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Indian Journal of Nuclear Medicine :... 2023Ectopic thyroid tissue can be present in the embryonal path of descent of the thyroglossal duct anywhere from the foramen caecum to the thyroid gland. However, for such...
Ectopic thyroid tissue can be present in the embryonal path of descent of the thyroglossal duct anywhere from the foramen caecum to the thyroid gland. However, for such ectopic thyroid tissue to be hyperfunctioning is quite rare. Here, we discuss a 56-year-old female patient who presented with persistent thyrotoxicosis for over 7 years. She had undergone thyroidectomy in 1982 for thyrotoxicosis and was rendered hypothyroid (thyroid-stimulating hormone of 75 μIU/mL). Whole-body technetium scan was done twice which did not show any uptake in the neck or other parts of the body and an empirical dose of 15 mCi of radioiodine therapy was also given to treat the thyrotoxicosis. She continued to be thyrotoxic and was on carbimazole 30 mg/day along with beta-blockers. In 2021, an Iodine whole-body scan revealed small remnant thyroid tissue and an ectopic thyroid tissue in a thyroglossal cyst. In such cases of persistent or recurrent thyrotoxicosis despite standard treatments, an ectopic location should be sought after and treated.
PubMed: 37180193
DOI: 10.4103/ijnm.ijnm_93_22 -
Frontiers in Endocrinology 2022
Topics: Arrhythmias, Cardiac; Humans; Thyroid Hormones
PubMed: 36147578
DOI: 10.3389/fendo.2022.1024476 -
BMJ Case Reports Jan 2021The authors present a case of a 55-year-old gentleman with a medical history of atrial fibrillation on amiodarone who presented with weight loss, palpitations and...
The authors present a case of a 55-year-old gentleman with a medical history of atrial fibrillation on amiodarone who presented with weight loss, palpitations and exertional dyspnoea. Thyroid function tests revealed thyrotoxicosis with a free thyroxine (T4) of 117 pmol/L and a thyroid-stimulating hormone (TSH) of <0.008 mIU/L. Interleukin-6 level was low. The negative TSH-receptor antibody status, the presence of a small thyroid gland with heterogeneous echotexture and decreased internal vascularity on ultrasound together with the relatively quick drop in free T4 and free tri-iodothyronine (T3) levels once prednisolone therapy was added to carbimazole suggested that this was typical of amiodarone-induced thyrotoxicosis (AIT) type 2. Subsequently, carbimazole was discontinued and treatment with prednisolone was continued. This case highlights that AIT management may be challenging and it is of paramount importance to establish the type of AIT present as this will guide management and is key to improving prognosis.
Topics: Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Humans; Male; Middle Aged; Thyrotoxicosis
PubMed: 33419749
DOI: 10.1136/bcr-2020-238145 -
Frontiers in Endocrinology 2023
Topics: Humans; Female; Pregnancy; Endocrine System Diseases; Placenta; Vascular Diseases
PubMed: 38027154
DOI: 10.3389/fendo.2023.1321072 -
Presse Medicale (Paris, France : 1983) Jun 2022Radioiodine uptake (RAIU) test with iodine-123 (Na[I]I) or iodine-131 (Na[I]I) enables accurate evaluation and quantification of iodine uptake and kinetics within...
Radioiodine uptake (RAIU) test with iodine-123 (Na[I]I) or iodine-131 (Na[I]I) enables accurate evaluation and quantification of iodine uptake and kinetics within thyroid cells. Thyroid Scintigraphy (TS) employing Na[I]I or Tc-pertechnetate (Na[Tc]TcO) provides information regarding the function and topographical distribution of thyroid cells activity, including detection and localization of ectopic thyroid tissue. Destructive thyrotoxicosis is characterized by low RAIU with scintigraphically reduced radiotracer activity in the thyroid tissue, while productive thyrotoxicosis (i.e. hyperthyroidism "stricto sensu") is characterized by high RAIU with scintigraphically diffuse (i.e. Graves' Disease, GD and diffuse thyroid autonomy) or focal (i.e. autonomously functioning thyroid nodules, AFTN) overactivity. Accordingly, RAIU and/or TS are widely used to differentiate different causes of thyrotoxicosis. In addition, several radiopharmaceuticals are also available to help differentiate benign from malignant thyroid nodules and inform clinical decision-making: scintigraphic identification of AFTNs obviate fine-needle aspiration (FNA) biopsy, and [Tc]Tc-hexakis-(2‑methoxy-2-isobutyl isonitrile ([Tc]Tc-MIBI) and/or F-fluoro-d-glucose ([F]FDG) may complement the work-up of cytologically indeterminate "cold" nodules for reducing the need for diagnostic lobectomies/thyroidectomies. Finally, RAIU studies are also useful for calculating the administered therapeutic activity of Na[I]I to treat hyperthyroidism and euthyroid multinodular goiter. All considered, thyroid molecular imaging allows functional characterization of different thyroid diseases, even before clinical symptoms become manifest, and remains integral to the management of such conditions. Our present paper summarizes basic concepts, clinical applications, and potential developments of thyroid molecular imaging in patients affected by thyrotoxicosis and thyroid nodules.
Topics: Humans; Iodine Radioisotopes; Thyroid Nodule; Molecular Imaging
PubMed: 35124101
DOI: 10.1016/j.lpm.2022.104116 -
Archives of Endocrinology and Metabolism Nov 2022The aim of this study was to assess the effect of hyperthyroidism and its treatment on body weight and composition, insulin resistance, and mediators of appetite and...
OBJECTIVE
The aim of this study was to assess the effect of hyperthyroidism and its treatment on body weight and composition, insulin resistance, and mediators of appetite and energy homeostasis, namely ghrelin, leptin, adiponectin, and fibroblast growth factor 21 (FGF21).
SUBJECTS AND METHODS
Thirty-five adult patients (27 female and 8 male, aged 39.63 ± 9.70 years) with overt hyperthyroidism were evaluated for leptin, ghrelin, adiponectin, and FGF21 levels; insulin resistance; and body composition using DEXA both at baseline and a minimum of two months following normalization of serum thyroxin on carbimazole treatment. Comparison of means between the baseline and post treatment values was performed by the paired t test for normally distributed parameters and by the Wilcoxon signed-rank test for non-normally distributed data.
RESULTS
Hyperthyroidism correction resulted in an increase in weight from 51.15 ± 8.50 kg to 55.74 ± 8.74 kg ( < 0.001), paradoxically accompanied by a decrease in insulin resistance as measured by HOMA-IR from 1.35 (1.02-1.72) to 0.73 (0.52-0.93) ( < 0.001). Correction of hyperthyroidism was also associated with a decrease in FGF21 from 58 (55-64) to 52 (47-58) pg/mL ( < 0.001) and in leptin levels from 17 (7-36) to 11 (4.6-28) ng/mL ( = 0.03).
CONCLUSION
Despite lower body weight, thyrotoxicosis is associated with insulin resistance. High levels of thermogenic hormones, leptin, and FGF21 were observed in thyrotoxicosis and may be partly responsible for the excessive heat production typical of this condition.
Topics: Adult; Humans; Male; Female; Leptin; Ghrelin; Adiponectin; Insulin Resistance; Hyperthyroidism; Homeostasis; Body Weight; Thyrotoxicosis
PubMed: 35929907
DOI: 10.20945/2359-3997000000511 -
Annals of Medicine and Surgery (2012) Sep 2022Thyrotoxicosis is a clinical syndrome produced by a multitude of disorders. Thyrotoxicosis is a serious medical condition that, if left untreated, can lead to a fatal... (Review)
Review
BACKGROUND
Thyrotoxicosis is a clinical syndrome produced by a multitude of disorders. Thyrotoxicosis is a serious medical condition that, if left untreated, can lead to a fatal illness. This review of recent evidences give additional input for perioperative management of thyrotoxic patients.
METHODS
The literatures were found with Boolean operators in the form of thyrotoxicosis AND anesthesia, antithyroid medications AND perioperative optimization AND beta blockers OR calcium channel blockers in electronic data base sources such as the Cochrane library, PubMed, and Google scholar. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement.
CONCLUSIONS
and recommendations: Before surgery and anesthesia, manifestation of thyrotoxicosis including palpitation, irritability etc should be ruled out.
PubMed: 36147169
DOI: 10.1016/j.amsu.2022.104487 -
BMC Endocrine Disorders Jun 2021Thyrotoxicosis is the state of thyroid hormone excess. But, in sub-Saharan Africa (SSA), specifically Northern Ethiopia, scientific evidence about thyrotoxicosis and its...
BACKGROUND
Thyrotoxicosis is the state of thyroid hormone excess. But, in sub-Saharan Africa (SSA), specifically Northern Ethiopia, scientific evidence about thyrotoxicosis and its cardiac complications like dilated cardiomyopathy is limited. Therefore, this study aimed to explore the thyrotoxicosis presentation and management and identify factors associated with dilated cardiomyopathy in a tertiary hospital in Northern Ethiopia.
METHODS
An institution-based cross-sectional study was conducted in Ayder Comprehensive Specialized Hospital from 2017 to 2018. Data from 200 thyrotoxicosis cases were collected using a structured questionnaire. After describing variables, logistic regression was conducted to identify independent predictors of dilated cardiomyopathy. Statistical significance was declared at p < 0.05.
RESULTS
Mean age at presentation of thyrotoxicosis was 45 years and females accounted for 89 % of the cases. The most frequent etiology was multinodular toxic goiter (51.5 %). As well, the most common symptoms and signs were palpitation and goiter respectively. Thyroid storm occurred in 6 % of the cases. Out of 89 patients subjected to echocardiography, 35 (39.3 %) of them had dilated cardiomyopathy. And, the odds of dilated cardiomyopathy were higher in patients who had atrial fibrillation (AOR = 15.95, 95 % CI:5.89-38.16, p = 0.001) and tachycardia (AOR = 2.73, 95 % CI:1.04-7.15, p = 0.040). All patients took propylthiouracil and 13.0 % of them experienced its side effects. Concerning β-blockers, propranolol was the most commonly (78.5 % of the cases) used drug followed by atenolol (15.0 %). Six patients underwent surgery.
CONCLUSIONS
In developing countries like Ethiopia, patients with thyrotoxicosis have no access to methimazole which is the first-line anti-thyroid drug. Besides, they greatly suffer from dilated cardiomyopathy (due to late presentation) and side effects of propylthiouracil. Therefore, we recommend that patients should get adequate health information about thyrotoxicosis and anti-thyroid drugs including their side effects. Additionally, hospitals and other concerned bodies should also avail of TSH tests and methimazole at an affordable cost. Furthermore, community awareness about iodized salt and iodine-rich foods should be enhanced.
Topics: Adolescent; Adult; Antithyroid Agents; Cardiomyopathy, Dilated; Cross-Sectional Studies; Developing Countries; Ethiopia; Female; Goiter, Nodular; Humans; Iodine; Male; Methimazole; Middle Aged; Sodium Chloride, Dietary; Thyrotoxicosis; Young Adult
PubMed: 34182968
DOI: 10.1186/s12902-021-00796-5 -
Internal Medicine (Tokyo, Japan) Aug 2021Although headache attributed to hypothyroidism is coded within The International Classification of Headache Disorders, 3rd edition, an association between headache and...
Although headache attributed to hypothyroidism is coded within The International Classification of Headache Disorders, 3rd edition, an association between headache and thyrotoxicosis (hyperthyroidism) is mentioned only in the appendix. Reports on relevant cases are too scarce to establish a causal relationship. A young man with a history of migraine with aura arrived at our headache clinic with a 10-day history of headache and weight loss. Brain MRI revealed normal findings. Blood tests revealed thyrotoxicosis. A test for thyroid-related antibodies was negative. Thus, the patient was diagnosed with painless thyroiditis. The patient's headache resolved as his thyroid hormone levels decreased. To the best of our knowledge, this is the first reported case of headache exaggerated by painless thyrotoxicosis.
Topics: Headache; Humans; Hyperthyroidism; Hypothyroidism; Male; Thyroiditis; Thyrotoxicosis
PubMed: 33678752
DOI: 10.2169/internalmedicine.6975-20 -
Journal of Family Medicine and Primary... Oct 2023Incidence of thyroid dysfunctions including hypo- or hyperthyroidism is significantly increased. Hyperthyroidism is common in males, and hypothyroidism is often seen in...
Incidence of thyroid dysfunctions including hypo- or hyperthyroidism is significantly increased. Hyperthyroidism is common in males, and hypothyroidism is often seen in females. Here, we report two female patients suffering from hyperthyroidism, but their signs and symptoms are totally opposite to each other.
PubMed: 38074251
DOI: 10.4103/jfmpc.jfmpc_2366_21