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Giornale Italiano Di Cardiologia (2006) Mar 2017Amiodarone-induced thyroid dysfunction occurs in about 15-20% of patients under amiodarone therapy. Amiodarone-induced hypothyroidism (AIH) can develop in patients with... (Review)
Review
Amiodarone-induced thyroid dysfunction occurs in about 15-20% of patients under amiodarone therapy. Amiodarone-induced hypothyroidism (AIH) can develop in patients with an apparently normal thyroid gland or in those with an underlying chronic autoimmune thyroiditis. On a clinical ground, AIH is not challenging and can be easily treated with L-thyroxine therapy. Amiodarone-induced thyrotoxicosis (AIT) can occur in patients with (AIT 1) or without (AIT 2) an underlying thyroid disease. AIT 1 is a true iodine-induced hyperthyroidism occurring in patients with an underlying thyroid autonomy while AIT 2 is a drug-induced destructive thyroiditis. According to the different pathogenetic mechanism, AIT 2 is treated with glucocorticoids while AIT 1 usually responds to thionamides. Thyroidectomy should be considered when AIT represents an imminent risk for cardiac conditions, when patients require a prompt resolution of thyrotoxicosis or when they do not respond to the medical therapy. An effective collaboration between cardiologists and endocrinologists is crucial in each part of the management of AIT patients, including the evaluation of cardiological conditions with regard to thyroid hormone excess and whether, or not, it is necessary to continue amiodarone therapy.
Topics: Amiodarone; Anti-Arrhythmia Agents; Humans; Hypothyroidism; Thyroid Gland; Thyrotoxicosis
PubMed: 28398380
DOI: 10.1714/2674.27399 -
Seminars in Perioperative Nursing Jul 1998This article deals with the pathogenesis of thyrotoxicosis, the pathophysiological reasons for the manifestations, treatment modalities, and nursing implications.... (Review)
Review
This article deals with the pathogenesis of thyrotoxicosis, the pathophysiological reasons for the manifestations, treatment modalities, and nursing implications. Problems associated with surgery and potential complications are addressed.
Topics: Humans; Nursing Diagnosis; Patient Care Planning; Perioperative Nursing; Thyroidectomy; Thyrotoxicosis
PubMed: 9801668
DOI: No ID Found -
Endocrine Dec 2022This study aims to review all published cases on the association between thyrotoxicosis and Takutsubo Syndrome by describing clinical characteristics, diagnostic... (Review)
Review
PURPOSE
This study aims to review all published cases on the association between thyrotoxicosis and Takutsubo Syndrome by describing clinical characteristics, diagnostic work-up, treatment, and outcome.
METHODS
We searched PubMed and Embase databases from inception to the 17th of February 2022 for case reports or series reporting the above-mentioned association. We extracted data on demographic characteristics, clinical features, diagnostic work-up, treatment, and clinical outcomes. Cases were stratified into groups based on the presumed cause of the thyrotoxicosis (iatrogenic vs non-iatrogenic and Graves' diseases vs non-Graves' disease, respectively).
RESULTS
We identified 25 cases from 24 articles. The mean age was 61.7 years (+/- SD 14.5). Most patients were women (88%). Graves' disease (52%) was the leading cause of thyrotoxicosis. Previous cancer was significantly more common in patients with iatrogenic thyrotoxicosis (P = 0.03). The most common symptoms were respiratory symptoms (68%), chest pain (56%), and palpitations (40%). The most common ECG characteristics were T-wave abnormalities (48%) and ST-elevations (36%). Elevated troponin levels were found in 92% of the cases. Patients with Graves's disease and Takutsubo Syndrome had higher plasma levels of serum thyroxine (P = 0.03) and were more often treated with beta-blockers (P = 0.01) compared to patients with thyrotoxicosis of other origins. Notably, 40% of cases experienced in-hospital complications. No deaths were reported. All patients had improved cardiac function within a median follow-up of 42 days.
CONCLUSION
Evidence-based on current case reports suggests an increased risk of Takutsubo Syndrome and subsequently increased risk of in-hospital complications in patients with thyrotoxicosis.
Topics: Humans; Female; Middle Aged; Male; Takotsubo Cardiomyopathy; Thyrotoxicosis; Graves Disease
PubMed: 36018537
DOI: 10.1007/s12020-022-03174-w -
Endocrinology and Metabolism Clinics of... Mar 1998Graves' disease is the predominant cause of hyperthyroidism in the pediatric age group. Other disorders must be recognized, however, because adequate management relies... (Review)
Review
Graves' disease is the predominant cause of hyperthyroidism in the pediatric age group. Other disorders must be recognized, however, because adequate management relies on a precise diagnosis. Careful monitoring of the thyroid status is required during this active phase of growth and development.
Topics: Adenoma; Child; Child, Preschool; Graves Disease; Humans; Infant; Infant, Newborn; Mutation; Pituitary Neoplasms; Receptors, Thyrotropin; Thyrotoxicosis; Thyrotropin
PubMed: 9534032
DOI: 10.1016/s0889-8529(05)70302-9 -
European Journal of Endocrinology Jun 1996
Review
Topics: Antithyroid Agents; Child; Child, Preschool; Graves Disease; Humans; Iodine Radioisotopes; Prognosis; Recurrence; Thyroidectomy; Thyrotoxicosis
PubMed: 8766932
DOI: 10.1530/eje.0.1340678 -
Annales D'endocrinologie Feb 2019Amiodarone, a benzofuranic iodine-rich pan-anti-arrhythmic drug, induces amiodarone-induced thyrotoxicosis (AIT) in 7-15% of patients. AIT is a major issue due to its... (Review)
Review
Amiodarone, a benzofuranic iodine-rich pan-anti-arrhythmic drug, induces amiodarone-induced thyrotoxicosis (AIT) in 7-15% of patients. AIT is a major issue due to its typical severity and resistance to anti-thyroid measures, and to its negative impact on cardiac status. Classically, AIT is either an iodine-induced thyrotoxicosis in patients with abnormal thyroid (type 1), or due to acute thyroiditis in a "healthy" thyroid (type 2). Determination of the type of AIT is a diagnostic dilemma, as characteristics of both types may be present in some patients. As it is the main etiological factor in AIT, it is recommended that amiodarone treatment should be stopped; however, it may be the only anti-arrhythmic option, needing to be either continued or re-introduced to improve cardiovascular survival. Recently, a few studies demonstrated that amiodarone could be continued or re-introduced in patients with history of type-2 AIT. However, in the other patients, it is recommended that amiodarone treatment be interrupted, to improve response to thioamides and to alleviate the risk of AIT recurrence. In such patients, thyroidectomy is recommended once AIT is under control, allowing safe re-introduction of amiodarone.
Topics: Amiodarone; Anti-Arrhythmia Agents; Humans; Recurrence; Risk Factors; Tachycardia; Thioamides; Thyroidectomy; Thyrotoxicosis
PubMed: 30236455
DOI: 10.1016/j.ando.2018.05.001 -
Endocrine-related Cancer Jul 2019Thyrotoxicosis with concomitant thyroid cancer is rare and poorly recognized, which may result in delayed diagnosis, inappropriate treatment and even poor prognosis. To...
Thyrotoxicosis with concomitant thyroid cancer is rare and poorly recognized, which may result in delayed diagnosis, inappropriate treatment and even poor prognosis. To provide a comprehensive guidance for clinicians, the etiology, pathogenesis, diagnosis and treatment of this challenging setting were systematically reviewed. According to literatures available, the etiologies of thyrotoxicosis with concomitant thyroid cancer were categorized into Graves' disease with concurrent differentiated thyroid cancer (DTC) or medullary thyroid cancer, Marine-Lenhart Syndrome with coexisting DTC, Plummer's disease with concomitant DTC, amiodarone-induced thyrotoxicosis with concomitant DTC, central hyperthyroidism with coexisting DTC, hyperfunctioning metastases of DTC and others. The underlying causal mechanisms linking thyrotoxicosis and thyroid cancer were elucidated. Medical history, biochemical assessments, radioiodine uptake, anatomic and metabolic imaging and ultrasonography-guided fine-needle aspiration combined with pathological examinations were found to be critical for precise diagnosis. Surgery remains a mainstay in both tumor elimination and control of thyrotoxicosis, while anti-thyroid drugs, beta-blockers, 131I, glucocorticoids, plasmapheresis, somatostatin analogs, dopamine agonists, radiation therapy, chemotherapy and tyrosine kinase inhibitors should also be appropriately utilized as needed.
Topics: Combined Modality Therapy; Diagnosis, Differential; Disease Management; Humans; Hyperthyroidism; Thyroid Neoplasms; Thyroidectomy; Thyrotoxicosis
PubMed: 31026810
DOI: 10.1530/ERC-19-0129 -
The Indian Journal of Medical Research Mar 2012Thyrotoxicosis, a clinical syndrome characterized by manifestations of excess thyroid hormone, is one of the commonly-recognised conditions of the thyroid gland.... (Review)
Review
Thyrotoxicosis, a clinical syndrome characterized by manifestations of excess thyroid hormone, is one of the commonly-recognised conditions of the thyroid gland. Thyrotoxicosis causes acceleration of bone remodelling and though it is one of the known risk factors for osteoporosis, the metabolic effects of thyroxine on bone are not well discussed. Studies show that thyroid hormones have effects on bone, both in vitro and in vivo. Treatment of thyrotoxicosis leads to reversal of bone loss and metabolic alterations, and decreases the fracture risk. There are limited studies in India as to whether these changes are fully reversible. In this review we discuss about the effects of thyrotoxicosis (endogenous and exogenous) on bone and mineral metabolism, effects of subclinical thyrotoxicosis on bone and mineral metabolism and effects of various forms of treatment in improving the bone mineral density in thyrotoxicosis.
Topics: Bone Diseases; Humans; Thyrotoxicosis
PubMed: 22561612
DOI: No ID Found -
Minerva Endocrinologica Jun 2005Thyrotoxicosis is associated with increased cardiovascular morbidity and mortality, primarily due to heart failure and thromboembolism. Palpitations, caused by sinus... (Review)
Review
Thyrotoxicosis is associated with increased cardiovascular morbidity and mortality, primarily due to heart failure and thromboembolism. Palpitations, caused by sinus tachycardia and occasionally by atrial fibrillation, are the most frequent cardiovascular symptom. As atrial fibrillation may be the only manifestation of thyrotoxicosis, thyroid hormone excess should routinely be excluded in patients with this rhythm disturbance. Heart failure occurs mostly in the presence of underlying heart disease or tachycardia-induced cardiomyopathy in patients with long-standing atrial fibrillation. On occasion, long-standing hyperthyroidism may lead to heart failure even in the absence of concomitant cardiac conditions. Beta-blockers offer symptomatic relief and at the same time slow the ventricular response in patients with atrial fibrillation. Amiodarone, and occasionally iodinated contrast agents, may cause iodine-induced thyrotoxicosis. Clinical suspicion is essential in the diagnosis of amiodarone-induced thyrotoxicosis (AIT), because the antiadrenergic effect of the drug may conceal symptoms. AIT should be considered in any patient on amiodarone in the presence of new-onset or recurrent atrial arrhythmias or unexplained weight loss. Beyond discontinuation of amiodarone, treatment options include propylthiouracil or methimazole, potassium perchlorate, steroids, lithium and, if pharmacological treatment fails, surgery. Amiodarone may potentially be used less frequently in the future since recent studies have shown that this drug is inferior to implantable cardioverter defibrillators in prevention of sudden cardiac death in patients with severe heart failure. In addition, non-iodinated amiodarone analogues are currently in advanced phase of clinical testing.
Topics: Adrenergic beta-Antagonists; Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cardiovascular Diseases; Drug Combinations; Humans; Thyrotoxicosis
PubMed: 15988401
DOI: No ID Found -
Endocrinology and Metabolism Clinics of... Mar 1998Subclinical thyrotoxicosis is defined as low serum thyrotropin (TSH) and normal serum thyroid hormone concentrations. It must be distinguished from nonthyroidal illness... (Review)
Review
Subclinical thyrotoxicosis is defined as low serum thyrotropin (TSH) and normal serum thyroid hormone concentrations. It must be distinguished from nonthyroidal illness and secondary hypothyroidism. The most common causes are excessive thyroid hormone therapy, autonomously functioning thyroid adenoma, multinodular goiter, and Graves' disease, but many patients have no evident thyroid disease. A few patients have minor symptoms and signs of hyperthyroidism. The likelihood of progression to overt thyrotoxicosis is low, and many patients have normal serum TSH concentrations weeks or months later. Treatment should be based on consideration of the cause of the subclinical thyrotoxicosis, and whether the patient has any clinical manifestations of thyroid hormone excess or underlying problems likely to be aggravated by small increases in thyroid secretion.
Topics: Humans; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine
PubMed: 9534026
DOI: 10.1016/s0889-8529(05)70296-6