Only one case of apathetic thyrotoxicosis presenting with hemoptysis has been reported in the literature [ 1 ]. 2. [pubs.sciepub.com]

Case presentation A 59-year-old Caucasian man was admitted with lethargy and progressive weight loss for 6 to 8 months prior to presentation. [jmedicalcasereports.biomedcentral.com]

[…] thyrotoxic [ thi´ro-tok″sik ] marked by the effects of presentation to the tissues of excessive quantities of the thyroid hormones. thy·ro·tox·ic heart dis·ease cardiac symptoms, signs, and physiologic impairment due to overactivity of the thyroid gland [medical-dictionary.thefreedictionary.com]

Atrial fibrillation, a recognized precipitant of heart failure in thyrotoxicosis was also present in 42% of the patients presenting with heart failure. [pjms.com.pk]

We describe two young patient with thyrotoxicosis who developed dilated cardiomyopathy and pulmonary oedema as the first presenting symptom. [heart.bmj.com]

• Congestive Heart Failure

  […] enlargement and congestive heart failure. [medical-dictionary.thefreedictionary.com]

  Even though cardiovascular effects are typically due to "high-output" heart failure, cases of "low-output" heart failure have also been observed. [jpgmonline.com]

  The risk of congestive heart failure (CHF) is increased in patients with age >60, those with long-term untreated hyperthyroidism, and those with pre-existing heart disease. [houstonendocrine.com]

  When left untreated, thyroid storm can cause congestive heart failure or fluid-filled lungs. The mortality rate for people with untreated thyroid storm is estimated to be 75 percent. [healthline.com]

  heart failure contractility coronary artery curve decrease diagnosis diastolic digitalis diuretics drug dyspnea ectopic effect ejection electrocardiogram fibers fibrillation filling findings first fluid function gallop heart disease heart sound Hemodynamic [books.google.de]

• Goiter

  Thyrotoxicosis without goiter OR other cause [icd9data.com]

  Keywords toxic goiter surgical treatment heart failure Abstract Changes in the severity of heart failure in patients with toxic goiter after surgery are insufficiently studied.The objective of the research was to study changes in cardiac disorders in [ojs.ifnmu.edu.ua]

  Topics covered include the following: thyroid synthesis and physiology; hyperthyroidism; hypothyroidism; thyroid nodules; goiter; differentiated thyroid cancer; subacute, silent, and postpartum thyroiditis; thyroid and pregnancy; thyroid and the elderly [books.google.de]

  […] thyroid disease or other autoimmune diseases Previous nontoxic multinodular goiter Signs and symptoms of thyrotoxicosis No differential features Goiter a Features of vascular goiter b Multinodular goiter or solitary nodule Ocular signs and symptoms Features [empendium.com]

  Hamburger JI, Hamburger SW, 1985 Diagnosis and management of large toxic multinodular goiter. J Nucl Med 26: 888-892. 3. Siegel RD, Lee SL, 1998 Toxic Nodular Goitre: Toxic adenoma and toxic multinodular goiter. [hormones.gr]

• Weight Loss

  Case presentation A 59-year-old Caucasian man was admitted with lethargy and progressive weight loss for 6 to 8 months prior to presentation. [jmedicalcasereports.biomedcentral.com]

  Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat. Several treatments are available for hyperthyroidism. [mayoclinic.org]

  They may include Being nervous or irritable Mood swings Fatigue or muscle weakness Heat intolerance Trouble sleeping Hand tremors Rapid and irregular heartbeat Frequent bowel movements or diarrhea Weight loss Goiter, which is an enlarged thyroid that [icdlist.com]

  Considering the whole-body effects this can have, a variety of symptoms may result, including weight loss, irritability, irregular heart rhythm, tremor, insomnia, hair loss, and more. [verywell.com]

  Case Presentation An 85 year old woman with past medical history of hypertension and euthyroid goiter presented with a two-week-history of subjective weight loss, cough, hemoptysis and progressively worsening dyspnea, associated with a two-pillow orthopnea [pubs.sciepub.com]

• Heat Intolerance

  He had been experiencing the symptoms for the past two months, had lost 37 pounds in weight in the previous 10 weeks, and was heat intolerant. He was taking methimazole 5mg daily. The patient denied chest pain, shortness of breath, and syncope. [radcliffecardiology.com]

  They may include Being nervous or irritable Mood swings Fatigue or muscle weakness Heat intolerance Trouble sleeping Hand tremors Rapid and irregular heartbeat Frequent bowel movements or diarrhea Weight loss Goiter, which is an enlarged thyroid that [icdlist.com]

  Case Report A previously healthy African- American woman, aged 33 years, presented for urgent care with a three-week history of exercise and heat intolerance, dyspnea on exertion, chest pain, and a four-day history of lower-extremity edema and headaches [ispub.com]

  intolerance, warm skin, excessive perspiration, menstrual changes, hand tremor, polydipsia and increased appetite ( J Am Geriatr Soc 1996;44:50 ) Late symptoms : cardiac (palpitations, congestive heart failure, cardiomegaly, atrial fibrillation, fatty [pathologyoutlines.com]

  intolerance and a tendency to become tired during ordinary activities. [mayoclinic.org]

• Fatigue

  They may include Being nervous or irritable Mood swings Fatigue or muscle weakness Heat intolerance Trouble sleeping Hand tremors Rapid and irregular heartbeat Frequent bowel movements or diarrhea Weight loss Goiter, which is an enlarged thyroid that [icdlist.com]

  Patients who are hyperthyroid describe crippling panic attacks, shortness of breath, heart palpitations, persistent diarrhea, irritability, hair falling out in handfuls, constant sweating, extreme muscle fatigue, and insomnia that leads to relentless [holtorfmed.com]

  Two months earlier she had complained of fatigue, palpitation, and chest discomfort. She had no risk factors for coronary artery disease, had regular menses, and denied smoking or alcohol consumption. [heart.bmj.com]

  Common Symptoms of Thyrotoxic Crisis: General symptoms Fever Weight loss and poor feeding habits Profuse sweating Respiratory distress GI symptoms Diarrhea Vomiting Fatigue common in elderly Nausea Jaundice Abdominal pain Neurologic symptoms Altered behavior [hyperthyroidismsymptomsx.com]

  thyroiditis, struma ovarii, choriocarcinoma, hydatidiform mole, pituitary adenoma ( Lancet 2016;388:906 ) Radiocontrast iodine based agent ( Arch Endocrinol Metab 2016;60:287 ) Clinical features Early symptoms : anxiety, palpitations, rapid pulse, fatigue [pathologyoutlines.com]

• Dyspnea

  Braunwald Brit cardiac output Cardiol Cardiovas Cardiovascular carotid catheter Catheterization cells Chap chest Circulation Res Clin clinical congestive heart failure contractility coronary artery curve decrease diagnosis diastolic digitalis diuretics drug dyspnea [books.google.de]

  but no paroxysmal nocturnal dyspnea or ankle swelling. [pubs.sciepub.com]

  Nineteen days later, the patient noted recurrence of exertional dyspnea, bipedal edema and three-pillow orthopnea. No chest pain or fever was observed. [asean-endocrinejournal.org]

  A 29-year-old female patient visited our hospital emergency department with aggravating dyspnea for 3 days. [synapse.koreamed.org]

  Case Report A previously healthy African- American woman, aged 33 years, presented for urgent care with a three-week history of exercise and heat intolerance, dyspnea on exertion, chest pain, and a four-day history of lower-extremity edema and headaches [ispub.com]

• Cough

  Case Presentation An 85 year old woman with past medical history of hypertension and euthyroid goiter presented with a two-week-history of subjective weight loss, cough, hemoptysis and progressively worsening dyspnea, associated with a two-pillow orthopnea [pubs.sciepub.com]

  METHODS Patients who were diagnosed with hyperthyroidism (thyrotoxicosis) and in addition presented with symptoms and signs of cardiac decompensation such as shortness of breath, paroxysmal nocturnal dyspnoea, cough, palpitations, leg and abdominal swelling [rwjms1.umdnj.edu]

• Diarrhea

  Common Symptoms of Thyrotoxic Crisis: General symptoms Fever Weight loss and poor feeding habits Profuse sweating Respiratory distress GI symptoms Diarrhea Vomiting Fatigue common in elderly Nausea Jaundice Abdominal pain Neurologic symptoms Altered behavior [hyperthyroidismsymptomsx.com]

  […] due to hyperthyroidism, thyroiditis or excessive ingestion of thyroid hormone ("factitious hyperthyroidism") Includes a wide range of symptoms, such as ophtalmopathy, dermatopathy, fever, marked tachycardia, heart failure, tremor, nausea, vomiting, diarrhea [pathologyoutlines.com]

  Hyperthyroid patients typically experience symptoms such as anxiety, insomnia, weight loss, rapid heartbeat, sweating, diarrhea, and eye or vision changes. [holtorfmed.com]

  They may include Being nervous or irritable Mood swings Fatigue or muscle weakness Heat intolerance Trouble sleeping Hand tremors Rapid and irregular heartbeat Frequent bowel movements or diarrhea Weight loss Goiter, which is an enlarged thyroid that [icdlist.com]

  Intestines Digestive symptoms, like dyspepsia and frequent bowel movements/diarrhea, may occur in hyperthyroidism as a result of the increase in gut motility. [verywell.com]

• Heart Disease

  thyrotoxic marked by toxic activity of the thyroid. thyrotoxic crisis a fulminating increase in all the clinical signs of thyrotoxicosis. thyrotoxic heart disease heart disease associated with hyperthyroidism, marked by atrial fibrillation, cardiac [medical-dictionary.thefreedictionary.com]

  Abstract Thirty-two patients with uncomplicated hyperthyroidism were compared to 17 patients deemed to be suffering from pure thyrotoxic cardiac failure, other heart disease having been excluded. [ncbi.nlm.nih.gov]

  Available online at http://www.world-heart-federation.org/cardiovascular-health/heart-disease/different-heart-diseases/ through http://www.world-heart-federation.org. Accessed June 24, 2014. Diseases and Conditions: Hypothyroidism. Mayo Clinic. [labtestsonline.it]

  Of note is the fact that there were no significant differences in the mean Body Mass Indices and body weights of people with thyrotoxic heart disease and those without thyrotoxic heart disease. [pjms.com.pk]

• Tachycardia

  Abstract Monomorphic ventricular tachycardia (VT) is a unique manifestation of hyperthyroidism. [radcliffecardiology.com]

  Severe thyrotoxicosis could worsen sinus tachycardia or atrial fibrillation and leads to heart failure, which is called tachycardia-induced cardiomyopathy. [synapse.koreamed.org]

  The cardiovascular manifestations of thyrotoxic crisis include tachycardia, atrial fibrillation, accelerated hypertension, cardiomyopathy, pulmonary edema, etc. [jpgmonline.com]

  An electrocardiogram showed sinus tachycardia, right atrial enlargement, and left ventricular hypertrophy. Chest radiographs revealed mild cardiomegaly with a normal pulmonary vascular pattern. [ispub.com]

  The normal cardiac response to hyperthyroidism: Tachycardia Sinus tachycardia is the most common problem in patients with both overt and subclinical hyperthyroidism. [houstonendocrine.com]

• Cardiomegaly

  Thyrotoxicosis can cause many cardiovascular manifestations including palpitation, arrhythmia, cardiomegaly, peripheral edema, and angina. [synapse.koreamed.org]

  In addition they had a longer duration of symptoms and cardiomegaly on chest radiography. [rwjms1.umdnj.edu]

  Chest radiograph now revealed multichambered cardiomegaly (Figure 2.) Click here to download Figure 2 Figure 2. [asean-endocrinejournal.org]

  Chest radiograph showed cardiomegaly with a cardiothoracic ratio of 0.60 [Figure 1] a with pulmonary venous hypertension. Transthoracic echocardiography showed cardiomegaly and global left ventricular ejection fraction was 30%. [jpgmonline.com]

  Chest X ray findings were cardiomegaly, unfolded aorta and features of pulmonary edema. [pubs.sciepub.com]

• Chest Pain

  Case Report A previously healthy African- American woman, aged 33 years, presented for urgent care with a three-week history of exercise and heat intolerance, dyspnea on exertion, chest pain, and a four-day history of lower-extremity edema and headaches [ispub.com]

  The patient denied chest pain, shortness of breath, and syncope. Physical examination revealed thyroid enlargement with no nodules or bruit, fine resting tremors, and lid lag. The patient’s serum electrolyte and magnesium levels were normal. [radcliffecardiology.com]

  pain Cardiovascular changes Increased resting heart rate Increased cardiac output Increased myocardial oxygen demand Decreased systemic vascular resistances Systolic hypertension Peripheral oedema Congestive cardiac failure (This seems paradoxical given [ecgmojo.com]

  As many as 12% of hyperthyroid patients report symptoms almost identical to an anxiety or depressive disorder, including heart palpitations, chest pain, nervousness, hand tremors, weight fluctuation, and sleeplessness. [holtorfmed.com]

  No chest pain or fever was observed. Upon readmission, she was tachycardic with distended neck veins, muffled heart sounds and Grade 2 bipedal edema. Deep tendon reflexes were normal with no tremors. [asean-endocrinejournal.org]

• Systolic Murmur

  Cardiovascular symptoms : Palpitations, hyperkinetic circulation (tachycardia, systolic hypertension, widened pulse pressure, loud heart sounds); frequently, arrhythmia with premature ventricular contractions or atrial fibrillation, systolic murmurs [empendium.com]

• Increased Sweating

  sweating, heat intolerance, warm skin, excessive perspiration, menstrual changes, hand tremor, polydipsia and increased appetite ( J Am Geriatr Soc 1996;44:50 ) Late symptoms : cardiac (palpitations, congestive heart failure, cardiomegaly, atrial fibrillation [pathologyoutlines.com]

  As you can see, hyperthyroidism can affect the entire body, top to bottom: Temperature Increased sweating, as the body produces more heat, is another common symptom of hyperthyroidism. [verywell.com]

  Nervousness or anxiety Rapid heart rate Heart palpitations (rapid, forceful, or irregular heartbeat) Increased sweating Increased appetite Heat intolerance Difficulty concentrating Restlessness Irregular menstrual periods (or none at all) Frequent bowel [holtorfmed.com]

• Tremor

  Her skin was dry, but there was no pretibial myxedema, proptosis, lid lag, lid retraction, ophthalmoplegia or tremors. [pubs.sciepub.com]

  2016;60:287 ) Clinical features Early symptoms : anxiety, palpitations, rapid pulse, fatigue, muscle weakness, weight loss, diarrhea, hyperactive reflexes, increased sweating, heat intolerance, warm skin, excessive perspiration, menstrual changes, hand tremor [pathologyoutlines.com]

  Patients experiencing thyrotoxicosis (thyroid storm), or symptomatic hyperthyroidism, can experience a number of effects that can include tachycardia, palpitations, tremor and/or nervousness. [ebmconsult.com]

  They may include Being nervous or irritable Mood swings Fatigue or muscle weakness Heat intolerance Trouble sleeping Hand tremors Rapid and irregular heartbeat Frequent bowel movements or diarrhea Weight loss Goiter, which is an enlarged thyroid that [icdlist.com]

  Considering the whole-body effects this can have, a variety of symptoms may result, including weight loss, irritability, irregular heart rhythm, tremor, insomnia, hair loss, and more. [verywell.com]

• Agitation

  Administration of intravenous hydrocortisone which inhibits the conversion of T4 to T3 Sedation with chlorpromazine is recommended in cases with severe agitation. Tepid sponging and with paracetamol intake is advised. [hyperthyroidismsymptomsx.com]

  Common symptoms include: racing heart rate ( tachycardia ) that exceeds 140 beats per minute, and atrial fibrillation high fever persistent sweating shaking agitation restlessness confusion diarrhea unconsciousness Individuals with hyperthyroidism who [healthline.com]

  […] excessive ingestion of thyroid hormone ("factitious hyperthyroidism") Includes a wide range of symptoms, such as ophtalmopathy, dermatopathy, fever, marked tachycardia, heart failure, tremor, nausea, vomiting, diarrhea, dehydration, restlessness, extreme agitation [pathologyoutlines.com]

  Thyroid storm is characterized by exaggerated symptoms of hyperthyroidism, such as a very fast heart rate, high fever, diarrhea, agitation, delirium, and/or decreased consciousness. [verywell.com]

  These can include diarrhoea, weight loss (although around 10% develop weight gain due to increased appetite), shaking or tremor (notably in the hands), sweating, increased heart rate that can be felt by the patient (palpitations), overactivity, agitation [yourhormones.info]

• Fine Tremor

  She had a small goiter and typical signs of thyrotoxicosis including warm, moist skin and a fine tremor. There was an audible S3 on cardiac auscultation. [heart.bmj.com]

  Tremor. Mental illness: may range from anxiety to psychosis. Heat intolerance. Loss of libido. Oligomenorrhoea or amenorrhoea. Palmar erythema. Sweaty and warm palms. Fine tremor. [patient.info]

  Neuropsychiatric symptoms : Anxiety, irritability, hyperactivity (hyperkinetic behavior), concentration problems, insomnia; rarely, psychotic symptoms (suggestive of schizophrenia or bipolar disorder); fine tremor and hyperreflexia. 3. [empendium.com]

• Tremulousness

  Patients typically appear markedly hyper-metabolic with high fevers, tachycardia, nausea and vomiting, tremulousness, agitation, and psychosis. [ecgmojo.com]

• Excitement

  Introduction Apathetic thyrotoxicosis is an uncommon manifestation of hyperthyroidism, characterized by apathy and depression in contrast to the excitability and hyperkinesis of hyperthyroidism. [pubs.sciepub.com]

LABORATORY WORKUP During the patient's first admission, free thyroxine (fT4) levels were elevated (40.2 pmol/L), and thyroid stimulating hormone (TSH) was low (0.1 uIU/mL). [asean-endocrinejournal.org]

The diagnostic workup begins with a thyroid-stimulating hormone level test. When test results are uncertain, measuring radionuclide uptake helps distinguish among possible causes. [aafp.org]

Truly refractory disease is rarely found in a properly conducted workup. Postgraduate Medicine 2000;107:123-45. 33. Klein I, Ojomata K. Thyroid hormone and blood pressure regulation. [pjms.com.pk]

PubMed PMID: 11589682. 2) Serum antibodies to thyroperoxidase ( TPO )—TPO Ab—and antibodies to thyroglobulin ( Tg )—Tg Ab—(least specific): Measurement of TPO Ab and Tg Ab is not suggested for the workup of patients with low TSH values, Weak recommendation [empendium.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.de]

Patients must be monitored for side effects of anti-thyroid drug treatment (see above); any major adverse effects require discontinuation of anti-thyroid drug treatment and selection of another treatment option. [clinicaladvisor.com]

Treatment The treatment of hyperthyroidism depends on the cause and severity of the disease, as well as on the patient’s age, goiter size, comorbid conditions, and treatment desires. [aafp.org]

Surgical Treatment (Thyroidectomy) 1. [empendium.com]

[…] the remote period after surgical treatment of toxic goiter.Material and methods. [ojs.ifnmu.edu.ua]

Other population groups at risk include: elderly (due to the increased prevalence of nodular thyroid disease) people living in areas of endemic iodine deficiency Treatment and prognosis Various treatment schedules have been proposed for prophylaxis 4, [radiopaedia.org]

Prognosis of thyrotoxic crisis Untreated thyrotoxic crisis can be life threatening and can prove to be fatal. The mortality rate ranges from between 20-50% following, early diagnosis and immediate treatment. [hyperthyroidismsymptomsx.com]

Generally, repetitive monomorphic VT produces no symptoms and has a good prognosis. [radcliffecardiology.com]

Presence of jaundice suggests especially poor prognosis. Ultimately, thyroid storm is a clinical diagnosis and requires prompt recognition and treatment. [mdcalc.com]

(Textbook chapter presenting clinical manifestations, treatment options, and prognosis of hyperthyroidism in children.) Bahn Chair, RS, Burch, HB, Cooper, DS. [clinicaladvisor.com]

Etiologic diagnosis of 204 pericardial effusions. Medicine (Baltimore). 2003; 82(6): 385-91. 16. Imazio M. Pericardial involvement in systemic inflammatory diseases. Heart. 2011; 97(22):1882-1892. http://dx.doi.org/10.1136/heartjnl-2011-300054. 17. [asean-endocrinejournal.org]

[…] 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]

Etiologic diagnosis influences prognosis and therapy. [aafp.org]

The finding of new onset atrial fibrillation in a patient with goiter and thyroid bruit, focused attention upon the thyroid gland as the etiology of this patient’s illness. [pubs.sciepub.com]

Ongoing controversies regarding etiology, diagnosis, treatment Thyroid storm is a rare complication of thyrotoxicosis. [clinicaladvisor.com]

Epidemiology and aetiology In Europe, thyrotoxicosis affects around 1 in 2,000 people annually. [ 1 ] Graves' disease is the most common cause of thyrotoxicosis, accounting for around 75% of cases. [patient.info]

However, one should take into account that data obtained form hospitalised patients may not exactly represent epidemiological data. [hormones.gr]

Amer J Epidemiology 2003;157:1101-7. 17. Rojeski MT, Gharib H. Nodular thyroid disease. New Eng J Medicine 1985;4:249-53. 18. Czarkowski M, Hilgertner L, Powalowski T, Radomski D, Mikulska M. [pjms.com.pk]

Epidemiology Graves’ disease occurs in approximately 1:5,000 children. There is no seasonal variation. The peak age of Graves’ disease is in adolescence; it is more common in females (~5:1 female:male ratio). [clinicaladvisor.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]

[…] cardiomyopathy and left ventricular failure. 6,7,20 Furthermore, the patient's pregnant condition, persistent tachycardia, and atrial fibrillation could have also contributed independently to the exaggeration of the heart failure symptoms. 8,21 The pathophysiology [asean-endocrinejournal.org]

In Laragh J H, Brenner B M, editors, Hypertension, pathophysiology, diagnosis and management. 2nd Ed, New York Raven Press 1995:p2247-62. Back to E-chocardiography Home Page. [rwjms1.umdnj.edu]

The pathophysiology of Graves' disease can have a variable effect on thyroid function and patients may remain euthyroid or become hypothyroid. There may be a personal or family history of autoimmune disease. [patient.info]

Etiology The causes of hyperthyroidism, and key clinical features that differentiate each condition, are outlined in Table 2. 6, 7 View/Print Table TABLE 2 Common Etiology and Clinical Diagnosis of Hyperthyroidism Cause Pathophysiology Gland size* Nodularity [aafp.org]

These medications prevent your thyroid gland from producing excess amounts of hormones without damaging the thyroid gland. [holtorfmed.com]

The most effective way to prevent the onset of thyroid storm is to keep up with your thyroid health plan. Take your medications as instructed. Keep all appointments with your doctor and follow through with blood work orders as needed. [healthline.com]

Early recognition and appropriate management of life-threatening thyrotoxicosis is vital to prevent the high morbidity and mortality that may accompany this disorder. [jpgmonline.com]

This condition requires early diagnosis and aggressive treatment to prevent serious health complications. [hyperthyroidismsymptomsx.com]

[…] propylthiouracil, methimazole) Potassium iodine Beta-blockade (propranolol, esmolol) Corticosteroid (hydrocortisone) Supportive care (fluids, acetaminophen) ICU level care Critical Actions Iodine therapy should be administered at least 1 hour AFTER thionamides to prevent [mdcalc.com]