Presentation
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]
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]
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]
Entire Body System
- 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]
Workup
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]
Treatment
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]
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]
· Discuss treatment options with the patient and reach a mutually-agreed long term treatment plan. [endolri.org.uk]
Treatment of Thyrotoxicosis There are a variety of ways to treat thyrotoxicosis, which are detailed on separate webpages (just click on the name of the treatment below for more information). [endocrinesurgery.net.au]
Prognosis
(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]
Etiology
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]
Therapy for hyperthyroidism depends on the etiology. [thebigl.co]
Epidemiology
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]
Pathophysiology
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]
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]
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]
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]
Prevention
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 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]
Various hyperthyroidism complications during pregnancy can be be prevented with anti-thyroid medications such as Methimazole and propylthiouracil (PTU) Radioiodine is an absolute contra-indication in pregnant women. [hyperthyroidismsymptomsx.com]