المؤلفون: Klein, Daniel J., Rose, Emily

المصدر: Clinical Practice and Cases in Emergency Medicine. 8(1)

مصطلحات موضوعية: Thyroid storm, pediatric afebrile seizure, thyrotoxicosis, Emergency Medicine, case report

الوصف: Introduction: Seizures are a common presenting complaint and account for approximately 1% of total emergency department (ED) visits. Seizures are especially common in children less than five years old as they have a lower seizure threshold as compared to adults. One potentially dangerous etiology that is far less common, especially in children, is thyroid storm, the extreme manifestationof hyperthyroidism.Case Report: We describe the case of a 3-year-old girl who presented to the ED with an afebrile seizure but was found to be in thyroid storm. This case should serve as a reminder for emergency physicians to consider thyroid disease when evaluating patients presenting with seizures.Conclusion: Although most pediatric seizures are self-limited and frequently benign, it is imperative that the emergency physician evaluate for and rule out any potentially associated dangerous conditions such as thyroid storm.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/9500t8m2Test

المؤلفون: Kunz, Matthew J., Martini, Wayne A., Filler, Levi

المصدر: Clinical Practice and Cases in Emergency Medicine. 8(1)

مصطلحات موضوعية: case report, thyrotoxicosis, methimazole, bone marrow suppression, agranulocytosis

الوصف: Introduction: Thyroid storm is a rare but potentially life-threatening metabolic disorder that presents unique management challenges in the emergency department. Thionamides are commonly used as monotherapy for first-line treatment of hyperthyroidism.Case Report: In this case, a 26-year-old male presented to the emergency department with sore throat, fever, and diarrhea. He was found to have thyrotoxicosis as well as methimazole-induced bone marrow suppression resulting in agranulocytosis.Conclusion: Thyroid storm is a rare condition that carries a high risk of mortality and can further compromise a patient’s immune system due to complications of common treatment modalities. It can potentially be misdiagnosed as sepsis due to tachycardia, febrile state, and tachypnea. This case report includes a discussion of diagnostic studies, as well as medical and surgical treatment modalities that led to the patient’s recovery.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/1251v3fcTest

المؤلفون: Ji Eun Jun, Tae Hyuk Kim, Sun Wook Kim, Jae Hoon Chung, Jae Hyeon Kim, You-Bin Lee, Mira Kang

المصدر: Scientific Reports, Vol 14, Iss 1, Pp 1-10 (2024)

مصطلحات موضوعية: Thyroid hormone, Subclinical hypothyroidism, Subclinical thyrotoxicosis, Diastolic disfunction, Medicine, Science

الوصف: Abstract Thyroid hormones modulate the cardiovascular system. However, the effects of subclinical thyroid dysfunction and euthyroidism on cardiac function remain unclear. We investigated the association between left ventricular (LV) diastolic dysfunction and subclinical thyroid dysfunction or thyroid hormones within the reference range. This cross-sectional study included 26,289 participants (22,197 euthyroid, 3,671 with subclinical hypothyroidism, and 421 with subclinical thyrotoxicosis) who underwent regular health check-ups in the Republic of Korea. Individuals with thyroid stimulating hormone (TSH) levels > 4.2 µIU/mL and normal free thyroxine (FT4, 0.78–1.85 ng/dL) and triiodothyronine (T3, 76–190 ng/dL) levels were defined as having subclinical hypothyroidism. Individuals with serum TSH levels 50% and (a) E/e’ ratio > 15, or (b) E/e’ ratio of 8–15 and left atrial volume index ≥ 34 mL/m2. Subclinical hypothyroidism was significantly associated with cardiac indices regarding LV diastolic dysfunction. The odds of having LV diastolic dysfunction was also increased in participants with subclinical hypothyroidism (adjusted odds ratio [AOR] 1.36, 95% confidence interval [CI], 1.01–1.89) compared to euthyroid participants. Subclinical thyrotoxicosis was not associated with LV diastolic dysfunction. Among the thyroid hormones, only serum T3 was significantly and inversely associated with LV diastolic dysfunction even within the normal range. Subclinical hypothyroidism was significantly associated with LV diastolic dysfunction, whereas subclinical thyrotoxicosis was not. Serum T3 is a relatively important contributor to LV diastolic dysfunction compared to TSH or FT4.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/fedd69c2089c4a069fd9690653833bf0Test

المؤلفون: Sara De Vincentis, Simona Loiacono, Eleonora Zanni, Roberta Sueri, Maria Laura Monzani, Daniele Santi, Ilaria Muller, Francesco Di Marco, Erica Crivicich, Mirco Armenti, Uberto Pagotto, Lorenzo Tucci, Carolina Cecchetti, Tommaso Trenti, Valentina Pecoraro, Giulia Canu, Manuela Simoni, Giulia Brigante

المصدر: European Thyroid Journal, Vol 13, Iss 3, Pp 1-9 (2024)

مصطلحات موضوعية: thyroid, sars-cov-2, vaccine, pandemic, thyrotoxicosis, covid-19, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: Objective: Many cases of subacute thyroiditis (SAT) have been described related to SARS-CoV-2 infection, but no prospective data about follow-up are known. This prospective, longitudinal, 3-year, multicentre study aims to explore the clinical peculiarities and outcome of SAT in relation to SARS-CoV-2 infection, ascertained with antibody dosage. Methods: All patients receiving SAT diagnosis from November 2020 to May 2022 were enrolled. Data on anamnesis, physical examination, blood tests (TSH, freeT4, freeT3, thyroglobulin, anti-thyroid antibodies, C-reactive protein, erythrocyte sedimentation rate, complete blood count), and thyroid ultrasound were collected. At baseline, the presence of IgG against the SARS-CoV-2 spike protein or nucleocapsid was investigated. Patients were evaluated after 1, 3, 6, and 12 months. Results: Sixty-six subjects were enrolled. At baseline, 54 presented with pain, 36 (67%) for at least 15 days. Serum SARS-CoV-2 IgG measurements documented that 7 out of 52 subjects (13.5%) had infection before SAT diagnosis (COVID+). No significant differences between the COVID+ and COVID− groups were found at baseline, except for respiratory symptoms and fever, which were more common in COVID+ (P = 0.039 and P = 0.021, respectively). Among the 41 subjects who completed follow-up, COVID+ and COVID− did not differ for therapeutic approach to SAT or outcome, all having an improvement in neck pain, inflammation parameters, and ultrasound features. Conclusion: This is the first prospective study investigating any difference both at diagnosis and at follow-up between SAT presentation in patients with previous SARS-CoV-2 infection and those without. Our data demonstrate that SARS-CoV-2 does not impact on SAT onset, evolution, and outcome.

وصف الملف: electronic resource

العلاقة: https://etj.bioscientifica.com/view/journals/etj/13/3/ETJ-24-0083.xmlTest; https://doaj.org/toc/2235-0802Test

الوصول الحر: https://doaj.org/article/bbdf4492a82e4c84a6fb5063bff666d7Test

المؤلفون: GE Yaxue, DING Zhiguo, CHEN Xiaoheng, LI Huilong, QI Shuo, HU Rui

المصدر: Zhongguo quanke yixue, Vol 27, Iss 21, Pp 2630-2638 (2024)

مصطلحات موضوعية: hashimoto disease, hashimoto thyroiditides, hashimoto thyroiditis complicated with thyrotoxicosis, traditional chinese medicine syndrome, regularity of distribution, factor analysis, cluster analysis, Medicine

الوصف: Background Traditional Chinese Medicine (TCM) has a systematic understanding of the occurrence, development, diagnosis and treatment of Hashimoto's thyroiditis complicated with thyrotoxicosis. However, at present, there are few studies on the clinical symptoms and syndrome distribution of TCM in this disease population, and there is also a lack of description of the syndrome distribution and syndrome diagnostic criteria of this disease in the national industry standards. Objective Using factor analysis combine with cluster analysis to explore the distribution of clinical symptoms and syndromes of Hashimoto's thyroiditis complicated with thyrotoxicosis, provide a basis for clinical syndrome differentiation and promote the standardization of Hashimoto's thyroiditis complicated with thyrotoxicosis syndrome. Methods From December 2020 to December 2021, 171 patients with Hashimoto's thyroiditis complicated with thyrotoxicosis who met the diagnostic criteria in the outpatient department of thyroid disease of Dongcheng District, Tongzhou District of Dongzhimen Hospital, Beijing University of Chinese Medicine and Sunsimiao Hospital was collected. The symptoms, signs, tongue, pulse and other four diagnostic information were collected by using the four diagnostic information collection table of Hashimoto's thyroiditis complicated with thyrotoxicosis'. Based on factor analysis and cluster analysis, the symptoms and syndrome distribution of Hashimoto's thyroiditis complicated with thyrotoxicosis were studied. Results Among the 171 patients with Hashimoto's thyroiditis complicated with thyrotoxicosis, there were 17 males and 154 females, with an average age of (39.98±13.30) years. Patients aged 20-60 years accounted for 87.72%. The symptoms with high frequency in the distribution of symptoms were fatigue, palpitation, irritability or impatience. Signs were swelling of the neck, finger tremor. The tongue image with higher frequency had red, thin tongue and tooth marks on the tongue. The moss were white and thin. The pulse condition were pulse string and pulse number. Factor analysis of 82 four diagnostic items of the questionnaire was collected, and 25 common factors were extracted. The cumulative variance contribution rate was 70.562%, and 62 meaningful symptoms were screened out. The 25 common factor results obtained by factor analysis were used as variables to perform R-type system cluster analysis, and a total of 5 types of syndrome types were obtained, namely: pattern of phlegm congealing due to liver depression, pattern of yin deficiency with effulgent fire, pattern of yang deficiency in spleen and kidney, pattern of qi stagnation due to liver depression, pattern of dual deficiency of qi and nutrient phases. Conclusion The basic TCM syndromes of Hashimoto's thyroiditis complicated with thyrotoxicosis can be divided into pattern of phlegm congealing due to liver depression, pattern of yin deficiency with effulgent fire, pattern of yang deficiency in spleen and kidney, pattern of qi stagnation due to liver depression, pattern of dual deficiency of qi and nutrient phases.

وصف الملف: electronic resource

العلاقة: https://www.chinagp.net/fileup/1007-9572/PDF/20230599.pdfTest; https://doaj.org/toc/1007-9572Test

الوصول الحر: https://doaj.org/article/97653b04dfff48d2a77499624c22ab8dTest

المؤلفون: Proboteanu Paul, Caloian Bogdan, Pop Dana

المصدر: Journal of Cardiovascular Emergencies, Vol 10, Iss 2, Pp 78-82 (2024)

مصطلحات موضوعية: thyrotoxicosis, basedow’s disease, cardiac failure, sinus tachycardia, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Thyroid hormones influence multiple systems, but most often the impact on the cardiovascular system is what brings the patient to the emergency department. Basedow’s disease, an autoimmune condition, is one of the most common causes of hyperthyroidism. The purpose of this presentation is to raise attention to an extracardiac cause that can lead to cardiac failure.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2457-5518Test

الوصول الحر: https://doaj.org/article/51aebbb709dc4962b727703a2ace8656Test

المؤلفون: O. O. Soloviuk, R. L. Kulynych, O. A. Soloviuk

المصدر: Zaporožskij Medicinskij Žurnal, Vol 26, Iss 3, Pp 254-257 (2024)

مصطلحات موضوعية: iodine-induced thyrotoxicosis, iodine transport, amiodarone, thyrostatics, glucocorticoids, Medicine

الوصف: Iodine-induced thyrotoxicosis (IIT) is an abnormal function of the thyroid gland towards increasing caused by excessive iodine intakes of the body. The main reasons for the development of IIT are effects of increased amounts of iodine in people with long-standing iodine deficiency, medical procedures with exposure to radiographic iodinated contrast media as well as long-term treatment with iodine-containing drugs, primarily amiodarone. Aim: to describe an original practical case of the type 2 amiodarone-induced thyrotoxicosis development, to analyze the peculiarities of its clinical manifestations, to evaluate the possibilities for pharmacological correction of thyropathy, and to show the importance of the thyroid gland function systematic monitoring to prevent amiodarone-associated thyroid complications on the example of a particular patient taking antiarrhythmic therapy for a long time. A 71-year-old patient S. was on inpatient treatment in the Endocrinology Department of MNE “Zaporizhzhia Regional Clinical Hospital” ZRC with diagnosed thyrotoxicosis based on complaints, laboratory and instrumental examinations, which was probably caused by long-term amiodarone treatment. A vitally important situation for the patient was the compression of mediastinal organs of unspecified genesis, which significantly complicated swallowing in the first place and impaired food passage into the stomach. Additional examinations using imaging methods were contraindicated due to thyrotoxicosis, since iodine-containing contrast agents could not be used. Surgical decompression of mediastinal organs was also not considered due to the presence of concomitant pathology which greatly increased the operative risk. Treatment of thyrotoxicosis with the use of thyrostatic drugs in dynamics did not result in a significant decrease in serum levels of thyroid hormones. It was decided to prescribe glucocorticoids. The patient started prednisolone therapy at a dose of 30 mg per day. A week later, positive dynamics were obtained as a reduction in compression phenomena. The patient began to swallow normally and take food independently. According to the treatment regimen, the dose of prednisolone and methimazole was gradually reduced to maintenance. On the 17th day of hospital stay, the patient was discharged for further treatment in an outpatient setting. After 4 months, the patient was examined by an endocrinologist. A palpable decrease in the thyroid gland size was noted. There were no objective signs of thyrotoxicosis. Based on laboratory tests, TSH was 1.28 μIU/ml (0.38–4.31 μIU/ml), free T4 was 15.52 ng/dL (0.82–1.63 ng/dL). The patient was capable of eating independently and did not complain of swallowing disorders or other clinical manifestations of mediastinal compression. He continued to take prednisolone at a dose of 5 mg per day, tyrosol 5 mg per day. Conclusions. Thus, the paper has described and analyzed the clinical case of the patient with type 2 amiodarone-induced thyrotoxicosis. Findings have indicated that cessation of amiodarone and management with glucocorticoids in view of ineffective thyrostatic treatment resulted in positive response to therapy of thyropathy in the patient. The importance of routine thyroid function monitoring to prevent amiodarone-induced thyroid complications of long-term antiarrhythmic therapy has also been shown.

وصف الملف: electronic resource

العلاقة: http://zmj.zsmu.edu.ua/article/view/292125/297252Test; https://doaj.org/toc/2306-4145Test; https://doaj.org/toc/2310-1210Test

الوصول الحر: https://doaj.org/article/092509ba31ac47cb98b09bbbe5f42a9dTest

المؤلفون: Kristina Yu. Zherebchikova, Dmitry S. Bubnov, Alexandra S. Ermolaeva, Madina O. Soltakhanova, Yulia P. Sych, Marat V. Ezhov, Valentin V. Fadeev

المصدر: Consilium Medicum, Vol 26, Iss 1, Pp 7-11 (2024)

مصطلحات موضوعية: amiodarone, amiodarone-induced thyrotoxicosis, glucocorticoids, thyroid gland, thyrostatics, agranulocytosis, atrial fibrillation, chronic heart failure, Medicine (General), R5-920, Therapeutics. Pharmacology, RM1-950

الوصف: Atrial fibrillation is the most common heart rhythm disorder in patients with chronic heart failure. One of the most effective antiarrhythmic drugs for the treatment and prevention of a wide range of supraventricular and ventricular tachyarrhythmia is amiodarone. In the group of patients with paroxysmal atrial fibrillation and low left ventricular ejection fraction, it is the drug of choice when conducting a „rhythm control“ strategy. Patients receiving amiodarone often develop an adverse event – amiodarone-induced thyrotoxicosis, which exacerbates the course of cardiovascular pathology. In this article, we consider a clinical case of amiodarone-induced thyrotoxicosis in a 30-year-old patient with dilated cardiomyopathy and agranulocytosis that developed against the background of thyrostatic therapy.

وصف الملف: electronic resource

العلاقة: https://consilium.orscience.ru/2075-1753/article/viewFile/631430/146875Test; https://doaj.org/toc/2075-1753Test; https://doaj.org/toc/2542-2170Test

الوصول الحر: https://doaj.org/article/07941297c2074e4188187a100fc2818aTest

المؤلفون: Ayana Yamagami, Shintaro Iwama, Tomoko Kobayashi, Xin Zhou, Yoshinori Yasuda, Takayuki Okuji, Masaaki Ito, Tetsushi Izuchi, Masahiko Ando, Takeshi Onoue, Takashi Miyata, Mariko Sugiyama, Daisuke Hagiwara, Hidetaka Suga, Ryoichi Banno, Hiroshi Arima

المصدر: Endocrine Journal, Vol 71, Iss 5, Pp 515-526 (2024)

مصطلحات موضوعية: pd-1, irae, thyroiditis, hypothyroidism, thyrotoxicosis, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: Anti-thyroglobulin antibodies (TgAb) and/or anti-thyroid peroxidase antibodies (TPOAb) positivity at baseline is a risk marker for thyroid immune-related adverse events (thyroid-irAEs) in anti-programmed cell death-1 antibody (PD-1-Ab) treatment; however, it is unknown if TgAb and TPOAb titers are associated with clinical characteristics of thyroid-irAEs. Among 586 patients treated with PD-1-Ab at Nagoya University Hospital between 2 November 2015 and 30 September 2021, 57 patients developed thyroid-irAEs (thyrotoxicosis [n = 38]; hypothyroidism without prior thyrotoxicosis {isolated hypothyroidism} [n = 19]) in whom thyroid function, and TgAb and TPOAb titers were determined at baseline and at the onset. The changes in TgAb (median, 54.8 vs. 0.2 IU/mL; p = 0.002) and TPOAb titers (31.6 vs. 0 IU/mL; p = 0.032) from baseline to onset of developing thyroid-irAEs were greater in patients with thyrotoxicosis than patients with isolated hypothyroidism. Higher TgAb and TPOAb titers, and the TgAb titer at baseline were associated with an earlier onset of thyrotoxicosis and higher peak free thyroxine levels, respectively. Twenty-eight patients who developed hypothyroidism after thyrotoxicosis had higher TgAb (54.5 vs. 10.7 IU/mL; p = 0.011) and TPOAb titers at baseline (46.1 vs. 9.0 IU/mL; p < 0.001) and greater changes in TgAb (61.7 vs. 7.8 IU/mL; p = 0.025) and TPOAb titers (52.8 vs. –0.8 IU/mL; p < 0.001) than patients who did not develop hypothyroidism. The TgAb titer at baseline and changes in the TgAb and TPOAb titers were greater in patients with thyrotoxicosis than patients with isolated hypothyroidism, suggesting that the magnitude of the thyroid autoimmune response reflects the clinical types of thyroid-irAEs.

وصف الملف: electronic resource

العلاقة: https://www.jstage.jst.go.jp/article/endocrj/71/5/71_EJ23-0480/_html/-char/enTest; https://doaj.org/toc/1348-4540Test

الوصول الحر: https://doaj.org/article/1d92f42bf79d45b888bf5aa2e26c67fcTest

المؤلفون: Georgios Kostopoulos, Grigoris Effraimidis

المصدر: European Thyroid Journal, Vol 13, Iss 2, Pp 1-16 (2024)

مصطلحات موضوعية: hyperthyroidism, thyrotoxicosis, atrial fibrillation, stroke, anticoagulation, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: Atrial fibrillation (AF) is a common condition with a global estimated prevalence of 60 million cases, and the most common cardiac complication of hyperthyroidism, occurring in 5–15% of overtly hyperthyroid patients. Additionally, subclinical hyperthyroidism and high-normal free T4 have been associated with an increased risk in the development of AF. Hyperthyroidism-related AF is a reversible cause of AF, and the majority of patients spontaneously revert to sinus rhythm in 4–6 months during or after restoration of euthyroidism. Therefore, restoring thyroid function is an indispensable element in hyperthyroidism-related AF management. Rate control with beta-blockers consists another first-line therapy, reserving rhythm control in cases of persistent hyperthyroidism-related AF. It is still controversial whether hyperthyroidism is an independent risk factor of stroke in nonvalvular AF. As a result, initiating anticoagulation should be guided by the clinical thromboembolic risk score CHA2DS2-VASc score in the same way it is applied in patients with non-hyperthyroidism-related AF. Treatment with the novel direct oral anticoagulants appears to be as beneficial and may be safer than warfarin in patients with hyperthyroidism-related AF. In this review, we address the epidemiology, prognosis, and diagnosis of hyperthyroidism-related AF, and we discuss the management strategies and controversies in patients with hyperthyroidism-related AF.

وصف الملف: electronic resource

العلاقة: https://etj.bioscientifica.com/view/journals/etj/13/2/ETJ-23-0254.xmlTest; https://doaj.org/toc/2235-0802Test

الوصول الحر: https://doaj.org/article/3b15a85674f34db7bf3e27bbe0a4f0acTest