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Thyrotoxicosis HELP
Based on 1,047 articles published since 2008

These are the 1047 published articles about Thyrotoxicosis that originated from Worldwide during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
51 Review MANAGEMENT OF ENDOCRINE DISEASE: Subclinical thyrotoxicosis: prevalence, causes and choice of therapy. 2017

Carlé, Allan / Andersen, Stine Linding / Boelaert, Kristien / Laurberg, Peter. ·Department of Endocrinology. · Department of Clinical BiochemistryAalborg University Hospital, Aalborg, Denmark. · Institute of Metabolism and Systems ResearchSchool of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Department of Clinical MedicineAalborg University, Aalborg, Denmark. ·Eur J Endocrinol · Pubmed #28274949.

ABSTRACT: Subclinical thyrotoxicosis is a condition affecting up to 10% of the population in some studies. We have reviewed literature and identified studies describing prevalences, causes and outcomes of this condition. Treatment should be considered in all subjects if this biochemical abnormality is persistent, especially in case of symptoms of thyrotoxicosis or in the presence of any complication. In particular, treatment should be offered in those subclinically thyrotoxic patients with a sustained serum TSH below 0.1 U/L. However it is important to recognise that there are no large controlled intervention studies in the field and thus there is no high quality evidence to guide treatment recommendations. In particular, there is no evidence for therapy and there is weak evidence of harm from thyrotoxicosis if serum TSH is in the 0.1-0.4 IU/L range. In this review, we describe the different causes of subclinical thyrotoxicosis, and how treatment should be tailored to the specific cause. We advocate radioactive iodine treatment to be the first-line treatment in majority of patients suffering from subclinical thyrotoxicosis due to multinodular toxic goitre and solitary toxic adenoma, but we do generally not recommend it as the first-line treatment in patients suffering from subclinical Graves' hyperthyroidism. Such patients may benefit mostly from antithyroid drug therapy. Subclinical thyrotoxicosis in early pregnancy should in general be observed, not treated. Moreover, we advocate a general restriction of therapy in cases where no specific cause for the presumed thyroid hyperactivity has been proven.

52 Review Acute severe asthma with thyroid crisis and myasthenia: a case report and literature review. 2017

Gong, Pi-Hua / Dong, Xiao-Song / Li, Chun / Bao, Jing / Cao, Zhao-Long / Yuan, Yun / Zheng, Ya-Li / Gao, Zhan-Cheng. ·Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China. · Department of neurology, Peking University First Hospital, Beijing, China. · Department of Respiratory and Critical Care Medicine, Peking University International Hospital, Beijing, China. ·Clin Respir J · Pubmed #26471346.

ABSTRACT: BACKGROUND AND AIMS: Acute severe asthma, thyroid crisis and acute myasthenia are all medical emergencies that rarely coexistent. Here, we report a young man with severe asthma attack, necessitate invasive mechanical ventilation at the onset, followed by thyroid crisis, rhabdomyolysis, acute kidney injury, thrombocytopenia and progressive myasthenia. The aim of this study is to better understand the relationships among severe asthma, autoimmune thyroiditis and myasthenia. METHODS: The case was presented and former literatures were reviewed. RESULTS: This is the first case report of a young patient presented with severe asthma and autoimmune thyroiditis, followed by thyroid storm, multiple organ dysfunction and myasthenia. Neither conventional treatment for asthma or thyroid storm was effective separately. The patient's clinical condition did not improve until after plasmapheresis. CONCLUSION: Here, we highlighted both the importance of early recognition of thyroid storm and prompt therapies, which likely attenuated organ dysfunction and enabled this patient to recover from the life-threatening attack. Asthmatic patients should be closely controlled when suspected of thyroid disorders, especially those with high levels of anti-thyroid antibodies irrespective of thyroid hormones concentrations.

53 Review [Rarer causes of thyrotoxicosis]. 2016

Krysiak, Robert / Kowalcze, Karolina / Okopień, Bogusław. · ·Przegl Lek · Pubmed #27526430.

ABSTRACT: Thyrotoxicosis is a pathological syndrome in which tissue is exposed to excessive amounts of circulating thyroid hormones. Including its subclinical form, it is considered as one of the most frequent endocrine disorders in the general population. If not detected in a timely fashion, thyrotoxicosis can have serious health consequences. The most common forms of thyrotoxicosis include diffuse toxic goiter (Graves' disease), toxic multinodular goiter (Plummer's disease), and toxic adenoma (Goetsch's disease). The significant progress in the fields of hormonal assessment, imaging procedures and molecular biology made in recent years has brought about great improvement in the identification, differentiation and treatment of many other disorders associated with thyrotoxicosis. Therefore, this paper discusses the etiopathogenesis, clinical manifestation, biochemical abnormalities and management of thyrotropinoma, resistance to thyroid hormone, de Quervain's, silent, acute, posttraumatic and radiation-induced thyroiditis, Riedel's goiter, differentiated thyroid cancer, struma ovarii, thyrotoxicosis factitia, other forms of iatrogenic thyrotoxicosis, gestational trophoblastic disease, neonatal Graves's disease, familial nonautoimmune hyperthyroidism and McCune-Albright syndrome. On the basis of available studies, some of whom were carried out in the recent years, we provide practical guidelines for clinical endocrinologists dealing with the diagnosis and treatment of thyrotoxicosis.

54 Review Novel melanoma therapies and their side effects. 2016

González, Noelani / Ratner, Désirée. ·Icahn School of Medicine at Mount Sinai, New York, New York, USA. · Icahn School of Medicine at Mount Sinai and Mount Sinai Beth Israel, New York, New York, USA. ·Cutis · Pubmed #27416087.

ABSTRACT: In the last few years, melanoma treatment has been revolutionized by the development of immune checkpoint-blocking antibodies or immune checkpoint inhibitors including ipilimumab, vemurafenib, dabrafenib, trametinib, nivolumab, and pembrolizumab. Although they have shown promising results, they also have caused multiple adverse events (AEs), particularly immune-related AEs (irAEs). Specialists should be familiar with these AEs.

55 Review Acute Thyrotoxicosis of Graves Disease Associated with Moyamoya Vasculopathy and Stroke in Latin American Women: A Case Series and Review of the Literature. 2016

Shah, Nirav H / Khandelwal, Priyank / Gordon-Perue, Gillian / Shah, Ashish H / Barbarite, Eric / Ortiz, Gustavo / Forteza, Alejandro M. ·Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Florida. · Department of Neurosurgery, Leonard M. Miller School of Medicine, University of Miami, Florida. · Department of Neurology, Kendall Regional Medical Center, Miami, Florida. Electronic address: alejandroforteza@gmail.com. ·World Neurosurg · Pubmed #27163552.

ABSTRACT: OBJECTIVE: Moyamoya disease is a cerebral vasculopathy characterized by stenosis of the terminal internal carotid artery, proximal middle cerebral artery, and anterior cerebral artery. There is an association between moyamoya vasculopathy and Graves disease, primarily in Asian populations. Here, we present the largest series of non-Asian, predominantly Latino patients with moyamoya vasculopathy in the setting of Graves thyrotoxicosis, as well as the largest review of the literature to date. METHODS: We retrospectively analyzed patients presenting with stroke in the setting of clinical Graves disease to our institution from 2004 to 2014. Moyamoya vasculopathy was diagnosed by magnetic resonance angiography in all patients. RESULTS: Eight patients with Graves disease thyrotoxicosis and moyamoya vasculopathy were identified. Six patients were effectively managed with aggressive medical management using antithyroid and antiplatelet medications. No recurrent strokes were noted once thyrotoxicosis was controlled. Intracranial bypass was necessary in 2 patients who failed medical management. Seventy-nine additional cases were reported from the literature. There was no significant difference in clinical improvement between medical therapy alone and medical therapy with neurosurgical prophylaxis (87.0% vs. 88.0%, respectively; P = 0.94). CONCLUSIONS: Moyamoya vasculopathy associated with Graves disease thyrotoxicosis in non-Asian women may be more common than previously thought. In addition, our series suggests that thyrotoxicosis promotes the progression of vasculopathy. Based on our review, there is no significant difference in clinical improvement between proper medical and surgical therapies. Aggressive medical therapy should be considered first-line treatment for moyamoya vasculopathy with Graves thyrotoxicosis, with neurosurgical rescue reserved for medically refractory cases.

56 Review Use of anticoagulation in thyroid disease. 2016

Polmear, James L / Hare, Matthew J L / Catford, Sarah R / Topliss, Duncan J / Dooley, Michael J. · ·Aust Fam Physician · Pubmed #27052045.

ABSTRACT: BACKGROUND: Hyperthyroidism and atrial fibrillation (AF) are both common in the Australian community, and often encountered in general practice. OBJECTIVE: This article discusses the risk of AF and thromboembolism in hyperthyroidism, the role of antithrombotic therapy in this setting, and appropriateness and safety of various antithrombotic agents in thyroid disease. DISCUSSION: Prevention of thromboembolism is an important consideration in the care of patients with AF and hyperthyroidism. However, the evaluation of thromboembolic risk and management in this setting is challenging. Thyroid disease results in a pro-coagulant state via disruption of coagulation pathways and alters the pharmacodynamics of anticoagulants. Currently, guidelines regarding anticoagulation in AF do not incorporate hyperthyroidism as an additional risk factor. Until further evidence becomes available, we recommend warfarin as the oral anticoagulant of choice in thyroid disease because of ease of monitoring and reversibility.

57 Review Hyperthyroidism. 2016

De Leo, Simone / Lee, Sun Y / Braverman, Lewis E. ·Endocrine Unit, Fondazione IRCCS Cà Granda, Milan, Italy (S De Leo MD) · Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy (S De Leo) · and Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA (S De Leo, S Y Lee MD, Prof L E Braverman MD). ·Lancet · Pubmed #27038492.

ABSTRACT: Hyperthyroidism is characterised by increased thyroid hormone synthesis and secretion from the thyroid gland, whereas thyrotoxicosis refers to the clinical syndrome of excess circulating thyroid hormones, irrespective of the source. The most common cause of hyperthyroidism is Graves' disease, followed by toxic nodular goitre. Other important causes of thyrotoxicosis include thyroiditis, iodine-induced and drug-induced thyroid dysfunction, and factitious ingestion of excess thyroid hormones. Treatment options for Graves' disease include antithyroid drugs, radioactive iodine therapy, and surgery, whereas antithyroid drugs are not generally used long term in toxic nodular goitre, because of the high relapse rate of thyrotoxicosis after discontinuation. β blockers are used in symptomatic thyrotoxicosis, and might be the only treatment needed for thyrotoxicosis not caused by excessive production and release of the thyroid hormones. Thyroid storm and hyperthyroidism in pregnancy and during the post-partum period are special circumstances that need careful assessment and treatment.

58 Review Onset of ulcerative colitis after thyrotoxicosis: a case report and review of the literature. 2016

Laterza, L / Piscaglia, A C / Lecce, S / Gasbarrini, A / Stefanelli, M L. ·Department of Internal Medicine, Gastroenterology and Liver Disease, Catholic University of the Sacred Heart of Rome, Rome, Italy. laterza.lucrezia@gmail.com. ·Eur Rev Med Pharmacol Sci · Pubmed #26957271.

ABSTRACT: OBJECTIVE: Ulcerative colitis is a chronic disease that could be triggered by acute stressful events, such as gastrointestinal infections or emotional stress. PATIENTS AND METHODS: We reported the case of the onset of an ulcerative colitis after a thyrotoxicosis crisis and reviewed the literature about the relationships between thyroid dysfunctions and ulcerative colitis. RESULTS: A 38-year-old woman was diagnosed with ulcerative colitis after her third thyrotoxicosis crisis, two years after the diagnosis of Graves' disease. In this case, thyrotoxicosis acted as a trigger for ulcerative colitis onset. CONCLUSIONS: Hyperthyroidism could be a trigger able to elicit ulcerative colitis in susceptible patients.

59 Review Precision Medicine Comes to Thyroidology. 2016

Ladenson, Paul W. ·Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0003. ·J Clin Endocrinol Metab · Pubmed #26908108.

ABSTRACT: CONTEXT: The broad spectrum of thyroid disease severity--from subclinical hypothyroidism to myxedema coma, subclinical thyrotoxicosis to thyroid storm, and microscopic papillary to anaplastic cancers--has always demanded that clinicians individualize their management of thyroid patients. Deepening knowledge of thyroid pathophysiology along with advances in diagnostic, prognostic, and therapeutic technologies applicable to thyroid diseases position this field to ride the wave of precision medicine in the decade ahead.

60 Review [Clinical procedure in amiodarone-induced thyroid dysfunction]. 2016

Różycka-Kosmalska, Monika / Michalak, Renata / Kosmalski, Marcin / Ptaszyński, Paweł / Wranicz, Jerzy Krzysztof / Zieleniewski, Wojciech / Cygankiewicz, Iwona. ·Medical University of Lodz. Poland: Department of Electrocardiology, Chair of Cardiology and Cardiac Surgery. · Medical University of Lodz. Poland: Department of Cardiology, Chair of Cardiology and Cardiac Surgery. · Department of Internal Diseases, Diabetology and Clinical Pharmacology, Medical University of Lodz. · Health Care Centre of the Ministry of Interior and Administration of Lodz. ·Pol Merkur Lekarski · Pubmed #26891437.

ABSTRACT: Amiodarone is an antiarrhythmic drug frequently used in everyday clinical practice. Its mechanism of action involves the interaction with many receptors, including those in the cardiac conduction system. Amiodarone usefulness is protect in the treatment of a variety of tachyarrhythmias, both benign and life-threatening. In contrast to other antiarrhythmic drugs, amiodarone is characterized by high therapeutic efficacy, both in patients with normal and impaired left ventricular systolic function. A significant limitation of its is associated with side effects including thyroid gland dysfunction. Disturbances of this organ associated with amiodarone are an important diagnostic and therapeutic problem. They may contribute to the occurrence of both Amiodarone- Induced Thyrotoxicosis (AIT) and Amiodarone-Induced Hypothyroidism (AIH). The risk of such complications should be considered for each patient individually, taking into account thyroid function at the beginning of pharmacotherapy. Appropriate procedure, both before and after treatment allows a rapid diagnosis and treatment of thyroid disturbances. It seems that the best parameter used to assess the hormonal imbalance during amiodarone therapy is the concentration of the free triiodothyronine (fT3). The evaluation of thyroid function should be performed before starting pharmacotherapy, and then repeated every six months. In the case of a thyroid dysfunction, assessment must be performed immediately according to standard diagnostic and therapeutic regimens. Despite abnormal thyroid function, high efficiency of amiodarone and relatively small risk of thyroid damage allows continuation therapy. Amiodarone therapy requires a care from both cardiologist and endocrinologist. The aim of this paper is to present the state of art of evaluation of the thyroid function and procedures implemented in care of thyroid dysfunction before and during treatment with amiodarone.

61 Review [Differential diagnosis of Graves' orbitopathy. Case report]. 2016

Erdei, Annamária / Steiber, Zita / Gazdag, Annamária / Bodor, Miklós / Berta, Eszter / Szász, Róbert / Szántó, Antónia / Ujhelyi, Bernadett / Barna, Sándor / Berényi, Ervin / Nagy, V Endre. ·Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4012. · Szemészeti Klinika, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen. · Klinikai Farmakológiai Tanszék, Debreceni Egyetem, Gyógyszertudományi Kar Debrecen. · Belgyógyászati Intézet, Hematológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen. · Belgyógyászati Intézet, Immunológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen. · Nukleáris Medicina Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen. · Radiológiai Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen. ·Orv Hetil · Pubmed #26876268.

ABSTRACT: Graves' orbitopathy is the extrathyroidal manifestation of Graves' disease, which is the most common cause of exophthalmos. As eye symptoms usually coincide with the development of thyrotoxicosis, the diagnosis of the disease is rarely difficult. The aim of the authors was to summarize the differential diagnosis of Graves' orbitopathy based on literature review and presentation of their own four problematic cases on this topic. They conclude that symptoms similar to endocrine orbitopathy are present in other disorders. Endocrinologists need to be aware of these other conditions to avoid treatment failures.

62 Review High-Output Heart Failure Caused by Thyrotoxicosis and Beriberi. 2015

McCulloch, Brenda. ·Sutter Medical Center, 2801 L Street, Sacramento, CA 95816, USA. Electronic address: mccullb@sutterhealth.org. ·Crit Care Nurs Clin North Am · Pubmed #26567494.

ABSTRACT: High-output heart failure is not seen as commonly as low-output heart failure and some of the typical guideline recommendations may not benefit patients with high-output failure. High-output failure is caused by several diseases, including thyrotoxicosis and beriberi, highlighted in this article. Thyrotoxicosis, caused by excessive thyroid hormone production, has profound hemodynamic effects. Wet beriberi, affecting predominately the cardiovascular system, is caused by severe thiamine deficiency, most commonly seen in patients with chronic alcoholism or poor nutrition from other causes. Prompt recognition of these infrequently seen syndromes is essential. This article outlines the medical treatment and nursing care needed to return these patients to a normal state.

63 Review Iopanoic Acid to Treat Acute Psychiatric Crisis Associated With Thyrotoxicosis: Three Case Reports and Review of the Literature. 2015

Way, Jennifer S / Shen, Yang / Martinez, Dorothy S. ·Department of Medicine, University of California, Los Angeles, Los Angeles, CA jway@mednet.ucla.edu Department of Medicine, University of California, Los Angeles, Los Angeles, CA. ·J Clin Psychopharmacol · Pubmed #26474011.

ABSTRACT: -- No abstract --

64 Review Fatal ischemic stroke in a case of progressive moyamoya vasculopathy associated with uncontrolled thyrotoxicosis. 2015

Ku, Bon D / Park, Key-Chung / Yoon, Sung Sang. ·Department of Neurology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea. · Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea. ·Korean J Intern Med · Pubmed #26161023.

ABSTRACT: -- No abstract --

65 Review Should we revisit anticoagulation guidelines during thyroid storm? 2015

Petersen, Andrew W / Puig-Carrión, Gisela D / López-Candales, Angel. · ·Bol Asoc Med P R · Pubmed #26035989.

ABSTRACT: Thyroid storm is a rare but potentially catastrophic disease expression of thyrotoxicosis with well-recognized cardiovascular manifestations such as heart failure and atrial fibrillation. Even through some studies have found an increased risk of cardiac thrombus formation and subsequent thromboembolism in these patients, the use of anticoagulation to prevent thromboembolic sequelae of thyrotoxic atrial fibrillation remains unclear. We present a patient presenting with new onset dilated cardiomyopathy and resistant atrial fibrillation with thyroid storm that had a large left atrial appendage clot. Case particulars are discussed and the literature reviewed.

66 Review Thyroid disorders during pregnancy and postpartum. 2015

Pearce, Elizabeth N. ·Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA, USA. Electronic address: elizabeth.pearce@bmc.org. ·Best Pract Res Clin Obstet Gynaecol · Pubmed #26028555.

ABSTRACT: An awareness of the gestational changes to thyroid physiology and the impact of uncontrolled thyroid disease on pregnancy and infant outcome is essential for the successful management of hypothyroidism and hyperthyroidism. This review summarizes strategies for the management of thyroid disease in pregnancy and post partum, and it highlights areas where there is still a lack of consensus.

67 Review Calcium maelstrom: recalcitrant hypocalcaemia following rapid correction of thyrotoxicosis, exacerbated by pregnancy. 2015

Shin, Terry / Guerrero, Arthur F. ·Department of Internal Medicine, Tripler Army Medical Center, Honolulu, Hawaii, USA. · Department of Endocrinology, Tripler Army Medical Center, Honolulu, Hawaii, USA. ·BMJ Case Rep · Pubmed #25969482.

ABSTRACT: A 29-year-old pregnant woman with Graves' disease presented with severe persistent hypocalcaemia after thyroidectomy. Six months prior to presentation she was diagnosed with Graves' disease and remained uncontrolled with methimazole. She was confirmed pregnant prior to radioactive iodine ablation (RAI), and underwent total thyroidectomy during her second trimester. After surgery, continuous intravenous calcium infusion was required until delivery of the fetus allowed discontinuation at postoperative day 18, despite oral calcium and calcitriol administration. A total of 38 g of oral and 7.5 g of intravenous elemental calcium was administered. We report an unusual case of recalcitrant hypocalcaemia thought to be due to a combination of postoperative hypoparathyroidism, combined with thyrotoxic osteodystrophy and pregnancy, after surgical correction of Graves' disease. Increased vigilance and early calcium supplementation should be a priority in the management of these patients.

68 Review Amiodarone and the thyroid. 2015

Jabrocka-Hybel, Agata / Bednarczuk, Tomasz / Bartalena, Luigi / Pach, Dorota / Ruchała, Marek / Kamiński, Grzegorz / Kostecka-Matyja, Marta / Hubalewska-Dydejczyk, Alicja. ·Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland. ajabrocka@op.pl. ·Endokrynol Pol · Pubmed #25931048.

ABSTRACT: Amiodarone, a benzofuranic iodine-rich antiarrhythmic drug, causes thyroid dysfunction in 15-20% of cases. Amiodarone can cause both hypothyroidism (AIH, amiodarone-induced hypothyroidism) and thyrotoxicosis (AIT, amiodarone-induced thyrotoxicosis). AIH is treated by L-thyroxin replacement and does not need amiodarone discontinuation. There are two main forms of AIT: type 1, a form of true iodine-induced hyperthyroidism; and type 2, a drug-induced destructive thyroiditis. However, mixed/indefinite forms exist, contributed to by both pathogenic mechanisms. Type 1 AIT usually occurs in diseased thyroid glands, whereas type 2 AIT develops in substantially normal thyroid glands. Thioamides represent the first-line treatment for type 1 AIT, but iodine-replete glands are poorly responsive; sodium/potassium perchlorate, by inhibiting thyroidal iodine uptake, may increase the response to thioamides. Type 2 AIT is best treated by oral glucocorticoids. Response depends on thyroid volume and severity of thyrotoxicosis. Mixed/indefinite forms may require a combination of thioamides, potassium perchlorate, and steroids. Radioiodine treatment is usually not feasible because amiodarone-related iodine load decreases thyroidal radioiodine uptake. Thyroidectomy represents an important and helpful option in cases resistant to medical therapy. Surgery performed by a skilled surgeon may represent an emergent treatment in patients who have severe cardiac dysfunction.

69 Review Painless thyroiditis-induced acute myocardial infarction with normal coronary arteries. 2015

Zheng, Wen / Zhang, Yu-Jiao / Li, Shu-Yan / Liu, Lu-Lun / Sun, Jian. ·Department of Cardiology, the First Hospital of Jilin University, Changchun, China. Electronic address: zhengw.jlu@gmail.com. · Department of Cardiology, the First Hospital of Jilin University, Changchun, China. Electronic address: fayjlu@gmail.com. · Department of Cardiology, the First Hospital of Jilin University, Changchun, China. Electronic address: shuyanli1992@163.com. · Thyroid Surgery Department, the First Hospital of Jilin University, Changchun, China. Electronic address: 81514260@qq.com. · Department of Cardiology, the First Hospital of Jilin University, Changchun, China. Electronic address: sunjianemail@126.com. ·Am J Emerg Med · Pubmed #25662207.

ABSTRACT: -- No abstract --

70 Review Clinical characteristics and outcome of thyroid storm: a case series and review of neuropsychiatric derangements in thyrotoxicosis. 2015

Swee, Du Soon / Chng, Chiaw Ling / Lim, Adoree. ·Department of Endocrinology, Singapore General Hospital, Singapore. ·Endocr Pract · Pubmed #25370315.

ABSTRACT: OBJECTIVE: The objectives of this study were (1) to describe the presentation, demographics, and clinical course of patients admitted for thyroid storm, and (2) to identify factors associated with mortality. METHODS: A retrospective review of subjects admitted to a single academic hospital from 2006 through 2011 was conducted. Medical records for all patients who were admitted with a diagnosis of thyrotoxicosis were systematically reviewed for clinical features of thyroid storm. RESULTS: A total of 28 cases were identified. Thyroid storm was the first clinical presentation of thyrotoxicosis in 13 patients (46.4%). Noncompliance with treatment was a major trigger in previously diagnosed patients, followed by infection. The mortality rate was 25% in this series. Cardiac manifestations were predominant, with >60% of patients having severe tachycardia (heart rate >140 beats per minunte) and/or atrial fibrillation. Although central nervous system (CNS) involvement was less frequent (n = 8, 28.6%), CNS derangement of worse than mild severity was statistically associated with mortality (P = .021). There was good agreement between the Burch-Wartofsky Point Scale and Japanese Thyroid Association criteria in the diagnosis of thyroid storm in this study cohort. CONCLUSION: Thyroid storm was the first presentation of thyrotoxicosis in a significant proportion of patients, highlighting the importance of a high index of suspicion in an appropriate clinical context. The presence of neuropsychiatric manifestations appeared to portend greater risk of mortality. Prevailing evidence suggests that there are complex interactions between thyroid hormones and neurotransmitter circuits in the pathogenesis of CNS symptomology in thyrotoxicosis.

71 Review Neonatal thyrotoxicosis with severe supraventricular tachycardia: case report and review of the literature. 2015

Abbasoğlu, Aslıhan / Ecevit, Ayşe / Tuğcu, Ali Ulaş / Erdoğan, Lkay / Kınık, Sibel Tulgar / Tarcan, Aylin. · ·J Pediatr Endocrinol Metab · Pubmed #25153577.

ABSTRACT: Neonatal thyrotoxicosis is a rare condition caused by the transplacental passage of thyroid stimulating immunoglobulins from mothers with Graves' disease. We report a case of neonatal thyrotoxicosis with concurrent supraventricular tachycardia (SVT). The female infant, who was born by section due to breech delivery and meconium in the amniotic fluid at 36 weeks of gestation, presented with tachycardia on day 7. Her heart rate was between 260 and 300 beats/min, and an electrocardiogram revealed ongoing SVT. Sotalol was effective after two cardioversions in maintaining sinus rhythm. Thyroid function studies revealed hyperthyroidism in the infant, and her mother was found to have Graves' disease. Since symptoms and signs can vary, especially in preterm infants with neonatal hyperthyroidism, we want to emphasize the importance of prenatal care and follow-ups of Graves' disease associated pregnancies and management of newborns after birth.

72 Review Amiodarone-induced thyroid dysfunction. 2015

Danzi, Sara / Klein, Irwin. ·Department of Biological Sciences and Geology, Queensborough Community College, Bayside, NY, USA saradanzi@gmail.com. · Department of Medicine, NYU School of Medicine, New York, NY, USA. ·J Intensive Care Med · Pubmed #24067547.

ABSTRACT: Amiodarone is an effective medication for the treatment of cardiac arrhythmias. Originally developed for the treatment of angina, it is now the most frequently prescribed antiarrhythmia drug despite the fact that its use is limited because of potential serious side effects including adverse effects on the thyroid gland and thyroid hormones. Although the mechanisms of action of amiodarone on the thyroid gland and thyroid hormone metabolism are poorly understood, the structural similarity of amiodarone to thyroid hormones, including the presence of iodine moieties on the inner benzene ring, may play a role in causing thyroid dysfunction. Amiodarone-induced thyroid dysfunction includes amiodarone-induced thyrotoxicosis (AIT) and amiodarone-induced hypothyroidism (AIH). The AIT develops more commonly in iodine-deficient areas and AIH in iodine-sufficient areas. The AIT type 1 usually occurs in patients with known or previously undiagnosed thyroid dysfunction or goiter. The AIT type 2 usually occurs in normal thyroid glands and results in destruction of thyroid tissue caused by thyroiditis. This is the result of an intrinsic drug effect from the amiodarone itself. Mixed types are not uncommon. Patients with cardiac disease receiving amiodarone treatment should be monitored for signs of thyroid dysfunction, which often manifest as a reappearance of the underlying cardiac disease state. When monitoring patients, initial tests should include the full battery of thyroid function tests, thyroid-stimulating hormone, thyroxine, triiodothyronine, and antithyroid antibodies. Mixed types of AIT can be challenging both to diagnose and treat and therapy differs depending on the type of AIT. Treatment can include thionamides and/or glucocorticoids. The AIH responds favorably to thyroid hormone replacement therapy. Amiodarone is lipophilic and has a long half-life in the body. Therefore, stopping the amiodarone therapy usually has little short-term benefit.

73 Review Thyroid storm: an updated review. 2015

Chiha, Maguy / Samarasinghe, Shanika / Kabaker, Adam S. ·Division of Endocrinology and Metabolism, Department of Medicine, Loyola University Medical Center, Maywood, IL, USA. · Section of Endocrine Surgery, Department of Surgery, Loyola University Medical Center, Maywood, IL, USA akabaker@lumc.edu. ·J Intensive Care Med · Pubmed #23920160.

ABSTRACT: Thyroid storm, an endocrine emergency first described in 1926, remains a diagnostic and therapeutic challenge. No laboratory abnormalities are specific to thyroid storm, and the available scoring system is based on the clinical criteria. The exact mechanisms underlying the development of thyroid storm from uncomplicated hyperthyroidism are not well understood. A heightened response to thyroid hormone is often incriminated along with increased or abrupt availability of free hormones. Patients exhibit exaggerated signs and symptoms of hyperthyroidism and varying degrees of organ decompensation. Treatment should be initiated promptly targeting all steps of thyroid hormone formation, release, and action. Patients who fail medical therapy should be treated with therapeutic plasma exchange or thyroidectomy. The mortality of thyroid storm is currently reported at 10%. Patients who have survived thyroid storm should receive definite therapy for their underlying hyperthyroidism to avoid any recurrence of this potentially fatal condition.

74 Review Animal models of disease: feline hyperthyroidism: an animal model for toxic nodular goiter. 2014

Peterson, Mark E. ·Animal Endocrine Clinic21 West 100th Street, New York, New York 10025, USADepartment of Clinical SciencesNew York State College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA Animal Endocrine Clinic21 West 100th Street, New York, New York 10025, USADepartment of Clinical SciencesNew York State College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA drpeterson@animalendocrine.com. ·J Endocrinol · Pubmed #25297557.

ABSTRACT: Since first discovered just 35 years ago, the incidence of spontaneous feline hyperthyroidism has increased dramatically to the extent that it is now one of the most common disorders seen in middle-aged to senior domestic cats. Hyperthyroid cat goiters contain single or multiple autonomously (i.e. TSH-independent) functioning and growing thyroid nodules. Thus, hyperthyroidism in cats is clinically and histologically similar to toxic nodular goiter in humans. The disease in cats is mechanistically different from Graves' disease, because neither the hyperfunction nor growth of these nodules depends on extrathyroidal circulating stimulators. The basic lesion appears to be an excessive intrinsic growth capacity of some thyroid cells, but iodine deficiency, other nutritional goitrogens, or environmental disruptors may play a role in the disease pathogenesis. Clinical features of feline toxic nodular goiter include one or more palpable thyroid nodules, together with signs of hyperthyroidism (e.g. weight loss despite an increased appetite). Diagnosis of feline hyperthyroidism is confirmed by finding the increased serum concentrations of thyroxine and triiodothyronine, undetectable serum TSH concentrations, or increased thyroid uptake of radioiodine. Thyroid scintigraphy demonstrates a heterogeneous pattern of increased radionuclide uptake, most commonly into both thyroid lobes. Treatment options for toxic nodular goiter in cats are similar to that used in humans and include surgical thyroidectomy, radioiodine, and antithyroid drugs. Most authorities agree that ablative therapy with radioiodine is the treatment of choice for most cats with toxic nodular goiter, because the animals are older, and the disease will never go into remission.

75 Review [Every sixth patient in amiodarone treatment develops thyrotoxicosis or hypothyreosis]. 2014

Olsen, Jimmi Sloth / Carlé, Allan / Thomsen, Henrik Holm. ·Medicinsk Afdeling, Regionshospitalet -Viborg, Heibergs Allé 4, 8800 Viborg. jimmi.olsen@viborg.rm.dk. ·Ugeskr Laeger · Pubmed #25293567.

ABSTRACT: Amiodarone is associated with multiple side effects among which a substantial number of patients are suffering from amiodarone-induced thyroid disease. In this review we present difficulties in diagnosing, sub typing and treating amiodarone-induced thyroid disease and give views on the future of this drug and one of the alternatives, dronedarone. Amiodarone holds a place in modern medicine due to its unique antiarrhythmic effects and associated thyroid diseases requires collaboration between cardiologists and endocrinologists due to the complexity hereof.

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