儿童甲亢的最常见原因。这篇综述对GD的管理进行了概述和更新。推荐使用抗甲状腺药物（ATD）作为初始治疗方法，但主要问题是复发率高（30％），因为在首个ATD疗程后即可达到缓解。更长时间的药物治疗可将缓解率提高至50％。如果复发，缺乏依从性或ATD毒性，则考虑采用替代疗法，例如放射性碘或甲状腺切除术。因此，临床医生一直在寻求缓解的预后指标。复发风险随着ATD治疗首个疗程的延长而降低，这突出了长期的ATD基本治疗对结局的积极影响。对其他预测因素的识别，例如诊断时严重的生化甲状腺功能亢进，年纪轻和没有其他自身免疫性疾病，使得可以根据ATD治疗后复发的风险对患者进行分层，从而通过促进识别来改善患者管理需要长期ATD或早期替代疗法的患者。新生儿自身免疫性甲状腺功能亢进症通常是短暂的，仅在患有GD的母亲的后代中发生约2％。心脏功能不全，宫内发育迟缓，颅骨狭窄，小头畸形和精神运动障碍是这些婴儿的主要风险，并突出显示了在患有GD的女性整个怀孕期间确定甲状腺激素受体抗体的重要性，并强调了早期诊断和治疗甲状腺功能亢进的必要性。

BACKGROUND & AIMS: :Adrenal myelolipomas are uncommon, nonfunctioning tumors that tend to be discovered incidentally on imaging. Such tumors are composed of mature adipose tissue and hematopoietic elements, but their etiology is still unknown. Thyroid hormones have important effects on development, growth, and metabolism, as well as tumorigenesis. We report a case of adrenal myelolipoma in a patient with hyperthyroidism; this benign tumor expressed both thyroid hormone receptor alpha and beta.

背景与目标： ：肾上腺髓样脂肪瘤是罕见的，无功能的肿瘤，通常在成像时偶然发现。此类肿瘤由成熟的脂肪组织和造血成分组成，但其病因仍未知。甲状腺激素对发育，生长和代谢以及肿瘤发生具有重要作用。我们报告甲状腺功能亢进患者的一例肾上腺骨髓脂肪瘤。这种良性肿瘤表达了甲状腺激素受体α和β。

BACKGROUND & AIMS: :A case of hyperthyroid disease after total thyroidectomy is reported. An initial scintigraph with Tc-99m sodium pertechnetate confirmed the absence of uptake in the neck. The view of the pelvis revealed a rounded area of increased uptake on the left, near the sacroiliac joint (results of bone scintigraphy were negative). A wholebody scan with iodine-131 confirmed a struma ovarii that was bilateral, which occurs in 5% to 10% of patients with this condition.

背景与目标： ：据报道全甲状腺切除术后甲状腺功能亢进症。最初的闪烁体示踪剂为Tc-99m高tech酸钠，证实了颈部没有摄取。骨盆视图显示sa骨关节附近左侧的摄取区域呈圆形（骨骼闪烁显像的结果为阴性）。用碘131进行的全身扫描证实为双侧卵巢，在这种情况下，有5％至10％的患者会发生这种情况。

BACKGROUND & AIMS: :A twin pregnancy with a coexisting complete hydatiform mole and a healthy fetus is rare. Associated with this condition are potentially serious maternal and fetal complications. We describe a case of a woman, 23/40 pregnant, who was diagnosed with a twin pregnancy complicated by a hydatiform mole, vaginal bleeding, hyperthyroidism and preterm labour at 26/40. Her hyperthyroidism was successfully treated with propylthiouracil. The preterm labour resulted in the livebirth of a healthy male infant. The baby developed biochemical hypothyroidism post-natally. The baby's thyroid function tests were unexpected, revealing a low T4 and a low-normal thyroid stimulating hormone. This is the first case reported in the literature to describe an infant's clinical and biochemical thyroid status after gestational trophoblastic disease complicated by hyperthyroidism.

背景与目标： ：双胎妊娠合并完全葡萄胎和健康胎儿是罕见的。与这种情况相关的潜在的严重的母婴并发症。我们描述了一个孕妇23/40的病例，该妇女被诊断为双胎妊娠，并伴有葡萄胎，葡萄胎出血，甲状腺功能亢进和26/40的早产。她的甲状腺功能亢进症成功地用丙基硫氧嘧啶治疗。早产导致了一个健康的男婴的出生。婴儿出生后发生生化甲状腺功能减退症。婴儿的甲状腺功能测试出乎意料，显示出较低的T4和较低的正常甲状腺刺激激素。这是文献中报道的第一例描述妊娠滋养细胞疾病并发甲状腺功能亢进症后婴儿的临床和生化甲状腺状况的文献。

BACKGROUND & AIMS: :Activating mutations in the TSH Receptor (TSHR) gene have been identified as the molecular basis for congenital non-autoimmune hyperthyroidism. We describe the clinical findings and molecular characterization in a girl who presented severe non-autoimmune hyperthyroidism since birth, born to a mother with autoimmune thyroid disease. She was treated with methylmercaptoimidazol and β-blockers, but remained hyperthyroid and required total thyroidectomy. To characterize the presence of an activating mutation, the whole coding sequence and intron-exon boundaries of TSHR gene were analyzed. The patient was heterozygous for p.Ser281Asn mutation and p.Asp727Glu polymorphism. This recurrent mutation, p.Ser281Asn, characterized in vitro by increased basal production of cAMP, is the unique germline activating gene variant described so far in the extracellular domain of TSH receptor. Interestingly, the patient's mother presented hyperthyroidism but without any TSHR gene activating mutation. Although congenital non-autoimmune hyperthyroidism is a rare condition, it should be investigated when severe disease persists, even in a newborn from an autoimmune hyperthyroid mother, in order to differentiate it from the more common congenital autoimmune disease.

背景与目标： TSH受体（TSHR）基因中的激活突变已被确定为先天性非自身免疫性甲状腺功能亢进症的分子基础。我们描述了一个出生后出现严重非自身免疫性甲状腺功能亢进症的女孩的临床发现和分子特征，该女孩出生于患有自身免疫性甲状腺疾病的母亲。她接受了甲基巯基咪唑和β受体阻滞剂的治疗，但甲状腺功能亢进，需要全甲状腺切除术。为了表征激活突变的存在，分析了TSHR基因的整个编码序列和内含子-外显子边界。该患者的p.Ser281Asn突变和p.Asp727Glu多态性是杂合的。这种复发性突变p.Ser281Asn在体外以cAMP的基础产量增加为特征，是迄今为止在TSH受体胞外域中描述的独特种系激活基因变异。有趣的是，患者的母亲表现出甲状腺功能亢进，但没有任何TSHR基因激活突变。尽管先天性非自身免疫性甲状腺功能亢进是一种罕见的疾病，但如果严重疾病持续存在，甚至在自身免疫性甲状腺功能亢进母亲的新生儿中仍应进行调查，以便将其与更常见的先天性自身免疫性疾病区分开。

BACKGROUND & AIMS: :Untreated hyperthyroidism may develop serious complications. This attempt was made to investigate the potential of Aloe vera gel in regulating experimentally induced hyperthyroidism in rats. Female Wistar rats were made hyperthyroid with L-thyroxine (L-T4) at 0.5 mg/kg/day, i.p. for 14 days and the effects of Aloe vera methanolic fraction (AVMF) (50 or 500 mg/kg/day, p.o.,) and a conventional antithyroid drug propylthiouracil (PTU) (10 mg/kg, i.p.) for 30 days were studied in those hyperthyroid rats. At the end, alterations in serum thyroid hormones and thyroid stimulating hormone (TSH); hepatic 5'mono-deiodinase-1(5'D1) activity, oxidative stress markers and antioxidants; serum inflammatory cytokines and the expression of thyrotropin receptor in thyroid gland were evaluated in all experimental animals. Hyperthyroid condition was confirmed by an increase in thyroid hormone levels and hepatic 5'D-1 activity with a decrease in TSH. However, either AVMF or PTU treatment in hyperthyroid rats decreased the levels of thyroid hormones and 5'D1 activity. AVMF administration in T4-induced rats also decreased the oxidative stress markers such as thiobarbituric acid reactive substances and lipid hydroperoxides and increased the antioxidant levels in liver tissues. Levels of liver marker enzymes, cytokines and different lipids were decreased in T4-induced AVMF treated rats. Further, a down regulation in the TSHR expression in thyroid was observed in AVMF or PTU treated groups. All these thyroid inhibiting effects were supported by an improvement in thyroid histology in hyperthyroid rats. It appears, about 15 compounds, as evidenced by LC-MS/MS study, mostly phenolics are involved in this anti-thyroid effects of the test compound.

背景与目标： ：未经治疗的甲状腺功能亢进症可能会导致严重的并发症。进行此尝试以研究芦荟凝胶调节大鼠实验性甲状腺功能亢进症的潜力。雌性Wistar大鼠以0.5 mg / kg /天的腹腔注射L-甲状腺素（L-T4）甲状腺功能亢进。持续14天，研究了芦荟甲醇分数（AVMF）（50或500 mg / kg /天，口服）和常规抗甲状腺药物丙硫氧嘧啶（PTU）（10 mg / kg，腹腔注射）30天的作用。那些甲状腺功能亢进的老鼠。最后，血清甲状腺激素和甲状腺刺激激素（TSH）的改变；肝脏5'mono-deiodinase-1（5'D1）活性，氧化应激标志物和抗氧化剂；在所有实验动物中评估了血清炎性细胞因子和甲状腺中促甲状腺激素受体的表达。甲状腺激素水平升高和肝脏5'D-1活性升高，TSH降低证实甲状腺功能亢进。但是，对甲亢大鼠进行AVMF或PTU治疗均会降低甲状腺激素水平和5'D1活性。在T4诱导的大鼠中施用AVMF还可以降低氧化应激标志物，例如硫代巴比妥酸反应性物质和脂质氢过氧化物，并增加肝组织中的抗氧化剂水平。在T4诱导的AVMF处理的大鼠中，肝标志物酶，细胞因子和不同脂质的水平降低。此外，在AVMF或PTU治疗组中观察到甲状腺TSHR表达的下调。所有这些甲状腺抑制作用都得到甲状腺功能亢进大鼠甲状腺组织学改善的支持。 LC-MS / MS研究表明，大约有15种化合物，其中大部分酚类物质参与了该测试化合物的抗甲状腺作用。

BACKGROUND & AIMS: OBJECTIVE:To determine whether clinical and biochemical features of Graves' disease at presentation predict response to medical and radioiodine treatment. METHODS:We carried out a retrospective 10-year study of 194 consecutive Saudi subjects with Graves' disease who were treated with antithyroid drugs, radioiodine therapy, or both, between January 1995 and December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. RESULTS:At diagnosis, the mean age was 32 +/- 0.9 years. Only 26% of patients had successful outcome after a course of antithyroid medication. None of the clinical or biochemical factors were associated with a favorable outcome of antithyroid treatment. One dose of radioiodine [13-15 mCi (481-555 MBq)] cured hyperthyroidism in 83% of patients. Presence of ophthalmopathy at presentation was shown to be a significant contributing factor to failure to respond to a single dose of radioiodine (odds ratio, 6.4; 95% CI, 1.51-24.4; p<0.01). Failure of radioiodine treatment was also associated with higher serum free T3 concentration at presentation (p=0.003). CONCLUSION:In patients with Graves' hyperthyroidism, radioiodine treatment is associated with higher success rate than antithyroid drugs. A dose of 13-15 mCi (481-555 MBq) seems to be practical and effective, and should be considered as first line therapy. Patients with high free T3 concentration and, those with ophthalmopathy at presentation were more likely to fail radioiodine treatment. A higher dose of radioiodine may be advisable in such patients.

背景与目标： 目的：确定演讲时Graves病的临床和生化特征是否可预测对药物和放射碘治疗的反应。
方法：我们对1995年1月至2004年12月间在沙特阿拉伯利雅得国王哈立德大学医院接受抗甲状腺药物，放射碘疗法或两者同时治疗的194名连续Graves病的沙特受试者进行了为期10年的回顾性研究。
结果：在诊断时，平均年龄为32 /-0.9岁。接受抗甲状腺药物治疗后，只有26％的患者获得了成功的预后。没有任何临床或生化因素与抗甲状腺治疗的良好结果相关。一剂放射性碘[13-15 mCi（481-555 MBq）]可治愈83％的患者甲亢。出现眼部疾病被证明是导致对单剂量放射性碘反应失败的重要因素（优势比：6.4； 95％CI：1.51-24.4； p <0.01）。放射碘治疗失败还与出现时血清游离T3浓度升高有关（p = 0.003）。
结论：在格雷夫斯甲状腺功能亢进症患者中，放射性碘治疗比抗甲状腺药物成功率更高。 13-15 mCi（481-555 MBq）的剂量似乎是切实有效的，应视为一线治疗。游离T3浓度高的患者以及出现眼病的患者更有可能无法接受放射性碘治疗。在此类患者中建议使用更高剂量的放射性碘。

BACKGROUND & AIMS: OBJECTIVE:When using radioiodine for hyperthyroidism there is no consensus regarding the administration of fixed or calculated doses. Guidelines do not specify the preferable approach or the parameters to use to calculate the dose. Therefore, the dose might be quite different with regard to the chosen procedure. This study was undertaken to evaluate the variability of the amount of radioiodine administered in Belgium in various cases of hyperthyroidism. DESIGN AND PATIENTS:Twenty-one Belgian nuclear medicine physicians received summarized clinical files from 10 patients suffering from overt hyperthyroidism (n = 7) or subclinical hyperthyroidism (n = 3). Five patients had homogeneous goiters, one had multinodular goiter, and four had hot nodule. Participants had to determine the radioiodine dose (millicuries, mCi) they would give in each case. RESULTS:Proposed doses varied between 2 mCi and 25 mCi. Mean proposed dose for nodular disease was 10.71 mCi; it was 6.79 mCi for homogeneous goiter. For individual cases, a difference between the lowest and the highest dose of more than 17 mCi was observed in more than 50% of the cases. CONCLUSIONS:We believe that more precise guidelines are mandatory, underlying uncertainties, controversies but recommending however, as minimal and maximal doses to administer, as well as clinical and biological parameters, if any, to be taken into account in order to modulate these doses.

背景与目标： 目的：使用放射性碘治疗甲状腺功能亢进症时，关于固定剂量或计算剂量的使用尚无共识。指南未指定用于计算剂量的首选方法或参数。因此，就所选择的程序而言，剂量可能会完全不同。进行这项研究是为了评估比利时在各种甲亢患者中施用的放射性碘的量的变异性。
设计和患者：21名比利时核医学医生从10例患有明显甲状腺功能亢进（n = 7）或亚临床甲状腺功能亢进（n = 3）的患者那里获得了总结的临床档案。 5例均患有甲状腺肿，1例患有多结节性甲状腺肿，4例患有热结节。参与者必须确定每种情况下的放射性碘剂量（毫厘米，mCi）。
结果：建议剂量在2 mCi和25 mCi之间变化。结节性疾病的平均建议剂量为10.71 mCi。均匀甲状腺肿为6.79 mCi。对于个别病例，在超过50％的病例中，观察到的最低剂量和最高剂量之间的差异超过17 mCi。
结论：我们认为，更精确的指南是强制性的，潜在的不确定性，争议，但建议作为调节这些剂量的最小和最大剂量，以及临床和生物学参数（如有），都应考虑在内。

BACKGROUND & AIMS: :A 74-year-old woman with hyperthyroidism was referred for radioiodine therapy. The patient was accidentally given 60 mCi of Lu-PSMA orally instead of I. Upon discovery of this medical event, we immediately started radiation protective actions including hydration, antiemetics, and laxatives. The patients did not have any symptoms. Static acquisition was performed from the abdominal-pelvic and head and neck regions at 20 and 90 hours after ingestion, which showed prominent intestinal activity and mild systemic activity in the kidneys, bladder, salivary, and lacrimal glands.

背景与目标： ：一名74岁甲状腺功能亢进的妇女被转介接受放射碘治疗。意外地给患者口服了60 mCi的Lu-PSMA，而不是口服。发现此医疗事件后，我们立即开始了辐射防护措施，包括水合作用，止吐药和泻药。患者没有任何症状。摄食后20和90小时，从腹部骨盆和头颈部区域进行静态采集，显示肾脏，膀胱，唾液和泪腺的肠道活动活跃，全身活动轻微。

BACKGROUND & AIMS: :The aim of the research is to explore the relationship between hyperthyroidism, iodine, antithyroid drugs (propylthiouracil) and vascular endothelial injury. In total, 136 SD rats were randomly allocated into the control group, the hyperthyroidism group, the hyperthyroidism propylthiouracil group, the hyperthyroidism low iodine group, the high iodine group, and the endothelial injury group. Rats were raised for 60 days. Afterward, indicators concerning endothelial damage were determined, including the von Willebrand Factor (vWF), thrombomodulin (TM), nitric oxide (NO), endothelin 1 (ET-1), and P-selectin, as well as the plant hemagglutinin sample type oxidized low-density lipoprotein receptor 1 (LOX-1) from the aorta and the number of endothelial progenitor cells (EPCs) in whole blood. The hyperthyroidism group had significantly higher values for vWF, TM, NO, ET-1, and P-selectin in serum and a higher number of EPCs in whole blood compared with the control group, similar to the LOX-1 expression in abdominal aorta. The hyperthyroidism low iodine group had significantly higher values for vWF, ET-1, and P-selectin in serum and a higher number of EPCs in whole blood compared with those of the control group, as was the case for LOX-1 expression in the abdominal aorta. The hyperthyroidism propylthiouracil group had significantly higher values for FT4 in the serum compared with those in the control group. The electron microscope showed that hyperthyroidism caused a certain degree of endothelial injury to the abdominal aorta in rats. Hyperthyroidism can damage the vascular endothelium and is a high-risk factor for cardio-cerebrovascular disease. Propylthiouracil could be used in the treatment of hyperthyroidism, thus protecting endothelial cells from damage.

背景与目标： ：该研究的目的是探讨甲状腺功能亢进症，碘，抗甲状腺药（丙基硫尿嘧啶）与血管内皮损伤之间的关系。将总共​​136只SD大鼠随机分为对照组，甲状腺功能亢进组，甲状腺功能亢进丙硫氧嘧啶组，甲状腺功能亢进低碘组，高碘组和内皮损伤组。将大鼠饲养60天。之后，确定了有关内皮损伤的指标，包括血管性血友病因子（vWF），血栓调节蛋白（TM），一氧化氮（NO），内皮素1（ET-1）和P选择素，以及植物血凝素样品类型从主动脉中氧化的低密度脂蛋白受体1（LOX-1）和全血中内皮祖细胞（EPC）的数量。甲状腺功能亢进组与对照组相比，血清中的vWF，TM，NO，ET-1和P-选择素的值明显较高，全血中的EPC数量较高，与腹主动脉中的LOX-1表达相似。与对照组相比，甲亢低碘组的血清中vWF，ET-1和P-选择素的值明显高于对照组，全血中的EPC数量也高于对照组。腹主动脉。与对照组相比，甲亢性丙硫氧嘧啶组的血清FT4值明显更高。电子显微镜显示甲状腺功能亢进症对大鼠腹主动脉有一定程度的内皮损伤。甲状腺功能亢进会损害血管内皮，并且是心脑血管疾病的高危因素。丙硫氧嘧啶可用于治疗甲状腺功能亢进症，从而保护内皮细胞免受损害。

BACKGROUND & AIMS: BACKGROUND:Hyperthyroidism is a disease in which excessive amounts of thyroid hormones circulate in the blood. Patients, among other things suffer from tachycardia, warm moist skin and raised body temperature. The treatment of hyperthyroidism includes symptom relief and therapy with antithyroid medications, radioiodine and thyroidectomy. Medicinal herbs are used alone or in combination with antithyroid agents to treat hyperthyroidism in China and some other countries. OBJECTIVES:To assess the effects of Chinese herbal medicines for treating hyperthyroidism. SEARCH STRATEGY:Studies were obtained from computerised searches of MEDLINE, EMBASE, The Cochrane Library, the Chinese Biomedical Database. SELECTION CRITERIA:Randomised controlled trials comparing the effects of Chinese herbal medicines alone with Chinese herbal medicines combined with antithyroid drugs, radioiodine or both. DATA COLLECTION AND ANALYSIS:Three authors interviewed authors of all potentially relevant studies by telephone to verify randomisation procedures. One author entered data into a data extraction form and another author verified the results of this procedure. MAIN RESULTS:Thirteen relevant trials with 1770 participants were included. All of them were of low quality. Fifty-two studies still need to be assessed because the original authors could not be interviewed. None of these trials analysed mortality, health related quality of life, economic outcomes or compliance. Compared to antithyroid drugs alone the results showed that Chinese herbal medicines combined with antithyroid drugs may offer benefits in lowering relapse rates, reducing the incidence of adverse effects, relieving symptoms, improving thyroid antibody status and thyroid function. Two trials investigated Chinese herbal medicine versus radioiodine and reported improvements in anxiety, tachycardia and heat intolerance. However, thyroid function - with the exception of restored thyroid stimulating hormone (TSH) - was not significantly altered. AUTHORS' CONCLUSIONS:The results suggest that traditional Chinese herbal medicines added to other routine treatment have a therapeutic potential for people with hyperthyroidism. However, due to methodological limitations, we could not identify a well-designed trial to provide strong evidence for Chinese traditional herbal medicine in the treatment of hyperthyroidism. Thus, we currently cannot recommend any single preparation or formulation for clinical use.

背景与目标： 背景：甲状腺功能亢进症是一种在血液中循环过多甲状腺激素的疾病。除其他外，患者患有心动过速，皮肤温暖潮湿和体温升高。甲状腺功能亢进症的治疗包括症状缓解和抗甲状腺药物，放射碘和甲状腺切除术的治疗。在中国和其他一些国家，药用草药可单独使用或与抗甲状腺药联合使用以治疗甲状腺功能亢进症。
目的：评估中草药治疗甲状腺功能亢进症的疗效。
搜索策略：研究是从MEDLINE，EMBASE，Cochrane图书馆，中国生物医学数据库的计算机搜索中获得的。
选择标准：随机对照试验，比较中草药单独使用，中草药与抗甲状腺药物，放射性碘或两者合用的效果。
数据收集与分析：三位作者通过电话采访了所有潜在相关研究的作者，以验证随机化程序。一位作者将数据输入数据提取表中，另一位作者验证了此过程的结果。
主要结果：包括13项相关试验，共有1770名参与者。他们都是低质量的。由于无法采访原始作者，因此仍需要评估52项研究。这些试验均未分析死亡率，与健康相关的生活质量，经济结果或依从性。结果表明，与单独使用抗甲状腺药相比，中草药与抗甲状腺药合用可能会降低复发率，减少不良反应的发生率，缓解症状，改善甲状腺抗体状态和甲状腺功能。两项试验研究了中草药与放射性碘的关系，并报告了焦虑，心动过速和热耐受性的改善。然而，除了恢复的甲状腺刺激激素（TSH）外，甲状腺功能没有明显改变。
作者的结论：结果表明，在其他常规治疗中添加传统中草药对甲亢患者具有治疗潜力。然而，由于方法上的局限性，我们无法确定一个设计合理的试验来为中草药治疗甲状腺功能亢进症提供有力的证据。因此，我们目前无法推荐任何单一制剂或制剂用于临床。

BACKGROUND & AIMS: RATIONALE:Thyrotoxic periodic paralysis is characterized by a sudden onset of hypokalemia and paralysis. This condition mainly affects the lower extremities and is secondary to thyrotoxicosis. The underlying hyperthyroidism is often subtle without typical symptoms such as palpitations, tremors, anxiety, and weight loss; this causes a difficulty in early diagnosis. Here, we reported a case of periodic paralysis in a patient with hyperthyroidism whose potassium level was within the normal range. PATIENT CONCERNS:A 33-year-old Taiwanese man presented to the emergency department with bilateral limb weakness (more severe in the lower limbs than in the upper limbs). On arrival, the patient's vital status was stable with clear consciousness. He denied experiencing recent trauma, back pain, chest pain, abdominal pain, headache or dizziness, or a fever episode. Physical examination showed no specific findings. Neurological examination showed weakness in the muscles of the bilateral upper and lower limbs. Muscle weakness was more severe in the proximal site than in the distal site. DIAGNOSIS:Blood examination showed normal complete blood count, normal renal and liver function, and normal potassium (3.5 mmol/L, normal range 3.5-5.1 mmol/L), sodium, and calcium levels; however, the examination showed impaired thyroid function (thyroid stimulating hormone: 0.04 uIU/mL, normal range 0.34-5.60 uIU/mL; free T4: 1.96 ng/dL, normal range 0.61-1.12 ng/dL). Brain computed tomography without contrast showed no obvious intra-cranial lesion. INTERVENTIONS:Intravenous potassium infusion (20 mEq/L) with normal saline was prescribed for the patient. OUTCOMES:After treatment, the patient felt a decrease in limb weakness. He was discharged from our emergency department with a scheduled follow-up in the endocrine outpatient department. LESSONS:TPP should be considered as a differential diagnosis in young Asian men presenting with limb paralysis that is more severe in the proximal site and in the lower limbs than in the distal site and in the upper limbs, respectively. It is important for emergency department physicians to consider TPP as a differential diagnosis as it can occur even if the patient's potassium level is within the normal range.

背景与目标： 理由：甲状腺毒性周期性麻痹的特点是突然出现低钾血症和麻痹。这种情况主要影响下肢，继发于甲状腺毒症。潜在的甲状腺功能亢进通常很细微，没有典型的症状，例如心pit，震颤，焦虑和体重减轻。这导致了早期诊断的困难。在这里，我们报道了一名甲状腺功能亢进症患者的周期性瘫痪，其钾水平在正常范围内。
患者注意事项：一名33岁的台湾男子因双侧肢体无力（下肢比上肢更严重）出现在急诊室。到达后，患者的生命状态稳定，意识清晰。他否认最近经历过外伤，背痛，胸痛，腹痛，头痛或头晕或发烧。体格检查未发现具体发现。神经系统检查显示双侧上肢和下肢的肌肉无力。与近端部位相比，近端部位的肌肉无力更为严重。
诊断：血液检查显示正常的全血细胞计数，正常的肾和肝功能以及正常的钾（3.5 mmol / L，正常范围3.5-5.1 mmol / L），钠和钙水平；然而，检查显示甲状腺功能受损（甲状腺刺激激素：0.04μuIU/ mL，正常范围0.34-5.60μuIU/ mL；游离T4：1.96μng/ dL，正常范围0.61-1.12μng/ dL）。没有对比的脑部计算机断层扫描显示没有明显的颅内病变。
干预措施：为患者开具静脉注射钾（20μmEq/ L）和生理盐水。
结果：治疗后，患者感到四肢无力减轻。他已从我们的急诊科出院，并计划在内分泌门诊部进行随访。
经验教训：TPP应该被视为亚洲年轻男性肢体麻痹的鉴别诊断，其近端部位和下肢部位比远端部位和上肢部位更为严重。对于急诊科医师而言，将TPP视为鉴别诊断非常重要，因为即使患者的钾水平在正常范围内，TPP也会发生。

BACKGROUND & AIMS: INTRODUCTION:Subclinical hyperthyroidism (SCH), also known as mildly symptomatic hyperthyroidism, has recently been diagnosed more frequently. One of the main endogenous causes of this disorder is autonomously functioning thyroid nodule (AFTN). Despite the fact that it is usually asymptomatic, SCH entails repercussions on the cardiovascular system and bone, and it carries a risk of progression to overt hyperthyroidism with a typical clinical picture. Treatment is still controversial, and its benefits are widely debated in literature. MATERIAL AND METHODS:From 459 patients authors selected a group of 49 patients (10.6% of all subjects with hyperthyroidism), 41 women (83.7%) with AFTN at the stage SCH treated in the Outpatient Endocrinological Clinic and the Department of Endocrinology of the Medical University of Lublin over a three-year period. The method applied in the study was a retrospective analysis of medical records with a particular account of medical history, physical examination, and additional tests obtained during the process of diagnostic and therapeutic procedures. RESULTS:Forty-one patients (83.7%) suffered from typical symptoms of hyperthyroidism; only eight patients (16.3%) were asymptomatic. The most frequently reported symptoms were tachycardia in women (51.2%) and anxiety in men (50%). The type of thyrostatic drugs and the length of therapy did not affect the outcome of iodine-131 therapy. In the vast majority of the patients (87.8%) radioidodine therapy was effective; 30 patients (61.2%) reached euthyreosis and 13 patients (22.5%) developed hypothyroidism. CONCLUSIONS:Most patients with SCH in the course of AFTN suffered from typical symptoms of overt hyperthyroidism; only every sixth patient was asymptomatic. The volume of autonomous adenomas did not affect the result of 131I therapy; however, the impact of AFTN volume as well as the thyroid volume on RIT efficacy requires futher investigation. In the vast majority of patients 131I therapy was an effective method of treatment, and an earlier therapeutic effect was observed more often in the patients with focal lesions located in the right lobe.

背景与目标： 简介：亚临床甲状腺功能亢进症（SCH），也称为轻度症状性甲状腺功能亢进症，最近被更频繁地诊断。这种疾病的主要内源性原因之一是自主功能的甲状腺结节（AFTN）。尽管通常无症状，但SCH会对心血管系统和骨骼造成影响，并且具有典型临床表现的发展为明显甲状腺功能亢进的风险。治疗仍然是有争议的，其益处在文献中得到了广泛的争论。
材料与方法：从459例患者中，作者选择了49例患者（占所有甲亢患者的10.6％），41例女性（83.7％）在门诊内分泌科和内分泌科进行SCH期SCH治疗的AFTN患者卢布林大学为期三年。该研究中使用的方法是对病历进行回顾性分析，并特别考虑病史，体格检查以及在诊断和治疗程序过程中获得的其他检查结果。
结果：41例（83.7％）患者出现典型的甲状腺功能亢进症状。仅8例（16.3％）无症状。报告最频繁的症状是女性的心动过速（51.2％）和男性的焦虑（50％）。甲状腺抑制药物的类型和治疗时间不影响碘131治疗的结果。在绝大多数患者（87.8％）中，放射性碘治疗是有效的。 30名患者（61.2％）达到了甲状腺功能正常，13名患者（22.5％）出现甲状腺功能减退。
结论：AFTN过程中大多数SCH患者表现为典型的甲状腺功能亢进症状。只有六分之一的病人没有症状。自主性腺瘤的数量不影响131I治疗的结果。但是，AFTN量和甲状腺量对RIT疗效的影响还需要进一步研究。在绝大多数患者中，131I治疗是一种有效的治疗方法，并且对于位于右叶的局灶性病变的患者，更经常观察到较早的治疗效果。

BACKGROUND & AIMS: :1. The effects of hyperthyroidism and hypothyroidism on the concentrations of glutamine and other amino acids in the muscle and plasma and on the rates of glutamine and alanine release from incubated isolated stripped soleus muscle of the rat were investigated. 2. Hyperthyroidism decreased the concentration of glutamine in soleus muscle but was without effect on that in the gastrocnemius muscle or in the plasma. Hyperthyroidism also increased markedly the rate of release of glutamine from the incubated soleus muscle. 3. Hypothyroidism decreased the concentrations of glutamine in the gastrocnemius muscle and plasma but was without effect on that in soleus muscle. Hypothyroidism also decreased markedly the rate of glutamine release from the incubated soleus muscle. 4. Thyroid status was found to have marked effects on the rate of glutamine release by skeletal muscle per se, and may be important in the control of this process in both physiological and pathological conditions.

背景与目标： ：1。研究了甲状腺功能亢进和甲状腺功能减退症对大鼠肌肉和血浆中谷氨酰胺和其他氨基酸的浓度以及从培养的分离的比目鱼比目鱼肌中谷氨酰胺和丙氨酸释放速率的影响。 2.甲状腺功能亢进降低比目鱼肌中谷氨酰胺的浓度，但对腓肠肌或血浆中的谷氨酰胺浓度没有影响。甲状腺功能亢进还显着增加了从比目鱼肌肉中释放谷氨酰胺的速率。 3.甲状腺功能减退症降低了腓肠肌和血浆中谷氨酰胺的浓度，但对比目鱼肌无影响。甲状腺功能减退症也显着降低了从比目鱼比目鱼肌释放谷氨酰胺的速率。 4.甲状腺状态被发现对骨骼肌本身释放谷氨酰胺的速率有显着影响，并且在生理和病理条件下对控制这一过程都可能很重要。

BACKGROUND & AIMS: :These clinical practice guidelines summarize the recommendations of the American Association of Clinical Endocrinologists for the diagnostic evaluation of hyperthyroidism and hypothyroidism and for treatment strategies in patients with these disorders. The sensitive thyroid-stimulating hormone (TSH or thyrotropin) assay has become the single best screening test for hyperthyroidism and hypothyroidism, and in most outpatient clinical situations, the serum TSH is the most sensitive test for detecting mild thyroid hormone excess or deficiency. Therapeutic options for patients with Graves' disease include thyroidectomy (rarely used now in the United States), antithyroid drugs (frequently associated with relapses), and radioactive iodine (currently the treatment of choice). In clinical hypothyroidism, the standard treatment is levothyroxine replacement, which must be tailored to the individual patient. Awareness of subclinical thyroid disease, which often remains undiagnosed, is emphasized, as is a system of care that incorporates regular follow-up surveillance by one physician as well as education and involvement of the patient.

背景与目标： 这些临床实践指南总结了美国临床内分泌学家协会对甲亢和甲状腺功能减退症的诊断评估以及这些疾病患者的治疗策略的建议。敏感的甲状腺刺激激素（TSH或促甲状腺激素）测定法已成为甲亢和甲状腺功能减退症的唯一最佳筛查方法，在大多数门诊临床情况下，血清TSH是检测轻度甲状腺激素过量或不足的最灵敏测试。 Graves病患者的治疗选择包括甲状腺切除术（目前在美国很少使用），抗甲状腺药物（经常与复发相关）和放射性碘（目前是治疗选择）。在临床甲状腺功能减退症中，标准治疗是左甲状腺素替代，必须针对个别患者量身定制。强调了对亚临床甲状腺疾病的意识，而这种意识通常仍未被诊断，同时也强调了一种护理系统，该系统结合了一名医生的定期随访监测以及对患者的教育和参与。