Goitrous myxedema with defect in iodide trapping and hormonogenesis.
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A molten hydroxide trapping process has been considered for removing radioiodine species from off-gas streams whereby iodine is reacted directly with molten hydroxides such as NaOH or KOH. The resulting product is the corresponding iodide, which can be separated by simple cooling of the molten mixture to grow the iodide primary phase once the mixture reaches 70-80 mol% in the iodide component. Thermodynamic analysis indicates that such a chemical process is highly favorable. Experimental testing of the trapping process using molecular iodine showed trapping of up to 96% of the volatile iodine. The trapping efficiency was dependent on operational parameters such as temperature and gas-melt contact efficiency, and higher efficiencies are expected as the process is further developed. While an iodide phase could be effectively isolated by slow cooling of a molten iodide-hydroxide mixture, the persistent appearance of hydroxide indicated that an appreciable solubility of hydroxide occurred in the iodide phase.
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IN the last few years, attention has been called to the occurrence of goiter and hypothyroidism in previously euthyroid children and adults after the prolonged administration of large amounts of iodide for bronchial asthma and other pulmonary conditions.Bell1 reported 5 cases in which goiter, noted in all, and myxedema, seen in 3 cases, followed administration of Lugol's solution or potassium iodide for periods of two months to seven years. Morgans and Trotter2 contributed 2 carefully studied cases of myxedema and goiter (in 1 case) after the ingestion of potassium iodide and sodium iodide for periods of six and four . . .
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Pretibial myxedema is an uncommon manifestation of Graves disease, and little information is available regarding its natural course and its relation to other manifestations of Graves disease. We reviewed 150 consecutive cases with the diagnosis of pretibial myxedema over a 20-year period in a referral center. Only 1 patient in this group did not have ophthalmopathy, whereas 88% had significant proptosis and 30% required orbital decompression surgery. Dermopathy was a late manifestation of Graves disease, and its onset usually followed the diagnosis of hyperthyroidism and ophthalmopathy. In a few patients, dermopathy preceded diagnosis of hyperthyroidism or onset of ophthalmopathy. Fourteen patients were never clinically hyperthyroid; spontaneous hypothyroidism had developed in 11 in this group. All cases involved the lower extremities, with only 1 patient having combined upper and lower extremity involvement. The most common form of thyroid dermopathy was nonpitting edema, followed by nodular and plaque forms, which occurred with equal frequency. The polypoid form occurred in 1 patient and the elephantiasic form in another; 7.3% had thyroid acropachy. Follow-up was available for 120 patients (range, 3 mo to 19 yr; mean, 3.2 yr), and complete remission was observed in only 12 patients. Topically applied corticosteroid therapy was used in 76 patients, and in this group 38% had sustained long-term partial remission, as opposed to 18% in the group receiving no corticosteroid therapy.
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The development of myxedema and/or goiter in children and adults during the prolonged administration of large doses of iodide has recently been reported (1, 2, 3). This phenomenon has been attributed to an antithyroid action of the iodide (2). Administration of desiccated thyroid (2) or cessation of the iodide (3) resulted in a regression of the symptoms.
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We have analyzed the clinical, analytical, radiologic, therapeutic an evolutive of cases of systemic mastocytosis (SM) skin lesions. The diagnostic of MS is difficult in the absence of skin lesions.
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