Radioiodine Therapy for Hyperthyroidism

Radioiodine Therapy for Hyperthyroidism RESULTS AND DISCUSSION Radioiodine therapy is now a day increasingly used for treatment for hyperthyroidism. The response to this treatment is unpredictable and the factors postulated to predict outcome have not generally proven clinically useful or is not widely accepted in clinical practice. So this retrospective study was carried out to determine whether the demographic, clinical and laboratory characteristics at presentation had any influence on the recurrence and the success of the radioiodine therapy. This study was carried out in the Nuclear Medicine Department of Kovai Medical Center And Hospital during the inclusive period of Jan 2014 to July 2014. At the beginning of the study 70 patients were included, but only 62 completed follow up. In this study, the records of 70 hyperthyroid patients were reviewed. Among those 70 patients, 23 (32.9%) males and 47 (67.1%) females were enrolled. The female to male ratio was 2.1:1, showing a higher incidence of hyperthyroidism in females than in males. Even though females are more prone to hyperthyroidism, this had no influence on the outcome of therapy (p=0.2330). Similar studies conducted by Antony Lewis et al also could not find any association between gender and outcome of therapy. (Table: 1 Graph: 1) As hyperthyroidism is relatively more common in adult population, for convenient analysis patients were categorized based on the age limit into 2 groups i.e. less than 35 years and above 35 years . The mean age of study patients was found to be 42.56Â ±13.44 years (range 15 to 72 years). 21 patients came under the category of less than 35 years with females and males with mean age of 27.42Â ±5.81 and 26.57Â ±7.45 years respectively. The remaining 49 patients comes under the age limit of above 35 years, the mean age of male patients was 49.06Â ±9.05 and 49.21Â ±10.21 years in females. This indicated a higher incidence of hyperthyroid conditions in subjects above 35 years. According to this study, there was no significant tendency for proportion cured to change with age (p=0.899). Studies done by Robert A.Nordyke et al also could not find any association with age and cure rate and also the mean age of the study population was also similar.(Table:2,3 Graph 2,3) The patients in this study received a fixed dose of 10 mCi for Graves’ disease and relatively higher doses for toxic multinodular goiters based on the size of thyroid gland determined by physical examination and thyroid uptake scan. Of the total of 70 patients who received radioactive iodine 52 (74.3%) patients were treated with an average dose of 5 mCi, range (0-10 mCi) and 18 patients received an average dose of 15 mCi, range (11-20 mCi) of radioactive iodine. The optimal method for determining the appropriate iodine-131 treatment dose remains controversial. Techniques vary from fixed dose to more elaborate calculations based on the gland size and iodine uptake. In calculated dose method, a dose of RAI is administered which is proportional to the size of the gland, this theoretically increases the chances of cure. But studies done by satzal-Mazer et al and Y.Khalid et al have failed to demonstrate any improvement in cure rate with calculated dose compared to fixed dose regim en. In this study ,a good result was seen in 90.9% of patient who received a dose of RAI in the range of 0-10 mCi and 83.3% of patients receiving a dose of 11-20 mCi, but this correlation was not significant.(p=0.403)(Table :4 Figure:4) Studies done by Funda Utsun et al revealed that majority of the patients was treated for Graves’ disease followed by toxic multinodular goiter. In this study also among the patients who received radioactive iodine, the largest group was diagnosed with Graves’ disease (54 patients, 77.2%), followed by toxic multinodular goiter (11 patients, 15.7%). The relatively smaller groups include those with thyrotoxicosis (4 patients, 5.7%) and solitary thyroid nodule (1patient, 1.4%). (Table: 5 Figure: 5) Clinical Graves’ ophthalmopathy was noted in 8 patients (11.4%) in which except one all others were female. 62 patients (88.6%) were free from ophthalmopathy. Of the 8 patients who had ophthalmopathy, 5 patients was treated successfully and hence there was no significant correlation between ophthalmopathy and outcome of the treatment in this study (p=1.00). Studies done by Wisam.K.Ghadban et al found out that there was no significant worsening or new development of ophthalmopathy post RAI treatment. In contrast, a systematic review done by Shamasunder H.Acharya et al concluded that radioiodine therapy is associated with increased risk of progression of ophthalmopathy compared with antithyroid drugs and hence pretreatment with steroids is necessary.(Table:6 Figure: 6) Presence of goiter was assessed clinically by endocrinologists and was documented as either present or absent at the time of radioiodine administration. About 58 patients (82.9%) showed the presence of goiter and in 12 patients (17.1%) the signs of goiter were not present. No significant association was seen in this study on goiter and treatment success. (p=0.326). In contrast, previous studies done by Anthony Lewis et al revealed that patients with small or no goiter were more likely to be successfully treated by a single dose.(Table: 7 Figure: 7) Prior use of antithyroid medication occurred in 63 patients (90%). Of these, 68.57% (48 patients) received treatment for more than one year whereas 21.43% (15) of patients received for a period of less than one year.10% (7) of patients had no pre-treatment with antithyroid medication before RAI administration. Previous studies done by Joyce S Y Yau et al demonstrated that there was no significant association between anti-thyroid medication and radioiodine treatment within one year. (Table: 8 Figure: 8) Among the study subjects who received pre-treatment, majority of the patients were treated with carbimazole (40%, 28 patients), followed by neomercazole (19 patients, 27.2%) and methimazole (15 patients, 21.4%). Only 1 patient among the 63 patients was treated with propylthiouracil (1.4%). All were advised to stop the drugs 7 days before radioiodine administration. A significant correlation was not observed between pretreatment with antithyroid drugs and treatment success (1.00). In a prior study done by Edward Prinat et al ,treatment success was obtained in patients with no pre-treatment and those who have stopped ATD seven days before 131I admnistration, while in the group of patients who received MMI until 131I application,success was significantly lower.(Table: 9 Figure:9) The primary objective of radioactive iodine therapy is to eliminate hyperthyroidism, but what is important to patients is the quickness of therapeutic effect. Graph 10 shows change in mean concentrations of TSH and T4 before and after I131 administration. The result revealed an increase in TSH concentration after the RAI treatment whereas the T4 levels showed a decrease in the concentration which indicates that therapeutic effect is achieved in the hyperthyroid patients. Piotr Szumowski et al came up with a study which showed similar results. (Table: 10 Graph: 10). Thyroid hormone concentrations before and after administration of radioiodine was analysed. A significant difference was found in the concentration of TSH and T4 before and after radioiodine therapy in patients who are on thyoxine replacement therapy after RAI administration (p=0.000 p=0.003 resp.). Whereas on comparing the concentration of TSH and T4 prior and post therapy on who were not on drugs, there was no significant difference (p=0.533 0.057) (Table: 14). As the time after radioiodine administration elapses,the percentage of hypothyroid patients increases. The incidence of hypothyroidism was 38.5 %( 27) in first trimester, 12.8 %( 9) in second trimester and 2.8 %( 2) in the third trimester. A prior study done by Ajith S Shinto et al also similar incidence of hypothyroidism after therapy. (Table: 12 Graph: 12) The assessment of overall efficacy of treatment at one year after I131 administration showed that a euthyroid status was achieved in 24.3% (17) of patients, hypothyroidism was observed in 54.3% (38 patients), while persistence or recurrence of hyperthyroidism was seen in 10% of patients , which revealed that a second dose of radioiodine is required in these patients. This outcome meant that 75.7% of patients require further treatment. In that 38 patients requires further hormone replacement therapy and 7 patients requires a second dose of radioactive iodine. The achievement of euthyroid and hypothyroid status is considered as good result. Studies done by Mosako Tsuruta et al and Sirianong Namwongprom et al also showed similar results.(Table:11 Graph 11)

Personal Scarlet Letter

La Seanda Hendrick AP English Ms. Avallone Period 2 October 10, 2012 PERSONAL SCARLET LETTER ESSAY Insecurity, a word we’re all familiar with. A person’s insecurity is a reflection of one’s self-esteem and pride within their self. There are many things I am insecure about: my face, my weight, my body, the list goes on. These are all things that I believe are flaws about myself. I tend to think that everyone is against me. As if I am everyone’s enemy. That no one is as genuine to me as I am to them. My flaw is overthinking. Always over analyzing someone’s words or actions into what I assume they are meant to be.This major flaw of mine I believe is the cause of my insecurities. Over thinking has caused me to stress myself out over minor situations that could have easily been avoided. I developed early, very early, as early as 7 years old. In my young mind, I thought I was just like everyone else. That was until someone finally spotted it out, making m e aware of my abnormality. This then made me feel self-conscious about my physical appearance. For years to pass, I continued to believe that my abnormality was wrong. As if I was supposed to look like one thing but did not. I hit puberty before anyone of my age.I was the tallest amongst my friends and classmates and the most developed. Boys at my age did not look at girls that were â€Å"bigger† than them, or looked older than them. They were interested in girls that looked their age, which was only about 9 and 10. I did not take this as â€Å"I’m too good for them† or â€Å"They’re not on my level yet. † I took this as â€Å"boys don’t want me because I am ugly. † I would think that people only wanted to befriend me just to have a reason to laugh at me, or make me cry – considering I was a huge cry baby – I would think no one genuinely wanted to be my friend.We are all taught to watch our surroundings and who we allow in our lives. After all, you are a reflection of those that you surround yourself with. As I’ve grown up and have matured, a lot, I am still very self-conscious, but I choose not to let people know. All the hurt and agony I feel, I hide and keep to myself. It can hurt to hear the truth, the desire to know the truth but afraid of what the answer may be. This is where the overthinking plays in. The simplest thought, I over analyze and interpret in my own way and this can most likely cause me to come up with conclusions that were never discussed.These thoughts that I come u with tend to bring me down, making me feel worse than before. My mind is consistently in motion, I am always processing something. Without the peace of mind I desperately want, I will always scrutinize everything. This is a truly personal flaw that no one could ever point out, much more complex than any physical â€Å"flaw†. I have grown to not care what people have to say about what may seem as a flaw to them but I still undergo a personal struggle of attempting not to over analyze situations and allowing them to solve itself instead of making up a solution in my conflicted mind.

James Harvey Robinson On Various Kinds of Thinking

A graduate of Harvard and the University of Freiburg in Germany, James Harvey Robinson (1863–1936) served for 25 years as a professor of history at Columbia University. As a co-founder of the New School for Social Research, he viewed the study of history as a way to help citizens understand themselves, their community and the problems and prospects of mankind. In the well-known essay  On Various Kinds of Thinking from his book The Mind in the Making (1921), Robinson employs classification to convey his thesis that for the most part our convictions on important matters...are pure prejudices in the proper sense of that word. We do not form them ourselves. They are the whisperings of the voice of the herd.   In that essay, Robinson defines thinking and that most pleasant type of it, the reverie, or free association of thoughts. He also dissects observation and rationalization at length. About On Various Kinds of Thinking In On Various Kinds of Thinking Robinson says, â€Å"The truest and most profound observations on Intelligence have in the past been made by the poets and, in recent times, by story-writers.† In his opinion, these artists had to hone to a fine point their powers of observation  so that they could accurately record or recreate on the page life and the wide array of human emotions. Robinson also believed that philosophers were ill-equipped for this task because they often displayed â€Å"†¦a grotesque ignorance of mans life and have built up systems that are elaborate and imposing, but quite unrelated to actual human affairs.† In other words, many of them failed to grasp how the average person’s thought process worked and separated the study of the mind from a study of emotional life, leaving them with a perspective that did not reflect the real world. He notes, Formerly philosophers thought of mind as having to do exclusively with conscious thought. The flaw in this, though, is that it doesnt take into account whats happening in the unconscious mind or the inputs coming from the body and outside the body that influence our thoughts and our emotions.   The insufficient elimination of the foul and decaying products of digestion may plunge us into a deep melancholy, whereas a few whiffs of nitrous oxide may exalt us to the seventh heaven of supernal knowledge and godlike complacency. And vice versa, a sudden word or thought may cause our heart to jump, check our breathing, or make our knees as water. There is a whole new literature growing up which studies the effects of our bodily secretions and our muscular tensions and their relation to our emotions and our thinking. He also discusses all that people experience that has an impact on them but that they forget—just as a consequence of the brain doing its daily job as a filter—and those things that are so habitual that we dont even think about them after weve become accustomed to them. We do not think enough about thinking, he writes, and much of our confusion is the result of current illusions in regard to it. He continues: The first thing that we notice is that our thought moves with such incredible rapidity that it is almost impossible to arrest any specimen of it long enough to have a look at it. When we are offered a penny for our thoughts we always find that we have recently had so many things in mind that we can easily make a selection which will not compromise us too nakedly. On inspection, we shall find that even if we are not downright ashamed of a great part of our spontaneous thinking it is far too intimate, personal, ignoble or trivial to permit us to reveal more than a small part of it. I believe this must be true of everyone. We do not, of course, know what goes on in other peoples heads. They tell us very little and we tell them very little....We find it hard to believe that other peoples thoughts are as silly as our own, but they probably are. The Reverie In the section on the reverie of the mind, Robinson discusses stream of consciousness, which in his time had come under scrutiny in the academic world of psychology by Sigmund Freud and his contemporaries. He again criticizes philosophers for not taking this type of thinking into account as important: This is what makes [old philosophers] speculations so unreal and often worthless.  He continues: [Reverie] is our spontaneous and favorite kind of thinking. We allow our ideas to take their own course and this course is determined by our hopes and fears, our spontaneous desires, their fulfillment or frustration; by our likes and dislikes, our loves and hates and resentments. There is nothing else anything like so interesting to ourselves as ourselves....[T]here can be no doubt that our reveries form the chief index to our fundamental character. They are a reflection of our nature as modified by often bidden and forgotten experiences. He contrasts reverie with practical thought, such as making all those trivial decisions that come to us constantly throughout our day, from writing a letter or not writing it, deciding what to purchase, and taking the subway or a bus. Decisions, he says, are a more difficult and laborious thing than the  reverie, and we resent having to make up our mind when we are tired, or absorbed in a congenial reverie. Weighing a decision, it should be noted, does not necessarily add anything to our knowledge, although we may, of course, seek further information before making it.

First-Year Expectations The Dining Hall System - 1001 Words

First-year expectations: â€Å"The dining hall is great. I’ll probably never get tired of eating there!† The great excitement of an â€Å"All-you-can-eat buffet† at a college dining hall is dying out. It’s because the same food is served every day and students want more food and healthy options. Food assumes a critical part in our lives, particularly in college. Food impacts individuals physically, healthfully, and instructively. The dining halls at Arizona State University are a significant wellspring of meals and nourishment for college students. Doubtlessly, it is essential that students can consume at these dining halls. An analysis of the college students’ dining experience reports that the university has poor dining and food quality, the quality of the food varies by dining hall, the dining halls’ hours are limited, the meal plans offered to students are expensive and the food served to students is overpriced. The first reason students complain about meal plans is because they’re required to accept them and they are expensive. Meal plans are utilized whenever the dining hall is open, and each time students enter the dining place, they utilize one of the meals. As meals are sold individually, â€Å"college students lose because they have not utilized† their entire meal plan (Perozzi and Sullivan 20). Each meal that is not utilized is a waste of cash for that individual. With this being said, people would prefer not to be squandering cash. This is not a little â€Å"out of pocket† cost andShow MoreRelatedThe Kumbira1595 Words   |  7 Pages MANAGEMENT INFORMATION SYSTEM MGT.105 Prepared by: Roselle T. Aguilar Thor Loriega Domato J.r Instructor EXPECTATIONS The word Kumbira itself it sounds interesting; because it is the contest of different categories in different schools. 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