Metz, MD, FACP Patients with ITP continue to present difficulties in diagnosis and management. Two experts discuss the current approach to ITP. [books.google.com]

68-year-old female patient with no significant medical history presents with a 3-month history of progressive neurological symptoms, which began with left eye ptosis, blurred vision and non-painful jaw discomfort, followed by left spastic weakness and [ncbi.nlm.nih.gov]

About 0.15% of pregnancies present with new-onset Graves’ hyperthyroidism. [hyperthyroidismsymptomsx.com]

Case presentation A 42-year-old male presented to the emergency department with complaints of palpitations and paroxysmal sweating episodes of one-week duration. [edmcasereports.com]

`0 Precipitating event Absent 0 Present 10 Interpretation: Likelihood of Thyroid Storm Score: < 25 – Unlikely 25-44 – Impending >45 – Highly likely The patient’s presentation may reflect complications of thyroid storm (stroke, myocardial infarction, [cdemcurriculum.com]

• Fever

  Fever should not be treated with cooling mattresses, and Tylenol is ineffective. Fever may be controlled with Demerol (25-50 mg intravenously Q 6 hours) and chlorpromazine (25-50 mg intravenously Q 6 hours). [thebigl.co]

  Patients present with symptoms of hyperthyroidism (typically tachycardia, fever, anxiety, palpitations, hyperhidrosis, etc.) in the absence of an enlarged thyroid gland. [clinicaladvisor.com]

  Weight loss in 90% cases, weight gain in 10% Heat intolerance Sweating Fast or irregular heart rate Vomiting or diarrhoea Irregular periods and infertility A fine tremor with possible muscle weakness (unable to climb stairs) Heart failure in the elderly Fever [endocrinesurgeon.co.uk]

  During Linda's seventh week of treatment she developed a fever, mouth ulcers and symptoms of gastroenteritis. A FBC revealed agranulocytosis (neutrophils 0.21 x 109/L). [racgp.org.au]

  Minor side effects include rash, fever, gastrointestinal effects, and arthralgia. Liver damage is another very rare side effect. [physio-pedia.com]

• Severe Pain

  Glucocorticoids may be required for more severe pain Thyroxine if the hypothyroid phase is prolonged or symptomatic Amiodarone induced thyroiditis Type 1 – excess iodine Type 2 – destructive thyroiditis Type 1 – underlying thyroid disease present. [racgp.org.au]

• Hoarseness

  [1] Anytime a therapist discovers unusual swelling or enlargement (with or without pain), tenderness, hoarseness, or dysphagia they should refer out. [physio-pedia.com]

  Hypothyroidism— Underactive thyroid gland; symptoms include fatigue, difficulty swallowing, mood swings, hoarse voice, sensitivity to cold, forgetfulness, and dry/coarse skin and hair. [encyclopedia.com]

  Hoarseness or voice changes without other obvious cause. Neck glands. Young age (before puberty). Older age (65 or more). [patient.info]

• Cough

  When working with these patients it is important to take the necessary precautions if the patient is coughing or expectorating. [physio-pedia.com]

• Hypertension

  Signs and symptoms associated with thyrotoxicosis include 1 : nervousness, anxiety, hyperactivity weight loss muscle weakness, tremor increased perspiration, heat intolerance palpitations, tachycardia or atrial arrhythmia, systolic hypertension stare [radiopaedia.org]

  Everyone will and shall inherit a particular disease such as heart problems like hypertension, metabolic problems such as diabetic mellitus, and endocrine problems such as hyperthyroidism and thyrotoxicosis. [differencebetween.net]

  A widened pulse pressure and hypertension are frequently seen. However, hypotension and shock may be seen as a complication of the thyroid storm or as a result of the inciting event (ex. septic shock). [cdemcurriculum.com]

  The following complications occur if hyperthyroidism is poorly controlled or left untreated during pregnancy: Maternal complications include: Preeclampsia, pregnancy-induced hypertension,highest rate of miscarriages, premature labor, cardiac failure, [hyperthyroidismsymptomsx.com]

  Untreated hyperthyroidism may have the following complications: Dehydration from excess heat, excess sweating, and diarrhea Systolic hypertension Bone loss with high blood calcium fractures Abnormalities of heart rhythm Complications may also arise from [emedicinehealth.com]

• Chest Pain

  IV Peripheral symptom control (ex. tachycardia, chest pain, dyspnea, etc.) is done primarily through β blockade. Traditionally this has been done with either oral or intravenous propranolol. [cdemcurriculum.com]

  Patients in thyroid storm may complain of chest pain, palpitations, shortness of breath, tremor, nervousness, increased sweating, disorientation, fatigue and fever. [path.upmc.edu]

  Other events to anticipate include: Temporary hair loss Headache Diarrhea Mood changes, i.e. nervousness, irritability Heat sensitivity, increased sweating Menstrual irregularities Adverse reactions such as chest pain, irregular heart rhythm, breathing [thyromate.com]

  Some cases of chest pain, particularly the elderly will remain challenging and thyroid replacement therapy might exacerbate angina [ 33 ]. [thyroidresearchjournal.biomedcentral.com]

• Confusion

  Although commonly done, thyrotoxicosis should not be confused with, nor is it synonymous with hyperthyroidism. The latter term solely means that a patient has abnormally-elevated thyroid hormone levels. [radiopaedia.org]

  One test seems to lead to another and it's become very confusing. Can anyone give me some insight on … read more Valarie RN 1,165 satisfied customers I take .05 synthroid medication. My eyes are driving me I take .05 synthroid medication. [justanswer.com]

  Do not confuse T 3 with T 3 uptake; these are two different tests. The latter is done very commonly as part of the usual thyroid profile. Less than 1% of T 3 is unbound. [beta.labcorp.com]

  Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances Twelve hours before this blood test do not take multivitamins or dietary supplements [mayomedicallaboratories.com]

  Such conditions may be confused with clinical hypo- or hyperthyroidism. When possible, patients may be asked to discontinue medications that are known to interfere with the tests several days or more prior to testing. [encyclopedia.com]

• Seizure

  Precipitants of thyroid storm: We can devise a table to classify these precipitants: Systemic disease Sepsis Surgery Trauma Child birth Eclampsia Diabetic ketoacidosis Hypoglycaemia Emotional stress Burns Pulmonary embolism Seizures Stroke Thyroid-specific [derangedphysiology.com]

  Children show symptoms, such as tachycardia, fever, nausea, seizure, diarrhea and irritability, and fatalities can occur. In adults, tachyarrhythmia, heart failure, myocardial infarction, stroke, psychosis and even death have been reported. [clinicaladvisor.com]

  A-fib Hyperdynamic precordium Widened pulse pressure Rub Neuro\psychiatric Anxiety to agitation to psychosis to coma Fine tremor, especially on extension of arms Paralysis Stroke Thyrotoxic periodic paralysis (Especially Asian men) Apathy\depression Seizures [cdemcurriculum.com]

• Convulsions

  Some common drugs known to depress thyroid hormone levels are dopamine, corticosteroids, lithium, salicylates, anti-convulsants, and androgens. Thyroid hormone levels may be increased by estrogens, clofibrate, and opiates. [encyclopedia.com]

Thyroid function testing, undertaken as part of the diagnostic workup, revealed an un-measureable thyroid-stimulating hormone (TSH) and free thyroxine (T 4 ). [edmcasereports.com]

Hyperthyroidism, Thyroid Storm, and Graves Disease: Differential Diagnoses & Workup. 3 June 2009. http://emedicine.medscape.com/article/767130-diagnosis. (accessed 11 April 2010). ↑ Duha S, Caroline S. K. [physio-pedia.com]

HYPERTHYROIDISM (THYROTOXICOSIS) Workup This disorder is the result of an excessive concentration of circulating thyroid hormone. [thebigl.co]

There are some recommendations that include thyroid peroxidase antibodies (TPOAb) in the thyroid workup of pregnant women. [thyroidresearchjournal.biomedcentral.com]

Make the best clinical decisions with an enhanced emphasis on evidence-based practice and expert opinions on treatment strategies. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography. [books.google.com]

· Discuss treatment options with the patient and reach a mutually-agreed long term treatment plan. [endolri.org.uk]

"Use of lithium in the treatment of thyrotoxicosis." Hong Kong Med J 12.4 (2006): 254-9. Weber, C., et al. "Thyroidectomy in iodine induced thyrotoxic storm." [derangedphysiology.com]

Following treatment with carbimazole, the neurological symptoms greatly improved. The authors concluded that the left pyramidal syndrome was secondary to autoimmune free T3-thyrotoxicosis. [ncbi.nlm.nih.gov]

(where there is excessive release of stored thyroid hormone without a concomitant increase in synthesis) high-dose radiation therapy surgical manipulation iodinated contrast administration (see: contrast medium-induced thyrotoxicosis ) Treatment and prognosis [radiopaedia.org]

Prognosis Good with treatment but remission and relapse common Increased incidence of other autoimmune diseases: SLE, T1DM, Addison’s Treatment Medical B-blockers for rapid symptom control Titration of carbimazole (reduces T3 and T4 by inhibiting thyroid [alancam.com]

Hyperthyroidism Prognosis Hyperthyroidism is typically treatable and rarely fatal. However, complications can arise with untreated hyperthyroidism. [emedicinehealth.com]

Prognosis Hyperthyroidism is characterised by relapses and remittances. Surgical treatment and radioactive iodine can both lead to hypothyroidism and thus close follow-up with TFTs is required. [patient.info]

Fukao A, Takamatsu J Recent Res Devel Endocrinol 3:369-376,2002 21 The relationship of psychological factors to the prognosis of hyperthyroidism in antithyroid drug-treated patients with Graves’ disease. [takamatsu.gr.jp]

We postulate that low dietary iodine intake may be an etiologic factor in some cases of T3 thyrotoxicosis. [ncbi.nlm.nih.gov]

Etiology There are multiple causes of thyrotoxicosis 1 : hyperthyroidism excessive exogenous thyroid hormone iatrogenesis or ingestion (e.g. hamburger thyrotoxicosis, thyrotoxicosis factitia ) thyroiditis (where there is excessive release of stored thyroid [radiopaedia.org]

Hypothyroidism: etiology, diagnosis, and management. Med Clin North Am. 2012; 96(2): 203-21. PubMed Carney LA, Quinlan JD, West JM. Thyroid disease in pregnancy. Am Fam Physician. 2014; 89(4): 273-8. PubMed Casey B, de Veciana M. [arupconsult.com]

[…] antithyroid drugs T4 hyperthyroidism : high T4, normal T3 Due to primary hyperthyroidism causes, also iodine, amiodarone ( Arch Pathol Lab Med 2003;127:e275 ), pregnancy (transient gestational hyperthyroidism syndrome, 1 - 3%, Hormones (Athens) 2015;14:59 ) Etiology [pathologyoutlines.com]

However, these patients are often critically ill and the complications or inciting etiology of the patient’s thyroid storm may require active airway intervention. [cdemcurriculum.com]

Epidemiology 1% of the population peak incidence 30-50y F>M Most common cause of endogenous hyperthyroidism Aetiology Unknown Genetic predisposition: HLA-DR3, -B8, DR2 CTLA-4 polymorphisms Potentially environmental factors: viral or bacterial infection [alancam.com]

Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology [brainscape.com]

Background and Epidemiology Overt (clinical) hyperthyroidism is thought to affect ~1.9% of women (0.8/1000/year) and 0.16% of men (0.14/1000/year) Subclinical hyperthyroidism is likely to be higher Presentation There are a wide range of symptoms and signs [dundeemedstudentnotes.wordpress.com]

Altered physiology of thyroid gland during pregnancy Clinically, the thyroid gland presents with the following changes that subside during postnatal period. bilateral enlargement Increased vascularity Epidemiology of hyperthyroidism during pregnancy In [hyperthyroidismsymptomsx.com]

Epidemiology/Pathophysiology Graves' disease is the most common form of hyperthyroidism accounting for 60-70% of all cases. It occurs in up to 3% of the population. [ocw.tufts.edu]

من الصفحات Werner & Ingbar’s The Thyroid: A Fundamental and Clinical Text, 10th Edition has been extensively revised and streamlined to deliver the most comprehensive coverage of the thyroid including anatomy, development, biochemistry, physiology, pathophysiology [books.google.com]

Epidemiology/Pathophysiology Graves' disease is the most common form of hyperthyroidism accounting for 60-70% of all cases. It occurs in up to 3% of the population. [ocw.tufts.edu]

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Thyroid hormones regulate a number of developmental, metabolic, and neural activities throughout the body. [mayomedicallaboratories.com]

Definition / general Increased thyroid hormone synthesis and secretion from the thyroid gland ( Lancet 2016;388:906 ) Pathophysiology Depends upon the underlying cause Graves disease ( Cochrane Database Syst Rev 2015 Nov 25;(11):CD010576 ): Autoimmune [pathologyoutlines.com]

In brief: The management strategy for thyroid storm revolves around preventing peripheral effects of raised thyroid hormone levels, and preventing the ongoing increase of said levels by inhibiting the synthesis and release of thyroid hormone. [derangedphysiology.com]

Diagnosis of overactive thyroid and treatment of the underlying cause can relieve symptoms and prevent complications. A variety of conditions can cause hyperthyroidism. [healthline.com]

Now, I have no idea if I should tell him to take the hydrocortisone to prevent an adrenal crisis, which could kill him. Or, if I should tell him not to take it because he got instantly ill last time and he's still suffering the same symptoms. [healthunlocked.com]

The book is arranged in eight sections concentrating on topics such as prevention of emergencies through patient evaluation (medical history) and specific types of more common emergencies that practitioners may encounter. [books.google.com]

The thyroid hormone production system is regulated by a feedback loop so that when the levels of the thyroid hormones thyroxine and triiodothyronine increase, they prevent the release of both thyrotropin-releasing hormone from the hypothalamus and thyroid [yourhormones.info]