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Endocrine Oct 2018For the treatment of thyrotoxicosis, alternative treatment modalities may be necessary if anti-thyroid drugs cannot be used due to side effects, inefficiencies, or there...
PURPOSE
For the treatment of thyrotoxicosis, alternative treatment modalities may be necessary if anti-thyroid drugs cannot be used due to side effects, inefficiencies, or there is a need to start a rapid action such as thyroid storm. By using therapeutic plasma exchange (TPE), it is possible to effectively and rapidly remove the increased thyroid hormones. We evaluated our results and experience on a rapid, effective, and reliable alternative treatment modality in thyrotoxic patients.
METHODS
TPE was performed in 46 thyrotoxic patients at the Adult Therapeutic Apheresis Center.
RESULTS
Forty six patients with a median age of 30 years (interquartile range [IQR] 30-50) were assessed. In 40 (87%) of the cases, the diagnosis was Graves' disease. The other causes of thyrotoxicosis were amiodarone-induced thyrotoxicosis (n = 4) and toxic nodular goiter (n = 2). The median and IQR of fT3 values in patients before TPE were 9.9 (6.5-16.8) pg/mL (N: 2.3-4.2) and the median and IQR of fT4 values were 2.9 (2.3-4.1) ng/dL (N: 0.74-1.52). When the procedure was terminated, the median and IQR of fT3 values in patients were 4.0 (3.1-5.2) pg/mL and the median and IQR fT4 values were 1.6 (1.4-2.0) ng/dL. The decrease in both free thyroid hormones was found to be statistically significant (p < 0.000).
CONCLUSION
Our study is the largest series of TPE in the literature used for thyrotoxicosis. In the light of the literature and our results, we conclude that TPE is an effective alternative treatment option to prepare for ablative treatment for cases that have side effects or ineffectiveness of anti-thyroid drugs.
Topics: Adult; Female; Humans; Male; Middle Aged; Plasma Exchange; Plasmapheresis; Thyrotoxicosis; Treatment Outcome
PubMed: 29968224
DOI: 10.1007/s12020-018-1661-x -
The Journal of the Association of... Nov 2017Thyrotoxic periodic paralysis (TPP), a disorder most commonly seen in Asian men, is characterized by abrupt onset of hypokalemia and paralysis. The condition primarily...
Thyrotoxic periodic paralysis (TPP), a disorder most commonly seen in Asian men, is characterized by abrupt onset of hypokalemia and paralysis. The condition primarily affects the lower extremities and is secondary to thyrotoxicosis. Early recognition of TPP is vital to initiating appropriate treatment and to avoiding the risk of rebound hyperkalemia that may occur if high-dose potassium replacement is given. Here we present a case of 31 year old male with thyrotoxic periodic paralysis with diagnostic and therapeutic approach.
Topics: Adult; Anti-Arrhythmia Agents; Antithyroid Agents; Atrial Fibrillation; Carbimazole; Channelopathies; Diagnosis, Differential; Electrocardiography; Humans; Hypokalemic Periodic Paralysis; Male; Muscle Weakness; Potassium; Propranolol; Thyrotoxicosis; Treatment Outcome
PubMed: 29322723
DOI: No ID Found -
Frontiers in Endocrinology 2023To explore the value of the FT4/TSH ratio in the etiological diagnosis of newly diagnosed patients with thyrotoxicosis.
OBJECTIVE
To explore the value of the FT4/TSH ratio in the etiological diagnosis of newly diagnosed patients with thyrotoxicosis.
METHODS
The retrospective study was conducted on 287 patients with thyrotoxicosis (122 patients with subacute thyroiditis and 165 patients with Graves' disease) and 415 healthy people on their first visit to our hospital. All patients underwent thyroid function tests including the measurement of T3, T4, FT3, FT4, TSH, T3/TSH, and T4/TSH. The receiver operating characteristic (ROC) curve was employed to evaluate the value of FT4/TSH in the differential diagnosis of Graves' disease and subacute thyroiditis, and compared with other related indicators.
RESULTS
The area under the curve of FT4/TSH for diagnosing Graves' disease and thyroiditis was 0.846, which was significantly larger than the area under the curve of T3/T4 ratio (< 0.05) and FT3/FT4 ratio (< 0.05). When the cut-off value of the FT4/TSH ratio was 5731.286 pmol/mIU, the sensitivity was 71.52%, the specificity was 90.16%, the positive predictive value was 90.77% and the negative predictive value was 70.06%. The diagnostic accuracy was 79.44%.
CONCLUSION
FT4/TSH ratio can be used as a new reference index for the differential diagnosis of thyrotoxicosis.
Topics: Humans; Thyroiditis, Subacute; Diagnosis, Differential; Retrospective Studies; Graves Disease; Thyrotoxicosis; Thyrotropin
PubMed: 37396175
DOI: 10.3389/fendo.2023.1148174 -
British Journal of Hospital Medicine... Jan 2024Amiodarone is an antiarrhythmic drug used to treat cardiac tachyarrhythmias. It has many adverse effects, with thyroid dysfunction one of the most notable. Through...
Amiodarone is an antiarrhythmic drug used to treat cardiac tachyarrhythmias. It has many adverse effects, with thyroid dysfunction one of the most notable. Through various mechanisms, both thyrotoxicosis and hypothyroidism can occur secondary to amiodarone therapy. There are two types of amiodarone-induced thyrotoxicosis: type 1 occurs in those with pre-existing thyroid disease and is treated with thionamide, whereas type 2 occurs in those without and is treated with glucocorticoids. Patients with amiodarone-induced hypothyroidism may be given levothyroxine to replace thyroid hormone, but in some cases, the appropriate management may be cessation of amiodarone.
Topics: Humans; Amiodarone; Anti-Arrhythmia Agents; Hypothyroidism; Thyrotoxicosis
PubMed: 38300678
DOI: 10.12968/hmed.2023.0214 -
Clinical Endocrinology Jun 2018Anaemia and thyrotoxicosis are both relatively common. It is unclear whether thyrotoxicosis results in anaemia in the absence of other causes. The aim of this study was...
OBJECTIVES
Anaemia and thyrotoxicosis are both relatively common. It is unclear whether thyrotoxicosis results in anaemia in the absence of other causes. The aim of this study was to determine the prevalence and characteristics of anaemia in patients with thyrotoxicosis.
DESIGN
A prospective cohort study of patients with thyrotoxicosis.
PATIENTS
353 patients referred to a regional endocrinology centre in New Zealand from March 2013 to November 2014 for new-onset thyrotoxicosis.
MEASUREMENTS
Detailed assessment including thyroid function tests, full blood count, inflammatory markers, haematological parameters and coeliac serology. Anaemia was defined as a haemoglobin value <115 g/L (woman) or <130 g/L (men).
RESULTS
Anaemia was present in 31 (8.7%) patients at diagnosis. Of these, pre-existing anaemia was present in 10, and a further 11 had one or more identifiable underlying cause(s) for the anaemia. Only 10 patients (2.8% of the entire cohort) had anaemia not clearly attributable to another cause. Median free thyroid hormone levels were higher in those with anaemia of unknown cause compared to patients with thyrotoxicosis alone. The median duration of anaemia was shorter in patients with thyrotoxicosis-associated anaemia compared to those with anaemia due to an underlying cause (1 vs 6 months, P = .001). In all patients with thyrotoxicosis-associated anaemia, the anaemia resolved, either prior to, or on becoming euthyroid.
CONCLUSION
Anaemia coexisting with thyrotoxicosis is less common than previously reported and is mild and transient. Patients with thyrotoxicosis and significant anaemia should be investigated for other potential causes, particularly when anaemia persists.
Topics: Adult; Aged; Anemia; Female; Graves Disease; Hemoglobins; Humans; Male; Middle Aged; Prospective Studies; Thyrotoxicosis; Young Adult
PubMed: 29566435
DOI: 10.1111/cen.13598 -
Bulletin Du Cancer Feb 2020The immune checkpoint inhibitors (CPI) such as anti-PD(L)1 or anti-CTLA4 had improved long-term patients' outcomes in different malignancies. Thyroid disorders are the... (Review)
Review
The immune checkpoint inhibitors (CPI) such as anti-PD(L)1 or anti-CTLA4 had improved long-term patients' outcomes in different malignancies. Thyroid disorders are the most frequent endocrine side effects from CPI reported in clinical trials and in clinical routine practice. The incidence of thyroid dysfunction is variable according to ICP used (more frequent under anti-programmed cell death 1 (PD1) or anti-programmed cell death-ligand 1 (PDL1)). Most thyroid dysfunctions have been reported to occur 2 to 4 courses after CPI initiation. The clinical symptoms are generally nonspecific (asthenia, weight change, rarely cardiac rhythm disorder). These thyroid dysfunctions are commonly painless thyroiditis with a biphasic evolution: thyrotoxicosis followed by a secondary hypothyroidism frequently definitive. Diagnosis is made on a thyroid test (TSH and FT4). In most cases, no further exam is necessary. Beta blockers therapy is recommended in symptomatic thyrotoxicosis with palpitations. Thyroid hormones therapy will be introduced quickly in case of hypothyroidism. Thyroid dysfunctions are not a contra-indication to the continuation of immunotherapy. Due to the high frequency of these complications, close monitoring of the thyroid status is recommended under CPI.
Topics: B7-H1 Antigen; Diagnosis, Differential; Humans; Hypothyroidism; Immunotherapy; Neoplasms; Thyroid Diseases; Thyroiditis; Thyrotoxicosis
PubMed: 31879018
DOI: 10.1016/j.bulcan.2019.10.005 -
European Journal of Endocrinology Jun 2017Subclinical thyrotoxicosis is a condition affecting up to 10% of the population in some studies. We have reviewed literature and identified studies describing... (Review)
Review
Subclinical thyrotoxicosis is a condition affecting up to 10% of the population in some studies. We have reviewed literature and identified studies describing prevalences, causes and outcomes of this condition. Treatment should be considered in all subjects if this biochemical abnormality is persistent, especially in case of symptoms of thyrotoxicosis or in the presence of any complication. In particular, treatment should be offered in those subclinically thyrotoxic patients with a sustained serum TSH below 0.1 U/L. However it is important to recognise that there are no large controlled intervention studies in the field and thus there is no high quality evidence to guide treatment recommendations. In particular, there is no evidence for therapy and there is weak evidence of harm from thyrotoxicosis if serum TSH is in the 0.1-0.4 IU/L range. In this review, we describe the different causes of subclinical thyrotoxicosis, and how treatment should be tailored to the specific cause. We advocate radioactive iodine treatment to be the first-line treatment in majority of patients suffering from subclinical thyrotoxicosis due to multinodular toxic goitre and solitary toxic adenoma, but we do generally not recommend it as the first-line treatment in patients suffering from subclinical Graves' hyperthyroidism. Such patients may benefit mostly from antithyroid drug therapy. Subclinical thyrotoxicosis in early pregnancy should in general be observed, not treated. Moreover, we advocate a general restriction of therapy in cases where no specific cause for the presumed thyroid hyperactivity has been proven.
Topics: Asymptomatic Diseases; Comorbidity; Humans; Practice Guidelines as Topic; Precision Medicine; Prevalence; Thyroid Gland; Thyrotoxicosis; Watchful Waiting
PubMed: 28274949
DOI: 10.1530/EJE-16-0276 -
Experimental and Clinical Endocrinology... Jun 2018Amiodarone is one of the most commonly prescribed antiarrhythmic agents in clinical practice owing to its efficacy, even with high toxicity profile. The high iodine... (Review)
Review
Amiodarone is one of the most commonly prescribed antiarrhythmic agents in clinical practice owing to its efficacy, even with high toxicity profile. The high iodine content and the prolonged biological half-life of the drug can result in thyroid dysfunction in a high proportion of patients treated with amiodarone even after cessation of amiodarone. Both hypothyroidism and hyperthyroidism are common side effects that mandate regular monitoring of patients with thyroid function tests. Amiodarone-induced hypothyroidism (AIH) is diagnosed and managed in the same way as a usual case of hypothyroidism. However, differential diagnosis and clinical management of amiodarone-induced thyrotoxicosis (AIT) subtypes can be challenging. With the aid of a case snippet, we update the current evidence for the diagnostic work up and management of patients with amiodarone-induced thyroid dysfunction in this article.
Topics: Amiodarone; Anti-Arrhythmia Agents; Chest Pain; Coronary Artery Disease; Humans; Male; Middle Aged; Thyroid Diseases; Thyroid Function Tests; Thyrotoxicosis
PubMed: 29558786
DOI: 10.1055/a-0577-7574 -
The Journal of the Association of... Jan 2023Thyroid gland dysfunction greatly alters the hemodynamics of the body resulting in major changes in cardiac output, blood pressure and pulmonary vascular resistance...
INTRODUCTION
Thyroid gland dysfunction greatly alters the hemodynamics of the body resulting in major changes in cardiac output, blood pressure and pulmonary vascular resistance amongst others. Hyperthyroidism is associated with an increased morbidity and mortality from cardiovascular disease. Thyrotoxicosis is commonly associated with exacerbation of underlying coronary heart disease, with atrial fibrillation and systolic dysfunction. It is less well appreciated that hyperthyroidism is also associated with pulmonary arterial hypertension (PAH) and right heart failure.
MATERIALS
History -We present a 46 years old female, Presented to our hospital with complaints of Breathlessness on exertion since 3 months gradually progressed from MMRC grade 1 to grade 4 over the period of 2 months without any diurnal/postural variation Cough with expectoration since 3 weeks associated with weight loss.
RESULT
Examination-Patient is severely malnourished with BMI 11.6 kg/m2 . Bilateral multiple cervical lymph nodes palpable, 6-8 in number discrete, mobile, soft consistency, measuring 1 cm in size changes. Thyroid is symmetrically enlarged, soft in consistency, moving with deglutition, Systemic examination-Apex beat palpable at 5th intercostal space 2 cm lateral to the MCL with normal character Parasternal heave grade 3+ Palpable P2+ A high pitched, rumbling, pansystolic murmur of grade 3, non radiating heard best with the diaphragm of stethoscope with patient in supine position. Unique features-Both thyroid lobes appear enlarged in size and show homogeneously increased radiotracer uptake.
CONCLUSION
IMPRESSION- Well-visualized thyroid gland with increased trapping function. In the given clinical context scan findings favour hyperthyroid status-Graves'disease. Take home message-Hyperthyroidism is a reversible cause of pulmonary hypertension.
Topics: Humans; Female; Middle Aged; Hyperthyroidism; Thyrotoxicosis; Hypertension, Pulmonary; Atrial Fibrillation
PubMed: 37116024
DOI: No ID Found -
Presse Medicale (Paris, France : 1983) Sep 2018Amiodarone, a benzofuranic iodine-rich pan antiarrhythmic drug, is frequently associated with thyroid dysfunction. This side effect is heterogeneous and unpredicted,... (Review)
Review
Amiodarone, a benzofuranic iodine-rich pan antiarrhythmic drug, is frequently associated with thyroid dysfunction. This side effect is heterogeneous and unpredicted, motivating regular evaluation of thyroid function tests. In contrary to hypothyroidism, amiodarone-induced thyrotoxicosis (AIT) is a challenging situation owing to the risk of deterioration of the general and cardiac status of such debilitating patients. Classically, AIT is either an iodine-induced thyrotoxicosis in patients with an abnormal thyroid (type I), or due to a subacute thyroiditis on a "healthy" thyroid (type II). Even if many studies tried to better identify the types of AIT, the diagnostic dilemma of type of AIT could be present, and many patients are treated by an association of antithyroid drugs (useful for type I AIT) with corticoids (useful for type II AIT). Being the main etiological factor in AIT, amiodarone is supposed to be stopped, but it could remain the only anti-arrhythmic option that is needed to be either continued or reintroduced to improve the cardiovascular survival. Recently, many studies demonstrated that amiodarone could be continued or reintroduced in patients with history of type II AIT. Nevertheless, in the other patients, amiodarone maintenance complicates the therapeutic response to the antithyroid drugs and increases the risk of AIT recurrence. Thus, amiodarone therapy is preferred to be interrupted. In such patients, thyroid ablation is recommended once AIT is under control.
Topics: Amiodarone; Anti-Arrhythmia Agents; Endocrinology; Humans; Thyroid Function Tests; Thyroidectomy; Thyrotoxicosis
PubMed: 30274916
DOI: 10.1016/j.lpm.2018.09.001