- Ensulin Autoimmune Syndrome in a Patient with Methimazole-Treated Graves' Disease: A Case report.
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Joong Kyu Lim, Yong An Woo, Sung Jin Kang, Sung Sik Yoo, Kun Young Hong, Soon Ho Kim
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J Korean Endocr Soc. 1998;13(4):612-616. Published online January 1, 2001
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- Insulin autoimmune syndrome (IAS) includes fasting or reactive hypoglycemia, hyperinsulinemia and the presence of insulin-binding antibodies in patients who have never been exposed to exogenous insulin. This report concems a 29-year-old male patient with Graves disease who had history of having taken methimazole for two months, without any consequence, 6 months previously. However, when methimazole was administered again for three weeks, the patient suffered hypoglycemia during the next fourth week. He denied history of diabetes mellitus (DM), of taking any oral hypoglycemic agent or of having received insulin injection. Laboratory data showed total serum insulin level > 300 pu/mL, C-peptide reactivity (CPR) 8.0ng/mL and insulin antibody 89%. After stopping methimazole, he was treated with radioiodine (131I). There was no episode of hypoglycemic attack during 8 months of follow-up.
- Suppressive Therapy with Levothyroxine in Benignn Solitary Thyroid Nodule.
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Sun Ho Kim, Jin Ho Choo, Ki Chang Oh, Hyoung Churl Cho, Jang Hyeon Cho, Joong Kyu Lim, Jin Duk Huh
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J Korean Endocr Soc. 1997;12(1):45-52. Published online January 1, 2001
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Abstract
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- BACKGROUND
Clinically apparent thyroid nodule is a very common disease in adults. Patients are often treated with thyroxine in order to reduce the size of the nodule, but the efficacy of thyroxine-suppressive therapy with thyroxine remains uncertain. We investigated the efficacy of thyroxine-suppressive therapy and the hormonal characteristics during thyroxine therapy to find out whether such measurement could be used to determine the effectiveness of this therapy in patients with benign solitary thyroid nodule proved by aspiration biopsy. METHODS: In this study, 54 patients were randomly assigned to receive L-thyroxine (Group I, n=24) or placebo (GroupII, n=30) for 1 year. High resolution ultrasonography (10MHz) was used to measure the size of the nodules at six month intervals. Thyroid hormones and thyroglobulin assay and FNA (fine needle aspiration) was done at the same time. The dose of thyroxine was 200ug/day. Patients were followed at 6 month intervals. RESULTS: The results were as follows: 1) 13 (54.1%) out of 24 Group I patients after adequate TSH suppression had a statistically significant reduction of nodule size and before-to-after nodule volume ratios were significantly different between the Group I and Group II patients. 2) In the responders among Group I patients, the before-to-after therapy ratio of the nodule volume was not related to the pretreatment nodule size, thyroid hormones and thyroglobulin levels. CONCLUSION: Thus we concluded that an adequate suppressive dose of L-thyroxine significantly altered the volume of the benign solitary thyroid nodules 12 months later.
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