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Acta Endocrinologica (Bucharest,... 2021SARS-CoV-2 infection was declared a pandemic in 2020 and affected millions of people worldwide. Angiotensin-converting enzyme-2 receptors, through which coronavirus...
CONTEXT
SARS-CoV-2 infection was declared a pandemic in 2020 and affected millions of people worldwide. Angiotensin-converting enzyme-2 receptors, through which coronavirus enters the cells of different organs, have been detected in the thyroid gland. The most common cause of thyrotoxicosis is Graves' disease in which thyroid-receptors antibodies (TRAb) stimulate the TSH receptor, increasing thyroid hormone production and release.
CASE PRESENTATION
A 22-year-old woman had symptoms of palpitation, tremor, muscle weakness, anxiety and sleep disturbance. 3 weeks before the onset of these symptoms, the patient suffered from COVID-19, which lasted 14 days and was characterized by a course of moderate severity with fever up to 38C, general weakness without shortness of breath. The patient had no pre-existing thyroid problems. Her TSH was <0.01 mU/L, FT4, FT3 and TRAb were increased. Antithyroid drugs, glucocorticosteroids and β-blockers were prescribed. During 3 months of treatment doses of methimazole, methylprednisolone and bisoprolol were gradually reduced due to the improvement of the patient's condition and thyroid tests normalization.
CONCLUSIONS
COVID-19 infection can cause Graves' disease and thyrotoxicosis. The onset of this disease after SARS-CoV-2 does not depend on the presence of pre-existing thyroid pathology and requires the appointment of glucocortisteroids.
PubMed: 35342470
DOI: 10.4183/aeb.2021.413 -
European Thyroid Journal Mar 2021Hyperthyroid patients who are unresponsive to medical treatment remain a challenging clinical problem.
INTRODUCTION
Hyperthyroid patients who are unresponsive to medical treatment remain a challenging clinical problem.
OBJECTIVE
The goal of our study was to evaluate the use of therapeutic plasma exchange (TPE) in hyperthyroid patients and their outcome after TPE.
METHOD
We retrospectively reviewed 22 patients who underwent TPE for refractory thyrotoxicosis in our institution: 13 with Graves' disease, 7 with amiodarone-induced thyrotoxicosis (AIT), 1 with toxic goiter, and 1 pregnant patient with familial nonautoimmune thyrotoxicosis.
RESULTS
Before TPE, all patients had severe hyperthyroidism, and antithyroid drugs were either contraindicated or not sufficiently effective to restore euthyroidism promptly. After all the TPEs, free T (fT4) decreased significantly by 48% ( = 0.001) and fT3 by 52% ( = 0.0001). The median number of TPE sessions per patient was 4 (range: 1-10). There were no complications during the 91 TPE sessions. Total thyroidectomy with no severe side effects was performed on 16/22 patients and 1 other patient was treated with radioactive iodine. One patient died from severe thyrotoxicosis during medical care. The remaining 4 patients were followed up without any radical treatment. For all 7 patients with AIT, iterative TPE led to a significant clinical improvement, and amiodarone was continued for 1 patient. Available treatments were continued between TPE sessions (cholestyramine for 13 patients [60%] and glucocorticoids for 16 patients [73%]).
CONCLUSION
TPE allowed a safe decrease of 50% in thyroid hormone levels, and it should be considered for refractory hyperthyroid patients when medical treatments are contraindicated or have failed to restore euthyroidism, irrespective of the etiology of the thyrotoxicosis.
PubMed: 33777824
DOI: 10.1159/000507019 -
AACE Clinical Case Reports 2022Transient thyrotoxicosis has been documented in the setting of hyperemesis gravidarum (HG) with elevated human chorionic gonadotropin (hCG) levels. Thyroid storm in...
BACKGROUND
Transient thyrotoxicosis has been documented in the setting of hyperemesis gravidarum (HG) with elevated human chorionic gonadotropin (hCG) levels. Thyroid storm in pregnancy is rarer and typically associated with autoimmune hyperthyroidism. We described thyroid storm in a primigravid 18-year-old patient due to hCG level elevation secondary to HG, which resolved in the second trimester of pregnancy.
CASE REPORT
Our patient presented with vomiting, hyperthyroidism, and cardiac and renal dysfunction at 16 weeks' gestation. She was clinically found to have a thyroid storm, with undetectable thyroid-stimulating hormone (TSH) and a free thyroxine level of >6.99 ng/dL. The hCG level was elevated at 246 030 mIU/L (9040-56 451 mIU/L). She was treated with methimazole, saturated solution potassium iodide, and propranolol. Because thyroid autoantibodies were absent, thyroid ultrasound yielded normal results, and thyroid function testing results rapidly improved as the hCG level decreased, the medications were tapered and ultimately discontinued by day 10 of hospitalization. The thyroid function remained normal after discharge.
DISCUSSION
Because hCG and TSH have identical alfa subunits and similar beta subunits, hCG can bind to the TSH receptor and stimulate thyroxine production. The hCG level peaks at around 8-14 weeks of gestation, correlating with decreased TSH levels in this same time frame. This case emphasizes the relevant physiology and importance of timely and thorough evaluation to determine the appropriate management, prognosis, and follow-up for patients with thyroid storm in the setting of HG.
CONCLUSION
Although transient thyrotoxicosis is documented in patients with HG, thyroid storm is rare, and our case illustrates a severe example of these comorbidities.
PubMed: 35602873
DOI: 10.1016/j.aace.2021.12.005 -
Cureus Jan 2022Thyrotoxicosis is a clinical syndrome with persistently elevated concentrations of free triiodothyronine, free thyroxine, or both, which correlates with an increased... (Review)
Review
Thyrotoxicosis is a clinical syndrome with persistently elevated concentrations of free triiodothyronine, free thyroxine, or both, which correlates with an increased thyroid metabolic function. This article has discussed the direct effect of increased thyroid hormone on the heart, as the thyroid hormone physiologically exhibits a close harmony with hormones of the cardiovascular system. This action can lead to disturbances in hemodynamic stability, exacerbating the possibility of developing complications such as heart failure and life-threatening arrhythmias. This article has also explored the multifaceted pathogenesis of thyrotoxicosis and various pharmacological treatment options, including beta-blockers and anti-thyroid drugs. This article has reviewed numerous studies that have concluded that the main goal of therapy should always aim to normalize thyroid hormone levels based on the etiology of the thyrotoxicosis, although cardiovascular conditions are associated with a higher rate of mortality.
PubMed: 35186521
DOI: 10.7759/cureus.21213 -
BMJ Nutrition, Prevention & Health 2023An outbreak of exogenous thyrotoxicosis is an uncommon cause of thyrotoxicosis. This study aimed to investigate the characteristics and outcomes of exogenous...
INTRODUCTION
An outbreak of exogenous thyrotoxicosis is an uncommon cause of thyrotoxicosis. This study aimed to investigate the characteristics and outcomes of exogenous thyrotoxicosis and electrolyte imbalance in a prison during an outbreak of exogenous thyrotoxicosis in the Phitsanulok, Thailand prison.
METHODS
This study collected cross-sectional data during an outbreak of thyrotoxicosis among inmates at Phitsanulok prison between 29 December 2019 and 17 January 2020. In the first phase, a total of 2815 prisoners were screened for thyroid-stimulating hormone (TSH), potassium levels and pulse rate. In the second phase, samples from 490 male prisoners were collected for test on thyroid function, serum electrolytes and urine electrolytes. Thyroglobulin levels were also measured in patients with thyrotoxicosis. A questionnaire was used to obtain patient information about signs and symptoms of thyrotoxicosis.
RESULTS
The prevalence of subclinical thyrotoxicosis was 78.1%. The pulse rate was significantly higher in the subclinical thyrotoxicosis group. Weight loss, palpitation, muscle weakness and fatigue were found predominantly in the subclinical thyrotoxicosis group. The prevalence of hypokalaemia was 38.4%; however, there was no difference between subclinical thyrotoxicosis and normal TSH. The mean magnesium levels were significantly lower in the subclinical thyrotoxicosis group. Patients with hypokalaemia mainly showed potassium loss through the kidneys. Almost all patients with suppressed TSH levels had low to normal thyroglobulin levels. In addition, the mean of calculated total step-up deiodinase activity in patients with subclinical thyrotoxicosis was lower than 30 nmol/s, which was an additional clue to confirm exogenous thyrotoxicosis. The frozen meat during the outbreak had higher levels of thyroid hormone compared with the control group.
CONCLUSIONS
With an outbreak of thyrotoxicosis, most likely due to exposure to exogenous thyroid hormone in frozen meat, our findings have raised awareness of nutritional problems in prison. The development of surveillance systems to prevent outbreaks is urgently needed.
PubMed: 38618547
DOI: 10.1136/bmjnph-2023-000789 -
Advances in Clinical and Experimental... Jul 2021The paper summarizes the current knowledge about the influence of SARS-CoV-2 on the thyroid gland and benign thyroid diseases, with emphasis on the situation in Poland.... (Review)
Review
The paper summarizes the current knowledge about the influence of SARS-CoV-2 on the thyroid gland and benign thyroid diseases, with emphasis on the situation in Poland. Based on the latest scientific literature published up to May 1, 2021 and the PubMed, Google Scholar, EMBASE and Web of Science database searches, keywords related to SARS-CoV-2 and its impact on the thyroid gland and benign thyroid diseases were searched. COVID-19-related thyroid disorders include non-thyroid syndrome, hypothyroidism and thyrotoxicosis. The authors paid special attention to the treatment of thyroid disease during the pandemic. The emphasis was on radioiodine therapy, which is of high clinical value due to the lower risk of neutropenia or agranulocytosis. It is currently unknown whether COVID-19 may lead to de novo thyroid dysfunction or if it can aggravate an existing thyroid disease. Patients with uncontrolled thyrotoxicosis are in a risk group for complications (e.g., cytokine storm) from any infection (especially from SARS-CoV-2 infection). Moreover, this group of patients should receive more extensive care, bearing in mind the neutropenia from taking antithyroid drugs, which may mask the symptoms of COVID-19.
Topics: COVID-19; Humans; Iodine Radioisotopes; Poland; SARS-CoV-2; Thyroid Gland
PubMed: 34286519
DOI: 10.17219/acem/139622 -
Cureus Jan 2023Thyrotoxicosis-induced dilated cardiomyopathy is a rare but potentially life-threatening complication of thyrotoxicosis, with an incidence of <1%. This condition is...
Thyrotoxicosis-induced dilated cardiomyopathy is a rare but potentially life-threatening complication of thyrotoxicosis, with an incidence of <1%. This condition is characterized by a dilatation of the ventricular chamber and a decrease in cardiac contractility. Untreated, it can lead to irreversible changes in cardiac structure and function, including dilated ventricular chamber, a decrease in ejection fraction (EF), and an increased risk of atrial fibrillation. We present a case of a 39-year-old patient with a diagnosis of thyrotoxicosis-induced acute heart failure. A two-dimensional (2D) echocardiogram disclosed an ejection fraction of 36%, with diffuse mild dilation of the atria and ventricles with trace mitral and tricuspid regurgitation. The anti-thyroid-stimulating hormone (TSH) receptor was positive, and Grave's disease was diagnosed. The patient eventually returned to baseline functional status and could return to basic activities of daily living without limitations. The patient was encouraged to follow up with outpatient cardiology. Early diagnosis of cardiac involvement in patients with thyrotoxicosis is critical. Promptly delivered intensive treatment with the rapid achievement of euthyroid state can potentially reverse cardiac dysfunction and improve patient outcomes.
PubMed: 36694856
DOI: 10.7759/cureus.33988 -
Thyroid Research Apr 2021There have been several reports of secondary anemia associated with Graves' disease. There are no reports of secondary anemia resulting from thyrotoxicosis due to...
BACKGROUND
There have been several reports of secondary anemia associated with Graves' disease. There are no reports of secondary anemia resulting from thyrotoxicosis due to painless thyroiditis (silent thyroiditis). We report the case of a patient with pancreatic diabetes who developed anemia caused by thyrotoxicosis due to painless thyroiditis.
CASE PRESENTATION
The patient was a 37-year-old man who visited the hospital complaining of fatigue, palpitations, and dyspnea. His hemoglobin was 110 g/l (reference range, 135-176), and mean corpuscular volume was 81.5 fl (81.7-101.6). His free thyroxine (FT4) was high, at 100.4 pmol/l (11.6-21.9); the free triiodothyronine (FT3) was high, at 27.49 pmol/l (3.53-6.14); TSH was low, at < 0.01 mIU/l (0.50-5.00); and TSH receptor antibody was negative. Soluble IL-2 receptor (sIL-2R) was high, at 1340 U/ml (122-496); C-reactive protein (CRP) was high, at 6900 μg/l (< 3000); and reticulocytes was high, at 108 10 /l (30-100). Serum iron (Fe) was 9.5 (9.1-35.5), ferritin was 389 μg/l (13-401), haptoglobin was 0.66 g/l (0.19-1.70. Propranolol was prescribed and followed up. Anemia completely disappeared by 12 weeks after disease onset. Thyroid hormones and sIL-2R had normalized by 16 weeks after onset. He developed mild hypothyroidism and was treated with L-thyroxine at 24 weeks.
CONCLUSIONS
This is the first case report of transient secondary anemia associated with thyrotoxicosis due to painless thyroiditis. The change in sIL-2R was also observed during the clinical course of thyrotoxicosis and anemia, suggesting the immune processes in thyroid gland and bone marrow.
PubMed: 33892761
DOI: 10.1186/s13044-021-00100-6 -
Frontiers in Endocrinology 2023To probe the appropriate iodine nutritional status for patients with Graves'disease (GD) hyperthyroidism and on antithyroid drugs (ATD) or after drugwithdrawal. (Review)
Review
AIM
To probe the appropriate iodine nutritional status for patients with Graves'disease (GD) hyperthyroidism and on antithyroid drugs (ATD) or after drugwithdrawal.
METHOD
Studies were retrieved from three databases (Embase, Medline, and Cochrane Library) and were screened and evaluated using predefined criteria. The risk of bias of each trial was assessed using a tool from Cochrane. The iodine nutritional status of the subjects was redefined according to the World Health Organization (WHO) criteria and classified as insufficient/adequate/above requirements/excessive iodine intake.
RESULT
Two randomized controlled trials (RCTs) and 3 observational studies were selected from the 376 retrieved papers, which had different degrees of risk of bias in study design. The heterogeneity among them prevented us from further synthesizing effect indicators and subsequent statistical analyses. Two RCTs with high quality showed that insufficient or above requirements iodine intake was detrimental for ATD-treated GD patients; adequate iodine intake was associated with a lower risk of recurrence and better efficacy in controlling thyrotoxicosis. It could be speculated from three low-quality observational studies that excessive iodine intake may be associated with higher (or similar) recurrence rates and lower remission rates compared to above requirements iodine intake in these patients, but none of them could answer the question of the effect of insufficient or adequate iodine intake on this issue.
CONCLUSION
Although the available evidence is suboptimal, this systematic review tentatively suggests that in adult patients with GD hyperthyroidism receiving ATDs and according to WHO criteria for iodine nutritional status, adequate iodine intake is associated with a lower recurrence rate, a higher remission rate and a better efficacy to control thyrotoxicosis than insufficient, above requirement, or excessive iodine intake. Future RCTs with large samples are expected to elucidate the actual impact of different iodine nutritional statuses on the recurrence rate of hyperthyroidism and the efficacy of ATD to control thyrotoxicosis in these patients.
SYSTEMATIC REVIEW REGISTRATION
identifier CRD42022359451.
Topics: Humans; Adult; Antithyroid Agents; Iodine; Nutritional Status; Graves Disease; Hyperthyroidism; Thyrotoxicosis
PubMed: 37900151
DOI: 10.3389/fendo.2023.1234918