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Article
Electromyographic Changes in Thyrotoxicosis

Author: Khalid I. Mussa,;
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2007 Volume: 49 Issue: 1 Pages: 69-72
Publisher: Baghdad University جامعة بغداد

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Abstract

Objectives: To document electromyographic changes in thyrotoxic patients, and to categorize the type of myopathic process in thyrotoxicosis.
Design: This case control study was designed to show the electromyographic changes in thyrotoxic patients and to compare these findings with that of normal aged matched controls to show the significance of these changes in thyrotoxic patients. Student’s test was applied on the results and P value was extracted.
Subjects: Subjects in this study were chosen according to certain criteria depending mainly on their blood level of thyroid hormone (T3, and T4) and TSH. All of them are thyrotoxic patients, their ages range between 15 to 45 years. They were 25 patients (15 female and 10 males). Another 25 subjects were chosen as normal controls they were of the same age and sex, patient with features of myopathy or neuropathy from diseases other than thyrotoxicosis were excluded carefully from studied patients and the normal controls.
Results: EMG finding in thyrotoxic patients was as follows: No spontaneous activities in the proximal muscles (deltoid and in rectus femoris muscles). The amplitude of the motor unit action potentials was ranging between (200-800 microv) with a mean of (488.8 +/- 159.3microv.) in the deltoid muscle, while the amplitude of the action potential In rectus femoris muscle in thyrotoxic patients was ranging between (350-900 microv.). In abductor pollicis brevis muscle the action potential amplitude in thyrotoxic patients was ranging between (500-2150 microv.), there was significant difference between thyrotoxic patients and normal controls. The duration of the motor unit potential in thyrotoxic patients was ranging between (7—11.5 msec.) with a mean of (8.51+/- 1,24 msec) in the deltoid muscle, slightly higher figures in rectus femoris muscle, this indicates significant difference in the duration of action potential between patients and normal controls. The other parameters of EMG study all indicate a myopathic process involving proximal muscles in 76% of thyrotoxic patients and a neuropathic process involving distal muscles in 28% of thyrotoxic patients.
Conclusions:
1-thyrotoxicosis involves proximal muscles more than distal muscles.
2-myopathic process in thyrotoxicosis can be observed clearly in EMG study of the proximal muscles.
3-EMG findings in thyrotoxic myopathy includes, short duration polyphasic potentials, with early recruitment full interference pattern.
4-Distal muscles in thyrotoxic patients may show EMG findings of a rather neuropathic process.


Article
BIOCHEMICAL CHANGES IN PATIENTS WITH HYPERTHYROIDISM
التغييرات الكيموحيوية لدى المرضى المصابين بفرط افراز الغدة الدرقية

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Abstract

This study is an attempt to investigate the biochemical changes caused by hyperthyroidism. It has been carried out on the sera of (106) Patients diagnosed with hyperthyroidism collected during their attendance to the endocrinology department, Tikrit teaching hospital – Tikrit and Kirkuk general hospital – Kirkuk / Iraq, compared with (50 ) samples of normal individuals used as control. The results indicated that the rate of hyperthyroidism is the highest among the age group (40-50) years old. Calcium, Phosphorus, and Potassium serum levels increase, while the level of Sodium remains within the normal range. Total Cholesterol, Triglycerides, LDL, VLDL and HDL levels decrease. Deficiency in the level of total protein and Albumin has been detected in patients with hyperthyroidism.

استهدفت هذه الدراسه التحري عن التغييرات الكيموحيويه التي تحصل نتيجة الاصابه بفرط افراز الغده الدرقيه. تمت هذه الدراسه باستخدام مصل الدم ل ( 106) من المرضى المشخصين باصابتهم بفرط افراز الغدة الدرقية الذين راجعوا قسم الغدد الصماء في مستشفى تكريت التعليمي- مدينة تكريت ومستشفى كركوك العام-كركوك / العراق , كما تم اختيار 50 شخصاً طبيعياً كمجموعة سيطرة . بينت النتائج بأن معدل الاصابة بمرض فرط افراز الغدة الدرقية كان الاعلى في المجموعة العمرية ( 40 – 50 سنة ) كما اظهرت النتائج زيادة مستوى الكالسيوم و الفوسفور , والبوتاسيوم وكان مستوى الصوديوم ضمن الحدود الطبيعية .اظهرت نتائج هذه الدراسه ايضا انخفاض مستوى الكوليسترول والكليسرايد الثلاثي ومستويات الدهون البروتينية LDL,VLDL &HDL , كذلك وجد نقص في مستويات البروتين الكلي والزلال عند الاشخاص المصابين بفرط افراز الغده الدرقيه .


Article
Significance of Hypothyroidism in Post Thyroidectomy hypocalcaemi

Author: Taqi Saadoon Atiyah*;
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2012 Volume: 5 no 1 Issue: 11 Pages: 1243-1249
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Postoperative hypocalcaemia is one of the most common complications of thyroid surgery.Objective: To evaluate the significance of thyrotoxicosis in developing hypocalcaemia after thyroid surgery.Patients and Methods: A prospective study for patients whom submitted to bilateral subtotal thyroidectomy in AL-Kadhimiya Teaching Hospital in the period from Mars 2006-Mars 2011 were included in this study. Patients were divided into two groups; in group A the patients had toxic goiter, while in group B, the patients had euthyroid goiter. Both groups are nearly identical for age, sex, size of the goiter, and the size of the removed thyroid tissue. All the operations were done by the same surgeon and same technique. At least 2 parathyroid glands are identified and carefully preserved in every patient. Serum calcium was measured before and after operation. Patients with malignant thyroid and those underwent lobectomy were excluded from this study.Results: The total number was 97 patients. Group A, include 24 patients, 10(41.6%) of them had transient hypocalcaemia and 5(20.8%) patients had permanent hypocalcaemia. One patient (4.1%) died eighteen months after the operation due to cardiomyopathy and heart failure.GroupB, include 73patients, 5(6.8%) of them had transient hypocalcemia.The relative risk of hypocalcaemia in toxic goiter is 3.53 (confidence interval 95%) in comparison with euthyroid goiter; P value <0.001which is very significant.Conclusion: Thyrotoxicosis is a significant risk factor in developing hypocalcaemia after thyroid surgery.


Article
Clinical study of cases with hyperthyroidism in Erbil Governorate, Kurdistan Region-Iraq
دراسة سريرية لحالات فرط نشاط الغدة الدرقية في محافظة أربيل، إقليم كوردستان - العراق

Author: Dashty Abbas Al – Bustany
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2011 Volume: 15 Issue: 1 Pages: 6-12
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objectives: Thyrotoxicosis is a common and serious world-wide health problem, it’s one of the common problems in Erbil governorate.Methods: Clinical analysis done for 675 patients proved to have thyrotoxicosis by thyroid function tests.Results: Hyperthyroidism in females were 4 times more common than in males, the mean age was around 44 years, graves disease being the most common cause, followed by multinodular goiter, Iodine-induced thyrotoxicosis , single nodule goiter, T3-Thyrotoxicosis, then finally auto-immune lymphocytic thyroditis. Weight loss was the most common feature, followed by other well known features of autonomic hyperactivity, tremor was the most common sign reported while periodic paralysis was the least common sign.Conclusion: Graves disease is the commonest cause of thyrotoxicosis. Iodinization of salt program resulted in transient increase and later on decrease of thyrotoxicosis in the region.


Article
Thyrotoxicosis-10 Years Experience

Author: Taha Othman Asaad Mahwi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 2 Pages: 170-179
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Thyrotoxicosis is one of the most common presentations in thyroid disease, Graves’ disease, multinodular goiter, toxic adenoma and thyroiditis are its main common causes, almost every system is affected and there is great individual variation in the dominant features.OBJECTIVE:The study objectives are to explore the pattern of thyrotoxicosis in Sulaimania city during the years1996-2006.METHODS:From January1996 to January 2006,452 thyrotoxic cases 165 males and 287 females were evaluated for the causes, history of iodine prophylaxis program ,their manifestations, the eye signs and relation of the smoking with the eye signs.RESULTS:Analysis of 452 patients proved to have thyrotoxicosis by thyroid function tests, females were 64% and males 36%, the mean age was around 39 years, graves’ disease was the cause in 59.51% of the cases, followed by Iodine-induced thyrotoxicosis 21.9%, multinodular goiter 9.96%, single nodule goiter 7.97%, then finally subacute thyroditis 0.66%,Among the thyrotoxic cases 61.06% has weight loss and 50% has hand tremor , in those with eye sign 56% has non-infiltrative and44% has infiltrative eye signs.CONCLUSION:Thyrotoxicosis is twice more common in females than males, Graves’ disease is the commonest cause while iodine induced thyrotoxicosis is another important cause in the setting of iodine prophylaxis program, weight loss and hand tremor are commonest manifestation. In between ophthalmopathic smokers infiltrative eye signs were more common than non infiltrative.


Article
Propranolol Alone For Preoperative Preparation of Thyrotoxic Patients

Author: Talib A.Majid
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 1 Pages: 33-36
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Thyrotoxicosis is a common disease which might require surgery. Thyroidectomy without preoperative preparation exposes the patient to the fatal risk of thyrotoxic crisis. Neomercazole is the standard preoperative regimen. Propranolol might be an ideal alternative.OBJECTIVE:This study aims to demonstrate the safety and the convenience of the Beta-blocker propranolol in the preoperative preparation of the thyrotoxic patients.METHODS:Over a period from. 1998 to 2006 fifty patients undergoing thyroidectomy for thyrotoxicosis in private and governmental hospitals were preoperatively prepared using propranolol alone.RESULT:Propranolol was very rapid in controlling thyrotoxicosis in a dose of 160-480 mg/day. The operative and postoperative periods went on smoothly without any complications.CONCLUSION:Propranolol is a cheap, safe and effective in the preoperative preparation of the thyrotoxic patients and might be used as a routine.


Article
Changing Patterns of Thyroid Pathology and Trends of Surgical Treatment

Authors: Khudayer Al-Rrawak د. خضير جاسم صبيح الرواق --- Salim A. Al-Sarraf --- Tharwat I. Sulaiman ثروت سليمان ادريس
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2009 Volume: 51 Issue: 1 Pages: 12-16
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: There were definite changes in pathologies involving thyroid gland allover the world with increasing incidence of thyrotoxicosis and differentiated malignancies. Patients and methods: 224 patients were operated upon by the same surgeon during 15 years period. Those patients were divided into two groups (GI from June 1990 up to June 2000) and (GII from June 2000-June 2005).Results: female to male ratio was 3.3:1. The most common presentation among both groups was Multinodular goiter (MNG) 76.8%. toxic goiter was recorded in 24% of patient with increase among GII patients. A significant effect of stress on the increasing incidence of thyrotoxicosis was elicited in more than 50% of patients with thyrotoxicosis. Malignant thyroid tumors constituted 8.5% of the diseases and they were mostly papillary carcinoma. There was increase incidence of malignant thyroid tumors among GII patients (2.65% in GI versus 13.5% in GII). The trend toward more radical surgery was evident among GII patients Conclusion: thyroid malignancy and thyrotoxicosis are increasing in our country and stress factor might play a role in this rise. Due to the previous changes, the surgeon attitude had changed toward more radical surgery.


Article
Pulse Rate can be taken as a marker for serum levels of T3 and T4 in thyrotoxic patients.
يمكن اتخاذ معدل نبض القلب كعلامة لمستوى كمية T3 و T4 في مصل الدم عند مرضى تسمم الغدة الدرقية

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Abstract:Background: The study was designed to evaluate the correlation between clinical parameters:(pulse rate and pulse pressure) and serum levels of triiodothyronine (T3) and thyroxine (T4) in thyrotoxic patients.Setting: The Specialized Centre for Endocrinology and Diabetes, Baghdad, Iraq.(2002 – 2003)Design: Randomized biochemical screening study.Outcome measures:-serum levels of T3 and T4, Resting pulse rate, and pulse pressure.Results: statistically significant positive correlation between T3 and T4 levels and pulse rate (r=0.428 p<0.01, r=0.328 p<0.05 respectively). While no significant correlation was found between pulse pressure and neither T3 nor T4.Conclusion: the study suggests using pulse rate as measured clinically as a marker for serum levels of T3 and T4 in thyrotoxic patients.Key words: T3, T4, pulse rate, thyrotoxicosis.

الملخص :الخلفية: صمم البحث لتقييم مدى الترابط بين معدل نبض القلب وضغط النبض ومستوى كمية T3 و T4 في مصل الدم عند المرضى بتسمم الغدة الدرقية.المكان: المركز التخصصي للغدد الصماء والسكري، بغداد، العراق.التصميم: دراسة فحص عشوائية كيمياوية حيوية.القياسات المأخوذة:- مستوى كمية T3 وT4 في مصل الدم -معدل نبض القلب -ضغط النبضالنتائج: أظهرت النتائج من ست وثلاثون مريضأ بتسمم الغدة الدرقية ان هناك ترابطا ايجابيا بين معدل نبض القلب ومستوى كمية T3(r=0.428 p<0.01 ) و T4 ( (r=0.328 p<0.05 في مصل الدم. بينما لم يظهر اي ترابط معتد احصائيا بين ضغط النبض و أي من T3 او T4 .الاستنتاج: يقترح البحث اتخاذ معدل نبض القلب المقاس سريريا كعلامة لمستوى كمية T3 وT4 في مصل الدم عند مرضى تسمم الغدة الدرقية.مفتاح الكلمات: T3 ، T4 ، معدل نبض القلب، تسمم الغدة الدرقية

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