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Thyrotoxic Heart Disease


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  • […] 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]
  • 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]
  • 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 present the case of a 41-year-old male with a history of hyperthyroidism presenting with palpitations secondary to non-sustained episodes of monomorphic VT. Cardiac arrhythmias due to thyrotoxicosis are perpetually supraventricular in origin.[radcliffecardiology.com]
Congestive Heart Failure
  • 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]
  • 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 is one of the recognized cardiovascular complications of thyroid storm.[jpgmonline.com]
Goiter
  • 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]
  • 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]
  • Thyrotoxicosis without goiter OR other cause[icd9data.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]
  • […] is causing compressive symptoms ( Am Fam Physician 2005;72:623 ) Gross description Multinodular goiter ( CMAJ 2003;168:575 ) Symmetrically enlarged thyroid gland Gross images Contributed by Andrey Bychkov, M.D., Ph.D.[pathologyoutlines.com]
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]
  • She reported no history of fevers, sore throat, rash, weight loss, or diarrhea. She had no history of syncope and reported being unable to sleep flat on her back without problems.[ispub.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]
  • , 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]
  • 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]
  • 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]
  • 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]
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]
  • 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]
  • She also gave history of palpitation, dyspnea, orthopnea, and bilateral pedal edema. Past medical history was unremarkable. On examination she was in NYHA class IV and pulse rate was 126/min and blood pressure was 100/56 mmHg.[jpgmonline.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
  • […] 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]
  • 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]
  • 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]
  • Once it begins, patients can experience profuse sweating, fever, vomiting, diarrhea, irregular heartbeat, seizures, severe weakness, jaundice (yellowing of the skin and eyes), dangerously low blood pressure, and eventually, coma or death.[newsmax.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
  • KEYWORDS: Cesarean section; Combined spinal epidural anesthesia; Hyperthyroidism; Thyrotoxic heart disease[ncbi.nlm.nih.gov]
  • 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]
  • Article : Thyrotoxic Heart Disease Title Thyrotoxic Heart Disease Authors Siu, CW Tse, HF Lau, CP Issue Date 2005 Publisher Medcom Limited.[hub.hku.hk]
  • disease heart disease associated with hyperthyroidism, marked by atrial fibrillation, cardiac enlargement and congestive heart failure.[medical-dictionary.thefreedictionary.com]
  • disease heart sound Hemodynamic hypertension hypertrophy impulse increased influence left atrium left ventricle left ventricular mechanism Metabolism mitral stenosis murmur Muscle myocardial infarction myocardium normal occur oxygen pacemaker patients[books.google.de]
Tachycardia
  • […] potassium produced pulmonary artery pulmonary edema pulse wave regurgitation renal rhythm right atrium right ventricle right ventricular second heart sound septal defect septum shunt significant sinus node sodium Sonnenblick stroke volume syncope syndrome tachycardia[books.google.de]
  • 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]
  • 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]
  • Heart failure resulting from thyrotoxicosis is due to a tachycardia-mediated mechanism leading to an increased level of cytosolic calcium during diastole with reduced ventricular contractility and diastolic dysfunction, often with tricuspid regurgitation[ncbi.nlm.nih.gov]
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 radiographs revealed mild cardiomegaly with a normal pulmonary vascular pattern. CT Chest with IV contrast showed an enlarged thyroid gland (Fig 1 & 2).[ispub.com]
  • 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]
Wide Pulse Pressure
  • The Cardiovascular signs include: Hypertension during initial stages Tachycardia Wide pulse pressure Hypotension at later stages resulting in shock High-output heart failure signs include Cardiac arrhythmia Supraventricular arrhythmias such as atrial[hyperthyroidismsymptomsx.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
  • 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]
  • Her skin was dry, but there was no pretibial myxedema, proptosis, lid lag, lid retraction, ophthalmoplegia or tremors.[pubs.sciepub.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]
  • Fine tremor. Tachycardia - may be atrial fibrillation and/or heart failure (common in the elderly). Hair thinning or diffuse alopecia. Urticaria, pruritus. Brisk reflexes. Goitre. Proximal myopathy (muscle weakness wasting). Gynaecomastia.[patient.info]
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]
Tremulousness
  • Patients typically appear markedly hyper-metabolic with high fevers, tachycardia, nausea and vomiting, tremulousness, agitation, and psychosis.[ecgmojo.com]

Workup

  • 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]

Treatment

  • 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]
  • Surgical treatment can be performed in cases resistant to medical therapy.[ncbi.nlm.nih.gov]
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia Bridging the Gap Challenge Yourself[nejm.org]
  • […] the remote period after surgical treatment of toxic goiter.Material and methods.[ojs.ifnmu.edu.ua]
  • Exact treatment depends on the cause of the condition.[yourhormones.info]

Prognosis

  • 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]
  • Severe heart failure in thyrotoxicosis is a rare manifestation, but its prognosis is comparably favorable. 1 , 2 Goland et al. reported two case of dilated cardiomyopathy in hyperthyroidism, and they had recovered without any sequel. 3 Cardiac manifestations[synapse.koreamed.org]

Etiology

  • […] 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]
  • 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]
  • The distinction between severe thyrotoxicosis and life-threatening thyrotoxicosis, or thyroid storm, is a matter of clinical judgment. [1] The most common etiologies for thyroid storm include Graves' disease, hypersecretory thyroid carcinoma, thyrotropin-secreting[jpgmonline.com]

Epidemiology

  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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 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]
  • In Laragh JH, Brenner BM, editors, Hypertension, pathophysiology, diagnosis and management. 2nd Edition, New York Raven Press 1995;2247-62. Professional Medical Publications Room No. 522, 5th Floor, Panorama Centre Building No. 2, P.O.[pjms.com.pk]

Prevention

  • 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]
  • These medications prevent your thyroid gland from producing excess amounts of hormones without damaging the thyroid gland.[holtorfmed.com]
  • This condition requires early diagnosis and aggressive treatment to prevent serious health complications.[hyperthyroidismsymptomsx.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]
  • […] 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]

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