-
The New England Journal of Medicine Jul 1992Many patients with thyrotoxicosis have clinical features that reflect the effects of excess thyroid hormone on the cardiovascular system. Thyrotoxicosis can aggravate... (Review)
Review
Many patients with thyrotoxicosis have clinical features that reflect the effects of excess thyroid hormone on the cardiovascular system. Thyrotoxicosis can aggravate preexisting cardiac disease and can also lead to atrial fibrillation, congestive heart failure, or worsening of angina pectoris. In elderly patients, these cardiac manifestations may dominate the clinical picture and warrant the measurement of the serum thyrotropin concentration. In the absence of preexisting cardiac disease, treatment of thyrotoxicosis usually results in a return of normal cardiac function.
Topics: Heart; Heart Diseases; Humans; Thyrotoxicosis
PubMed: 1603141
DOI: 10.1056/NEJM199207093270206 -
Minerva Endocrinologica Sep 2008Amiodarone (AM), a potent class III anti-arrhythmic drug, is an iodine-rich compound with a structural resemblance to thyroid hormones triiodothyronine (T3) and... (Review)
Review
Amiodarone (AM), a potent class III anti-arrhythmic drug, is an iodine-rich compound with a structural resemblance to thyroid hormones triiodothyronine (T3) and thyroxine (T4). At the commonly employed doses, AM causes iodine overload up to 50-100 times the optimal daily intake, which may be responsible of a spectrum of effects on thyroid function often counterbalancing its heart benefits. Although most patients on chronic AM treatment remain euthyroid, a consistent proportion may develop thyrotoxicosis (AM-induced thyrotoxicosis, AIT) or hypothyroidism. AIT is more prevalent in iodine-deficient areas and is currently subdivided in two different clinico-pathological forms (AIT I and AIT II). AIT I develops in subjects with underlying thyroid disease, and is caused by an exacerbation by iodine load of thyroid autonomous function; AIT II occurs in patients with no underlying thyroid disease and is probably consequent to a drug-induced destructive thyroiditis. Mixed or indeterminate forms of AIT encompassing several features of both AIT I and AIT II may be also observed. The differential diagnosis between AIT I and AIT II (which is important for the choice of the appropriate therapy) is currently made on radioiodine uptake (RAIU), which may be high, normal or low but detectable in AIT I, while is consistently very low or undetectable in AIT II and on colour-flow Doppler sonography (CFDS) showing normal or increased vascularity in AIT I and absent vascularity in AIT II. Quite recently, studies carried out in our Units at the University of Cagliari (Italy) showed that sestaMIBI thyroid scintigraphy may represent the best single test to differentiate AIT I (showing increased MIBI retention) from AIT II (displaying no significant uptake). Treatment of AIT is dependent from its etiology. AIT usually responds to combined thionamides and potassium perchlorate (KClO4) therapy, AIT II generally responds to glucocorticoids, while indeterminate forms may require both therapeutic approaches. In patients with AIT I definitive treatment of hyperthyroidism by administration of (131)I, initially not feasible for the low RAIU and/or the risk of thyrotoxicosis exacerbation, is advised after normalization of iodine overload. To control severe AIT additional treatment with lithium carbonate, the use of short course of iopanoic acid and plasmapheresis have been also proposed. In cases resistant to medical treatment and/or in patients with severe cardiac diseases who cannot interrupt AM or require quick AM reintroduction, total thyroidectomy (possibly carried out by minimally invasive video-assisted technique) may be proposed after rapid correction of thyrotoxicosis with combination of thionamides, KClO4, corticosteroids and a short course of iopanoic acid.
Topics: Amiodarone; Anti-Arrhythmia Agents; Humans; Interleukin-6; Iodine; Iodine Radioisotopes; Iopanoic Acid; Lithium Carbonate; Perchlorates; Plasmapheresis; Potassium Compounds; Technetium Tc 99m Sestamibi; Thyroid Diseases; Thyroidectomy; Thyrotoxicosis; Ultrasonography, Doppler, Color
PubMed: 18846027
DOI: No ID Found -
Endocrinology and Metabolism Clinics of... Mar 1998This review examines the molecular mechanisms by which thyroid hormone affects the cardiovascular system in naturally occurring thyroid disease states. The potential... (Review)
Review
This review examines the molecular mechanisms by which thyroid hormone affects the cardiovascular system in naturally occurring thyroid disease states. The potential utility of thyroid hormone therapy in the management of patients with various forms of cardiovascular disease is also discussed.
Topics: Cardiovascular Diseases; Cardiovascular System; Female; Humans; Pregnancy; Pregnancy Complications; Thyrotoxicosis
PubMed: 9534027
DOI: 10.1016/s0889-8529(05)70297-8 -
Radiographics : a Review Publication of... 2003The term thyrotoxicosis refers to the clinical syndrome of increased systemic metabolism that results when the serum concentrations of free thyroxine, free... (Review)
Review
The term thyrotoxicosis refers to the clinical syndrome of increased systemic metabolism that results when the serum concentrations of free thyroxine, free triiodothyronine, or both are elevated. The term hyperthyroidism refers to overactivity of the thyroid gland with a resultant increase in thyroid hormone synthesis and release into the systemic circulation. These terms are not interchangeable, since thyrotoxicosis can develop in thyroid conditions that are not associated with increased thyroid function, such as thyroiditis, or in so-called factitious hyperthyroidism. The clinical signs and symptoms of thyrotoxicosis are virtually identical regardless of the cause. However, in a given patient, every attempt should be made to determine the exact cause of the thyrotoxicosis, as this in turn determines the prognosis and treatment. Since thyroid scintigraphy demonstrates the functional state of the thyroid gland, it should be used, in conjunction with determination of radioactive iodine uptake, as the imaging modality of choice for diagnosis of thyrotoxicosis. Although the scintigraphic features of several of the thyroid disorders that cause thyrotoxicosis may overlap, their recognition helps narrow the differential diagnosis, thereby guiding the referring physician in the work-up and management of this disorder.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Thyrotoxicosis
PubMed: 12853661
DOI: 10.1148/rg.234025716 -
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 -
American Journal of Surgery Apr 2024
Topics: Humans; Parathyroidectomy; Hyperthyroidism; Thyrotoxicosis
PubMed: 38087726
DOI: 10.1016/j.amjsurg.2023.11.023 -
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 -
The American Journal of Medicine Aug 2023
Topics: Humans; Thyrotoxicosis; Graves Disease
PubMed: 37001719
DOI: 10.1016/j.amjmed.2023.03.006 -
Postgraduate Medicine Apr 1990Effective therapy for thyrotoxicosis hinges on prompt recognition of the syndrome. When the diagnosis is suspected clinically but is not certain, the free thyroxine... (Review)
Review
Effective therapy for thyrotoxicosis hinges on prompt recognition of the syndrome. When the diagnosis is suspected clinically but is not certain, the free thyroxine index is the most cost-effective test to order initially. The thyroidal radioactive iodine (123I) uptake is measured to differentiate Graves' disease from thyroiditis and other forms of thyrotoxicosis. Definitive therapy includes antithyroid drugs, iodine 131, and surgery. Patient preference has a large role in the final therapeutic choice.
Topics: Adrenergic beta-Antagonists; Algorithms; Antithyroid Agents; Combined Modality Therapy; Drug Therapy, Combination; Humans; Iodine Radioisotopes; Thyroid Crisis; Thyroidectomy; Thyrotoxicosis
PubMed: 1690882
DOI: No ID Found -
The Journal of Clinical Endocrinology... Jan 2001
Review
Topics: Aged; Amiodarone; Animals; Drug Therapy, Combination; Humans; Male; Thyroidectomy; Thyrotoxicosis
PubMed: 11231968
DOI: 10.1210/jcem.86.1.7119