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T3 Thyrotoxicosis


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]
  • Norwich, UK 3 Department of Gastroenterology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK Correspondence to Dr Carlo Canepa, Neurocanepa{at}gmail.com Summary 68-year-old female patient with no significant medical history presents[casereports.bmj.com]
  • Obtaining Free T3 level reports can be done as 5% of pregnant women present with T3 toxicosis.[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]
Weakness
  • 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]
  • […] gmail.com Summary 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[casereports.bmj.com]
  • Approximately 70% of people with hyperthyroidism will develop weakness in the proximal muscles, such as the hips, which is accompanied by myopathy. Muscle strength generally returns after two months of treatment.[physio-pedia.com]
  • Muscle wasting/weakness, proximal myopathy, hyperreflexia Change in bowel habit (increased/diarrhoea) Heat intolerance, increased sweating Warm, moist skin (excess sweating- diaphoresis) Increased appetite, weight change (loss or gain or stable despite[dundeemedstudentnotes.wordpress.com]
  • 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]
Pain
  • 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]
  • Thirty years ago an endoctinologist put me … read more Schuyler - ANP 11,418 satisfied customers I have pain all over my body, loose muscle, sweating at the I have pain all over my body, loose muscle, sweating at the hands feet and burning senation all[justanswer.com]
  • Correspondence to Dr Carlo Canepa, Neurocanepa{at}gmail.com Summary 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[casereports.bmj.com]
  • Thyroid pain, tenderness of neck, raised erythrocyte sedimentation rate (ESR), and leukocytosis are not usually associated with factitious thyrotoxicosis. Copyright 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.[clinicaladvisor.com]
  • Aspirin 650 mg PO QID may relieve the pain, and if aspirin is ineffective, prednisone 20-40 mg PO QD may offer relief.[thebigl.co]
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]
  • Minor side effects include rash, fever, gastrointestinal effects, and arthralgia. Liver damage is another very rare side effect.[physio-pedia.com]
  • […] hypermetabolic clinical syndrome due to elevated serum T3 or T4 May be due to hyperthyroidism, thyroiditis or excessive ingestion of thyroid hormone ("factitious hyperthyroidism") Includes a wide range of symptoms, such as ophtalmopathy, dermatopathy, fever[pathologyoutlines.com]
Malnutrition
  • […] other antithyroid med, NSAIDs, lithium, phenytoin, carbamazepine, anabolic steroids), iodine deficiency Thyroxine or Thyroid Binding Globulin, TBG Increased TBG : pregnancy, estrogen, ERT (estrogen replacement therapy), viral hepatitis Decreased TBG : malnutrition[med-ed.virginia.edu]
Blurred Vision
  • 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]
  • vision and non-painful jaw discomfort, followed by left spastic weakness and hyper-reflexia with positive Babinski and Hoffman signs.[casereports.bmj.com]
Ptosis
  • 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]
  • Trust, Great Yarmouth, UK Correspondence to Dr Carlo Canepa, Neurocanepa{at}gmail.com Summary 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[casereports.bmj.com]
Hyperreflexia
  • […] resting tachycardia, use-dependent oedema Hyperactivity, emotional lability, insomnia, irritability, nervousness, anxiety, agitation tremor Exercise intolerance, fatigue, muscle (mainly proximal) weakness Muscle wasting/weakness, proximal myopathy, hyperreflexia[dundeemedstudentnotes.wordpress.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. . (accessed 11 April 2010). Duha S, Caroline S. K. Myositis Associated with the Decline of Thyroid Hormone Levels in Thyrotoxicosis: A Syndrome?.[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

  • 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]
  • 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]
  • Rapidly consult with trusted authorities thanks to new expert-opinion treatment strategies and recommendations. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography.[books.google.com]
  • 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, and treatment[books.google.com]

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

  • 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]
  • 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]
Sex distribution
Age distribution

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]
  • We remain committed to the case method of instruction, and believe that there is no better method to learn medicine than to have an individual patient problem as the basis for study of pathophysiology, natural history, diagnosis and management.[books.google.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]
  • 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]

Prevention

  • 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]
  • 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]
  • 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]
  • 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]

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