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Przeglad Lekarski 2016Thyrotoxicosis is a pathological syndrome in which tissue is exposed to excessive amounts of circulating thyroid hormones. Including its subclinical form, it is... (Review)
Review
Thyrotoxicosis is a pathological syndrome in which tissue is exposed to excessive amounts of circulating thyroid hormones. Including its subclinical form, it is considered as one of the most frequent endocrine disorders in the general population. If not detected in a timely fashion, thyrotoxicosis can have serious health consequences. The most common forms of thyrotoxicosis include diffuse toxic goiter (Graves' disease), toxic multinodular goiter (Plummer's disease), and toxic adenoma (Goetsch's disease). The significant progress in the fields of hormonal assessment, imaging procedures and molecular biology made in recent years has brought about great improvement in the identification, differentiation and treatment of many other disorders associated with thyrotoxicosis. Therefore, this paper discusses the etiopathogenesis, clinical manifestation, biochemical abnormalities and management of thyrotropinoma, resistance to thyroid hormone, de Quervain's, silent, acute, posttraumatic and radiation-induced thyroiditis, Riedel's goiter, differentiated thyroid cancer, struma ovarii, thyrotoxicosis factitia, other forms of iatrogenic thyrotoxicosis, gestational trophoblastic disease, neonatal Graves's disease, familial nonautoimmune hyperthyroidism and McCune-Albright syndrome. On the basis of available studies, some of whom were carried out in the recent years, we provide practical guidelines for clinical endocrinologists dealing with the diagnosis and treatment of thyrotoxicosis.
Topics: Adult; Child; Disease Management; Female; Humans; Infant, Newborn; Pregnancy; Thyroid Hormones; Thyroid Neoplasms; Thyrotoxicosis
PubMed: 27526430
DOI: No ID Found -
Frontiers in Endocrinology 2022Subclinical thyrotoxicosis (SCT) is defined by low or undetectable thyroid-stimulating hormones and normal thyroid hormones. The treatment of SCT is uncertain despite...
BACKGROUND
Subclinical thyrotoxicosis (SCT) is defined by low or undetectable thyroid-stimulating hormones and normal thyroid hormones. The treatment of SCT is uncertain despite being associated with increased cardiovascular risk (CVR) and mortality. Circulating endothelial progenitor cells (cEPCs) and circulating angiogenic cells (CACs) have been found to be reduced in conditions with CVR. We aimed to evaluate whether endothelial function and cEPC and CAC counts were reduced in SCT and to study the effect of triiodothyronine (T3) on proangiogenic cell (PAC) function from young healthy controls.
METHODS
cEPCs (quantified by flow cytometry, 20 SCT/20 controls), CACs following cultures (15 SCT/14 controls), paracrine function of CACs, endothelial function by flow-mediated dilation (FMD, 9 SCT/9 controls), and the effect of T3 on apoptosis and endothelial nitric oxide synthase () expression in PACs were studied.
RESULTS
< 0.001, CD133/VEGFR-2 0.4 (0.0-0.7) vs. 0.6 (0.0-4.6), = 0.009, CD34/VEGFR-2 0.3 (0.0-1.0) vs. 0.7 (0.1-4.9), = 0.002; while CAC count was similar. SCT predicted a lower cEPC count after adjustment for conventional CVR factors. FMD was lower in SCT subjects versus controls (% mean ± SD, 2.7 ± 2.3 vs. 6.1 ± 2.3, = 0.005). studies showed T3 increased early apoptosis and reduced expression in PACs.
CONCLUSIONS
In conclusion, SCT is associated with reduced cEPC count and FMD, confirming increased CVR in SCT. Future outcome trials are required to examine if treatment of this subclinical hyperactive state improves cardiovascular outcome.
CLINICAL TRIAL REGISTRATION
http://www.controlled-trials.com/isrctn/, identifier ISRCTN70334066.
Topics: Cardiovascular Diseases; Endothelial Progenitor Cells; Heart Disease Risk Factors; Humans; Risk Factors; Thyrotoxicosis; Vascular Endothelial Growth Factor Receptor-2
PubMed: 35923624
DOI: 10.3389/fendo.2022.894093 -
BMJ Case Reports Mar 2022Neonatal Graves' is uncommon, but a potentially fatal condition caused by transplacental transfer of thyroid stimulating immunoglobulin (TSI). It is seen in 1%-5% of...
Neonatal Graves' is uncommon, but a potentially fatal condition caused by transplacental transfer of thyroid stimulating immunoglobulin (TSI). It is seen in 1%-5% of infants born to a mother with Graves' disease. Here, we report a unique case of transient neonatal thyrotoxicosis with positive TSI in a premature neonate born to the mother with primary hypothyroidism. A short course of antithyroid drug treatment leads to significant clinical and biochemical improvement followed by complete recovery.
Topics: Antithyroid Agents; Graves Disease; Humans; Hypothyroidism; Immunoglobulins, Thyroid-Stimulating; Infant, Newborn; Pregnancy Complications; Thyrotoxicosis
PubMed: 35264385
DOI: 10.1136/bcr-2021-247865 -
The Journal of Clinical Endocrinology... Apr 2022The significance of thyroid peroxidase (TPOAb) and thyroglobulin antibody (TgAb) in the pathogenesis of thyroid immune-related adverse events (irAEs) is unknown.
CONTEXT
The significance of thyroid peroxidase (TPOAb) and thyroglobulin antibody (TgAb) in the pathogenesis of thyroid immune-related adverse events (irAEs) is unknown.
OBJECTIVE
To characterize the association of anti-thyroid antibodies with the development of thyroid immune related adverse events.
METHODS
A retrospective cohort study was conducted of patients with melanoma receiving immune checkpoint inhibitor (ICI) treatment. TPOAb, TgAb, and interleukin-6 (IL-6) were measured retrospectively using tumor-banked samples at baseline and at time of diagnosis of a thyroid irAE. In euthyroid patients (without thyroid irAEs) measures were repeated 30 to 60 days after ICI commencement, which was similar to the median time to onset of thyroid irAEs in other patients.
RESULTS
A total of 122 patients were included-31 remained euthyroid, 47 developed subclinical thyrotoxicosis, 37 developed overt thyrotoxicosis, and 7 developed overt hypothyroidism without preceding thyrotoxicosis. Baseline elevation of TPOAb or TgAb was present in 19 (16%) and 28 (23%) patients, respectively. Positive TPOAb or TgAb at baseline was 97% and 100% specific for eventual development of a thyroid irAE, respectively. During ICI treatment, overt thyrotoxicosis, but not other subtypes of thyroid irAE, was associated with statistically significant increases in the titer of TgAb and TPOAb. Baseline IL-6 levels were not associated with thyroid irAE onset but statistically significantly increased during treatment in patients who developed overt hypothyroidism.
CONCLUSIONS
TPOAb and TgAb positivity at baseline was more prevalent in patients who developed thyroid irAEs. Statistically significant increases or new antibody positivity was observed in association with overt thyrotoxicosis. TPOAb and TgAb positivity or increases during ICI treatment may be a useful biomarker to identify patients at increased risk of thyroid irAEs, particularly overt thyrotoxicosis.
Topics: Autoantibodies; Humans; Hypothyroidism; Interleukin-6; Retrospective Studies; Thyrotoxicosis
PubMed: 35104870
DOI: 10.1210/clinem/dgac059 -
The Journal of Laryngology and Otology Mar 2023Total thyroidectomy can be used as a definitive treatment modality for thyrotoxicosis. This study assessed the outcomes of patients treated with surgery at a single...
OBJECTIVE
Total thyroidectomy can be used as a definitive treatment modality for thyrotoxicosis. This study assessed the outcomes of patients treated with surgery at a single secondary care site.
METHOD
A retrospective cohort study was conducted analysing consecutive patients who underwent thyroid surgery for thyrotoxicosis between 24 November 2000 and 26 April 2019 ( = 595).
RESULTS
Total thyroidectomy was performed in 95.4 per cent of patients. Two-thirds of patients had Graves' disease histology. Of patients, 22.8 per cent became transiently hypothyroid whilst on levothyroxine (thyroid hormone replacement therapy). Transient and persistent hypocalcaemia was present in 23.3 per cent and 2.8 per cent of patients respectively. Recurrent laryngeal nerve palsy was transient and persistent in 3.6 per cent and 0.3 per cent respectively. Of patients, 2.5 per cent developed post-operative haematomas that required surgical evacuation in the operating theatre.
CONCLUSION
The overall complication rate for thyroid surgery is higher in thyrotoxic than in euthyroid patients. Compared to other treatment modalities, total thyroidectomy appears to be the most effective, definitive means of managing Graves' disease.
Topics: Humans; Retrospective Studies; Thyrotoxicosis; Graves Disease; Hypothyroidism
PubMed: 35282842
DOI: 10.1017/S0022215122000664 -
Revista Espanola de Patologia :... 2021Amiodarone (AMD) is a class III antiarrhythmic drug whose chronic or high dosage administration alters the tests of thyroid function. AMD is also associated with...
Amiodarone (AMD) is a class III antiarrhythmic drug whose chronic or high dosage administration alters the tests of thyroid function. AMD is also associated with hypothyroidism or thyrotoxicosis. Total thyroidectomy is an efficient treatment of AMD-induced thyrotoxicosis in cases resistant to medical therapy, worsening of cardiac function and/or severe thyrotoxicosis. Although AMD is a widely used drug, its pathological consequences are not well known. We describe the pathological findings in the thyroid gland of a patient who underwent total thyroidectomy due to AMD-induced thyrotoxicosis. The surgical specimen was macroscopically normal, but histologically showed multiple follicles totally or partially invaded by clear vacuolated (foamy) histiocytes, sometimes multinucleated. Loss of thyrocytes, breaks in the follicular basal membrane and stromal fibrosis could also be appreciated but no lymphocytic infiltrates were found. An awareness of these histopathological features is particularly important for surgical pathologists, especially as there are very few published reports describing these alterations.
Topics: Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Humans; Male; Middle Aged; Thyroid Epithelial Cells; Thyroid Gland; Thyroidectomy; Thyrotoxicosis
PubMed: 33726888
DOI: 10.1016/j.patol.2019.04.001 -
Clinical Endocrinology Nov 2019To investigate the impact of mandatory iodine fortification (IF) on the incidence of nosological subtypes of overt thyrotoxicosis and hypothyroidism.
OBJECTIVE
To investigate the impact of mandatory iodine fortification (IF) on the incidence of nosological subtypes of overt thyrotoxicosis and hypothyroidism.
DESIGN
We identified and scrutinized all possible new cases of overt thyrotoxicosis and hypothyroidism in an open cohort in Northern Jutland (n = 309 434; 1 January 1997) during the years 2014-2016. Individual medical history was evaluated to verify and detail the incidence of overt thyroid dysfunction and for classification into nosological subtypes. A number of cases were excluded during final verification due to spontaneous normalization of thyroid function, as they had no medical history suggesting a known condition, which could transiently affect thyroid function (subacute/silent thyroiditis, PPTD and iatrogenic thyroid dysfunction). An identical survey was conducted in 1997-2000 prior to mandatory IF of salt (13 µg/g) that was in effect from year 2001.
RESULTS
The standardized incidence rate (SIR) of verified overt thyrotoxicosis decreased markedly from 97.5/100 000/year in 1997-2000 to 48.8 in 2014-2016 (SIRR: 0.50 [95% CI: 0.45-0.56]). This was due to a distinct decrease in the SIR of multinodular toxic goitre (SIRR: 0.18 [0.15-0.23]), solitary toxic adenoma (SIRR: 0.26 [0.16-0.43]) and to a lesser degree Graves' disease (SIRR: 0.67 [0.56-0.79]). SIR for overt hypothyroidism was unaltered by 2014-2016 (SIRR: 1.03 [0.87-1.22]). However, age distribution shifted with more young and fewer elderly cases of verified overt hypothyroidism.
CONCLUSION
Mandatory IF caused a substantial reduction in SIR of verified overt thyrotoxicosis (especially of nodular origin) while avoiding an increase in SIR of verified overt hypothyroidism.
Topics: Adult; Female; Humans; Hypothyroidism; Incidence; Iodine; Male; Middle Aged; Reactive Oxygen Species; Sodium Chloride, Dietary; Thyroid Function Tests; Thyrotoxicosis
PubMed: 31400012
DOI: 10.1111/cen.14072 -
The Journal of Clinical Endocrinology... Aug 2020The potential for endocrine care via telemedicine has been recognized since the early 2000s when clinical outcome data demonstrated improvements in glycemic control with...
CONTEXT
The potential for endocrine care via telemedicine has been recognized since the early 2000s when clinical outcome data demonstrated improvements in glycemic control with telemedicine. The widespread use of telemedicine during the COVID-19 pandemic has pushed telemedicine beyond diabetes care and into clinical areas with a paucity of published data. The evaluation and treatment of thyrotoxicosis heavily relies on laboratory assessment and imaging with physical exam playing a role to help differentiate the etiology and assess the severity of thyrotoxicosis.
CASE DESCRIPTION
We describe a patient presenting for evaluation of new thyrotoxicosis via telemedicine, and describe modifications to consider for thorough, safe evaluation via telemedicine.
CONCLUSION
Telemedicine may be an ideal way to assess and treat patients with thyrotoxicosis who are not able to physically attend a visit with an endocrinologist but still have access to a laboratory for blood draws. Potential challenges include access to imaging and high-volume surgeons if needed. Clinical and economic outcomes of telemedicine care of thyrotoxicosis should be studied so that standards of care for endocrine telemedicine can be established.
Topics: Adult; Betacoronavirus; COVID-19; Coronavirus Infections; Endocrinology; Female; Humans; Pandemics; Pneumonia, Viral; SARS-CoV-2; Symptom Assessment; Telemedicine; Thyrotoxicosis
PubMed: 32525973
DOI: 10.1210/clinem/dgaa373 -
Endocrine Jun 2024Thyrotoxicosis is defined as a condition caused by excessive thyroid hormone concentrations, with the main cause being inappropriately increased thyroid hormone...
PURPOSE
Thyrotoxicosis is defined as a condition caused by excessive thyroid hormone concentrations, with the main cause being inappropriately increased thyroid hormone production. Existing literature indicates a correlation between thyrotoxicosis and mortality. Thus, this descriptive analysis was conducted to assess the demographic and regional trends of thyrotoxicosis-related mortality in the United States.
METHODS
Death certificates from the Center of Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) from 1999 to 2020 were retrieved for thyrotoxicosis-related mortality in the United States. The crude and age-adjusted mortality rates (AAMRs) per 1,000,000 population and annual percentage change (APCs) were calculated.
RESULTS
There were 33,253 thyrotoxicosis-related deaths from 1999 to 2020. Initially, the AAMR increased from 1999 to 2003 (APC: 3.09; 95% CI 0.83 to 8.16), followed by a steep decline from 2003 to 2008 (APC: -4.28; 95% CI -7.46 to -2.47), followed by a marginal decline from 2008 to 2018 (APC: -0.71; 95% CI -1.70 to 0.95), and concluded by a significant increase from 2018 to 2020 (APC: 11.72; 95% CI 5.06 to 15.32). Non-Hispanic (NH) Black or African American, Hispanic or Latino, and NH White populations demonstrated a significant rise in thyrotoxicosis-related mortality during 2018 to 2020. In contrast, the NH Asian or Pacific Islander population did not denote any significant variations within the included study timeframe. States including West Virginia, the District of Columbia, Vermont, California, and Montana were in the top 10th percentile of thyrotoxicosis-related mortality.
CONCLUSION
After an extended period of decline, the recent increments in thyrotoxicosis-related mortality rates are concerning. Further consideration is urged with respect to thyroid screening, especially among females, in order to reduce the overall thyrotoxicosis-related mortality.
Topics: Humans; Thyrotoxicosis; Female; United States; Male; Middle Aged; Adult; Aged; Young Adult; Adolescent; Aged, 80 and over; Child; Mortality; Child, Preschool; Infant
PubMed: 38195967
DOI: 10.1007/s12020-024-03685-8 -
Acute Medicine 2018Thyrotoxicosis is common and can present in numerous ways with patients exhibiting a myriad of symptoms and signs. It affects around 1 in 2000 people annually in... (Review)
Review
Thyrotoxicosis is common and can present in numerous ways with patients exhibiting a myriad of symptoms and signs. It affects around 1 in 2000 people annually in Europe1. The thyroid gland produces two thyroid hormones - thyroxine (T4) and triiodothyronine (T3). Thyroxine is inactive and is converted by the tissues and organs that need it into tri-iodothyronine. In health, the production of these thyroid hormones is tightly regulated by the secretion of thyroid stimulating hormone (TSH; thyrotropin) from the pituitary gland. The term 'thyrotoxicosis' refers to the clinical manifestations of hyperthyroidism.
Topics: Antithyroid Agents; Disease Management; Graves Disease; Humans; Iodine Radioisotopes; Referral and Consultation; Thyroidectomy; Thyroiditis; Thyrotoxicosis; Thyrotropin
PubMed: 29589605
DOI: No ID Found