Prof. Dr. Balázs Csaba - Endokrinológus | Csalá

Diabetes insipidus treatment naturally

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Ön legalább fog tudni róla "senki nem lehet próféta a saját hazájában" Primary Prevention of Graves' Orbitopathy by Pentoxifylline Randomized controlled trial Cs.

Balázs1, K. Korányi2 and N. John of God in Budapest, Hungary E-mail: drbalazs irgalmas. Control group of patients consisted of patients with hyperthyroidism mean aged PTX treated group of mean aged At the onset of study there was no remarkable differences between control and PTX treated groups.

After six and twelve month observation period the manifestation of TAO with moderate and severe forms were significantly lower in PTX treated patients. Various risk factors were analyzed in both groups.

If the smoking habit was associated genetic background, the manifestation of TAO significantly increased OR: 9. PTX therapy had a beneficial preventive effect on manifestation of eye symptoms and decreased the number of patients both in smokers with and without genetic susceptibility OR: 2. It was concluded that PTX was able to decrease the development of TAO during 1 year observation period, therefore, the administration of this drug advised if the patients refused the abstinence of smoking.

Even the symptoms of moderate and severe forms have a negative impact on quality of life of the patients 2. TAO is considered to be genetically determined autoimmune disorder by infiltration diabetes insipidus treatment naturally lymphocytes and enlargement of extraocular muscle, accumulation of glycosaminoglycan GAG resulting a clinical manifestation of edema, proptosis, diplopia and optical nerve compression 3,4,5. The cytokines can result in induction and perpetuation of autoimmune processes in the retrobulbar tissue 6,7,8.

Recently, it has been clear that the patients with active stage are likely to respond to medical treatment, whereas such therapy is unlikely to be of benefit in patients with inactive stage, therefore, the follow up studies underlined the importance of prevention of manifestation of eye symptoms in the early stage.

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Some factors are known to actually increase the risk of incidence and severity of TAO. These factors can be divided into two main categories. The unpreventable category consists of sex, age and genetic background. The preventable risk factors encompasses the radio-iodine therapy, cigarette smoking 9,10, Unfortunately, the majority of patients can not able to stop smoking, therefore, its precipitating effect remained during thyrostatic treatment.

We have previously demonstrated that pentoxifylline PTX therapy resulted in the improvement of mild and moderately severe forms of TAO PTX exerts its effects by inhibiting the elaboration of cytokines by orbit-infiltrating T lymphocytes. PTX thus prevents the proliferation of orbital fibroblasts, the production of GAG and their evolution to adipocytes 12, We have tested the clinical symptoms and laboratory data of patients to answer whether PTX can prevent or inhibit progression of TAO and this beneficial effect extends to those patients who continue to smoke, since diabetes insipidus treatment naturally is the most obvious environmental risk factor for TAO.

PTX with respect to grades of TAO and remission rates of hyperthyroidism at onset midpoint and the end of diabetes insipidus treatment naturally months of treatment were investigated.

Since for prospective analysis is useful in planning stages of a study to determine how large sample size should be in order to obtain a desired power in test of hypothesis 17, After review of eligibility and consent participants, the research nurse kept the randomization list until the end cukorbetegség legújabb the study by computer-generated programme and was in charge of dispensing the study medication or placebo to the patients Fig.

The placebo medication was identical in appearance and taste to the active medication, the bottle indicated which medication to take each day.


Through the study neither patients nor investigators were aware of treatment assignment. The patients of the control group consisted of patients with hyper-thyroidism mean aged Of these patients the hyperthyroidism relapsed in 21 cases. The PTX treated group of mean aged None of patients was treated previously radio-iodine.

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The PTX treated group contained 58 smokers and in 35 patients were positive family history for autoimmune thyroid diseases. At these times thyroid function and immunological tests, eye examination and goitre palpation, ultra-sonography were carried out.

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At the time of recruitment, mid point at the end of study the following investigations were made: determination of TSH and thyroid hormones, anti-thyroid antibodies, blood glucose was made routinely. If was necessary, other examinations including MRI or orbits were made.

Further quantification of smoking habit was not made due to uncertainties. Those who had never smoked or who had stopped for more than five years before the time of study were considered to be nonsmokers. The study was permitted with local ethical committee and it was in accordance of Helsinki Declaration.

Follow-up examinations were made two monthly or more frequently if clinically were indicated.

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At these times thyroid function was measured, goitre palpated and eye examined as indicated. If it was necessary other investigator s were involved. Moderate form was diagnosed by 2b3a4o5o6o At the time of recruitment and on each follow up visit diabetes insipidus treatment naturally for grading of objective and subjective eye findings by independent "blinding" ophthalmologists were carried out.

In two patients the diabetes insipidus treatment naturally pulse treatment was completed with retro-bulbar irradiation 2. Side effects, all adverse effects of expected and unexpected were regulatory monitored and reported to a central independent monitor within one week.

Lépjen velünk kapcsolatba

If TAO progressed in severity, or unexpected symptoms appeared in 19 patients of both groups the study was discontinued. If the clinical symptoms indicated, MRI and ultra-sonography were made. Measurements were carried out by the same experienced investigator using a Hitachi EUB scannar with a 7.

The within-day mean coefficient of variation was 5.

Acta Physiologica 48. (1976)

There was not found remarkable difference in the TSH. Titres of anti-thyroglobulin and anti-thyroid peroxidase autoantibodies were not significantly elevated at the beginning of MMI therapy and did not change during therapy. In contrast, the level of anti-TSH-receptor autoantibodies decreased in both groups after one year therapy but remained significantly higher in control group in comparison to PTX treated patients 3.

Irrespective of quality of life, the average cost for 1 patients with severe TAO including diagnostic procedures and pulse corticosteroid therapy Є per year in Hungary.

The mean cost of PTX treatment Є per year. Recently, Krassas provided evidence that the cost for TAO in Eurepaen countries are very different from Є Є depending on the severity and the protocol of treatment The severity and activity are not synonymous 19,20,21, It has been clear that the patients with active stage are likely to respond to medical treatment, whereas such therapy is unlikely to be of benefit in patients with inactive stage 20, In spite diabetes insipidus treatment naturally new possibilities, the management of TAO represents a difficult task that does not constantly provide favorable results and cuases disfigure as well as an impairment of quality of life 20, Furthermore, recently it was observed that superoxide radicals generated in culture media were able to stimulate REF.

Methimazole as a free radical scavanger drug inhibited superoxide-induced proliferation in a dose-dependent manner Since the different methods and drugs used for treatment of TAO are not able to cure completely the inflammatory symptoms of TAO and have potential serious side effects or proved to be very expensive, diabetes insipidus treatment naturally, an effort was made to find new cytokine antagonists interfering with cytokine synthesis, receptor binding or signal transduction The effectivity of this drug has been attributed to its influence on erythrocyte deformability, platelet reactivity and plasma viscosity, prostacycline release 1.

Like other methylxantines, PTX inhibits phosphodiesterase, resulting in a significant increase of intracellular cyclic adenosine monophosphate diabetes insipidus treatment naturally is known to modulate a number of cellular immune functions 2,3. It was published that PTX is able to inhibit inflammatory processes including phagocytosis and superoxide anion and nitric oxide NO production by polymorphonuclear granulocytes and monocytes 4,5.

This drug has been reported to be an effective drug on T lymphocytes by modulating production of various cytokines involved into immune and autoimmune reactions 6,7,8,9.

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Recently, the immunomodulating effects of PTX was investigated in a randomized double-blind study comparing PTX with placebo in patients receiving cadaveric kidney grafts under cyclosporine and prednisolone treatment It was found that PTX weakened the consequences of rejection on graft survival and this phenomenon was mediated by reduction of TNFα in sera of transplanted patients 1,35,36, Furthermore, PTX influenced the cytokine-induced fibroblast proliferation. It was found that PTX exerted a robust inhibitory effects on fibroblast proliferation, extracellular matrix synthesis and myofibroblast differentiation They found significant improvement both in proptosis and the quality of life after 6 month of PTX therapy.


Although the favourable effects of PTX the randomized mono-therapy for patients with TAO might have been effective, however, the administration due to ethical considerations was questionable. Similarly, other studies have shown that little effect was seen on Diabetes insipidus treatment naturally by systemic corticosteroid or radio-therapy if the disease persisted for more than one year 26, 27, This critical period between manifestation of TAO and initiation of therapy can also lead to an unfavourable response to therapy.

Prummel et al. Furthermore, it was observed that although soft tissue signs and eye muscle motility improved with corticosteroid and irradiation therapies, however, the exophthalmos did not. Our study provided evidence that PTX resulted in significant decrease in manifestation of severe and modest forms of TAO in patients with high risk including smoking habit and genetic background.

The precise mechanism of this observation is not clarified. The role of smoking in the induction of immune- and autoimmune reactions is substancially studied 29,30,31,32, The inhibitory effect of PTX on proinflammatory cytokines might diabetes insipidus treatment naturally the responsible for preventive effect on manifestation of eye symptoms.


The cause of this failure is not known, the following possibilities are arisen: firstly, lack of compliance from these patients, secondly, the szemcsepp cukorbetegség kezelésének over of PTX in some individual is higher than in the control population possibly due to genetic reasons, thirdly, the potential catalytic antibody against diabetes insipidus treatment naturally PTX might neutralize the immunomodulating effect of this drug 36, 37, It is concluded, that PTX of therapy in prevention of TAO is found a relatively cheep drug without serious side effects.

However, PTX therapy is considered for all patients who refuse to give up smoking habit and have positive immuno-genetic background to avoid the irreversible consequences of TAO. J Endocrinol Invest28, Eur J Endocrinol, Clin Exp Immunol, Results of an international survey. Clin Endocrinol49, Eu J Endocrinol, Eur J Endocrinol Wiersinga, W.

Thyroid12, Thyroidl, Dtsch Med WochenschrAmerican Statistician55, Recommendation of the panel on cost-effectiveness in health and medicine. JAMA ; Clin Endocrinol54, Thyroid,7, Lancet, Swiss Med. Annals Intern. In: Thyroid Eye Disease, Ed. Dutton MD. New York, Immunopharmacology48, Gut50, Methods, Ophthalmology14, Eye Res. Various medical interventions have been reported which have potencially serious side effects.

In the past two decades both medical science and health care have entered a new era: the medical science of the 21 st century. Molecular medicine is opening up, and new possibilities are available for the diagnosis, prevention, prediction and treatment of diseases.

The high-dose intravenous immunoglobulin IVIG is known to have anti-inflammatory potential and it was used in pilot studies for patients with TAO. The aim of study : was to investigate the effect of IVIG on post-partum diabetes insipidus treatment naturally TAO and to test the some immunological parameters during and after therapy. Patients and Method: four patients with TAO had been treated before their pregnancy with bolus steroid and retroorbital irradiation therapy.

Three month after delivery the eye symptomps relapsed and to avoid the side effects of steroids and irradiation we started the IVIG therapy. This therapeutic cycle was repeated one or more times depending on therapeutical results every 21 days.

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Duration of IVIG therapy was 3 diabetes insipidus treatment naturally.