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BMJ Case Reports Jul 2021A 49-year-old woman, G8P7, presented with 1 week of worsening vaginal bleeding and abdominal cramps in the setting of a recently discovered unplanned pregnancy....
A 49-year-old woman, G8P7, presented with 1 week of worsening vaginal bleeding and abdominal cramps in the setting of a recently discovered unplanned pregnancy. Vaginal ultrasound findings and a significantly elevated human chorionic gonadotropin (hCG) level were concerning for molar pregnancy. She developed signs of hyperthyroidism on the night of admission, for which the endocrinology team was consulted. Laboratory data were consistent with hyperthyroidism. The patient was believed to have thyrotoxicosis secondary to molar pregnancy with concern for impending thyroid storm. Her mental health disorder and bacteraemia made taking care of her further challenging. She was started on a beta-blocker, antithyroid agent and intravenous corticosteroids. She underwent an uncomplicated suction dilation and curettage (D&C), with resolution of her symptoms a few days after. At a follow-up appointment, the patient continued to be asymptomatic and was feeling well.
Topics: Antithyroid Agents; Female; Humans; Hydatidiform Mole; Middle Aged; Pregnancy; Thyroid Crisis; Thyrotoxicosis; Vacuum Curettage
PubMed: 34226253
DOI: 10.1136/bcr-2021-242131 -
American Family Physician Sep 1996Outcome-oriented clinical studies and comprehensive management guidelines for thyroid disease have recently been published. Thyrotoxicosis is a differential diagnostic... (Review)
Review
Outcome-oriented clinical studies and comprehensive management guidelines for thyroid disease have recently been published. Thyrotoxicosis is a differential diagnostic challenge, and determining the etiology is the most critical step in management. Thyrotoxicosis is referred to as hyperthyroidism when sustained thyroid hyperfunction results in increased thyroid hormone biosynthesis and release from the gland. The most common cause is Graves' disease, but toxic nodular goiters frequently occur in elderly patients. Less common forms include iodine-induced hyperthyroidism, human chorionic gonadotropin-associated thyrotoxicosis and pituitary resistance to thyroid hormone regulation, in which free thyroxine is elevated in clinically euthyroid or hypothyroid patients but thyroid-stimulating hormone is normal to increased. Nonhyperthyroid thyrotoxic states are associated with low radioactive iodine uptake ratios, as seen in the three types of subacute thyroiditis, ectopic hormone production or exogenous ingestion of thyroid hormone. Management of thyrotoxicosis requires lowering of thyroid levels to maintain a euthyroid state. The patient should actively participate in therapeutic decisions. Antithyroid drugs, radioactive iodine and surgery are the principal forms of treatment. Adjunctive therapy may be indicated in some cases. Prolonged follow-up is necessary in all cases.
Topics: Diagnosis, Differential; Humans; Thyrotoxicosis
PubMed: 8816575
DOI: No ID Found -
Journal of Endocrinological... Feb 2024Amiodarone-induced thyrotoxicosis is associated with high morbidity and mortality rates. The approach to this condition is widely variable across different medical... (Review)
Review
INTRODUCTION
Amiodarone-induced thyrotoxicosis is associated with high morbidity and mortality rates. The approach to this condition is widely variable across different medical specialists and even among expert endocrinologists. As a matter of fact, the approach to amiodarone-induced thyrotoxicosis has always been considered difficult, due to diagnostic uncertainties easily resulting in missteps, and therapeutic challenges easily resulting in unresponsiveness or slow-responsiveness to the administered drugs.
PURPOSE
Our purpose is to review novelties emerged during the last years about this condition, with the aim to provide novel insights on the diagnostic and therapeutic management of this challenging condition.
Topics: Humans; Amiodarone; Anti-Arrhythmia Agents; Thyrotoxicosis; Thyroidectomy; Hyperthyroidism
PubMed: 37731073
DOI: 10.1007/s40618-023-02168-3 -
Soins; La Revue de Reference Infirmiere Feb 1990
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Nihon Rinsho. Japanese Journal of... May 2006
Review
Topics: Diagnosis, Differential; Female; Goiter, Nodular; Graves Disease; Hashimoto Disease; Humans; Male; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Prognosis; Thyroiditis, Subacute; Thyrotoxicosis
PubMed: 16776133
DOI: No ID Found -
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 -
The American Journal of Emergency... Apr 2019Syncope is a common emergency department (ED) chief complaint, with many known but also unknown causes. Here we present a novel ED presentation of a young woman with...
Syncope is a common emergency department (ED) chief complaint, with many known but also unknown causes. Here we present a novel ED presentation of a young woman with new-onset hyperthyroidism that masqueraded as a syncopal event with head trauma. A 21-year-old woman arrived in the ED with head trauma as the result of seemingly unprovoked syncope, due to her history as well as the nature of her trauma. Persistent tachycardia during her ED course after an unremarkable full trauma evaluation prompted ordering of additional lab testing, which revealed evidence of thyrotoxicosis. Here we consider the possibility of thyroid dysfunction resulting in syncope.
Topics: Antithyroid Agents; Craniocerebral Trauma; Diagnosis, Differential; Electrocardiography; Female; Humans; Methimazole; Syncope; Tachycardia; Thyroid Function Tests; Thyrotoxicosis; Young Adult
PubMed: 30700385
DOI: 10.1016/j.ajem.2019.01.018 -
Critical Care Nursing Clinics of North... Dec 2015High-output heart failure is not seen as commonly as low-output heart failure and some of the typical guideline recommendations may not benefit patients with high-output... (Review)
Review
High-output heart failure is not seen as commonly as low-output heart failure and some of the typical guideline recommendations may not benefit patients with high-output failure. High-output failure is caused by several diseases, including thyrotoxicosis and beriberi, highlighted in this article. Thyrotoxicosis, caused by excessive thyroid hormone production, has profound hemodynamic effects. Wet beriberi, affecting predominately the cardiovascular system, is caused by severe thiamine deficiency, most commonly seen in patients with chronic alcoholism or poor nutrition from other causes. Prompt recognition of these infrequently seen syndromes is essential. This article outlines the medical treatment and nursing care needed to return these patients to a normal state.
Topics: Beriberi; Cardiac Output; Disease Management; Heart Failure; Hemodynamics; Humans; Nursing Care; Thyrotoxicosis
PubMed: 26567494
DOI: 10.1016/j.cnc.2015.07.004 -
JAMA Internal Medicine Dec 2023Thyroid hormone is among the most common prescriptions in the US and up to 20% may be overtreated. Endogenous hyperthyroidism may be a risk factor for dementia, but data...
IMPORTANCE
Thyroid hormone is among the most common prescriptions in the US and up to 20% may be overtreated. Endogenous hyperthyroidism may be a risk factor for dementia, but data are limited for iatrogenic thyrotoxicosis.
OBJECTIVE
To determine whether thyrotoxicosis, both endogenous and exogenous, is associated with increased risk of cognitive disorders.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study performed a longitudinal time-varying analysis of electronic health records for patients receiving primary care in the Johns Hopkins Community Physicians Network between January 1, 2014, and May 6, 2023. Patients 65 years and older with at least 2 visits 30 days apart to their primary care physicians were eligible. None of the 65 931 included patients had a history of low thyrotropin (TSH) level or cognitive disorder diagnoses within 6 months of their first visit. Data analysis was performed from January 1 through August 5, 2023.
EXPOSURE
The exposure variable was a low TSH level, characterized based on the clinical context as due to endogenous thyrotoxicosis, exogenous thyrotoxicosis, or unknown cause, excluding those attributable to acute illness or other medical factors such as medications.
MAIN OUTCOMES AND MEASURES
The outcome measure was cognitive disorders, including mild cognitive impairment and all-cause dementia, to improve sensitivity and account for the underdiagnosis of dementia in primary care.
RESULTS
A total of 65 931 patients were included in the analysis (median [IQR] age at first visit, 68.0 [65.0-74.0] years; 37 208 [56%] were female; 46 106 [69.9%] were White). Patients exposed to thyrotoxicosis had cognitive disorder incidence of 11.0% (95% CI, 8.4%-14.2%) by age 75 years vs 6.4% (95% CI, 6.0%-6.8%) for those not exposed. After adjustment, all-cause thyrotoxicosis was significantly associated with risk of cognitive disorder diagnosis (adjusted hazard ratio, 1.39; 95% CI, 1.18-1.64; P < .001) across age groups. When stratified by cause and severity, exogenous thyrotoxicosis remained a significant risk factor (adjusted hazard ratio, 1.34; 95% CI, 1.10-1.63; P = .003) with point estimates suggestive of a dose response.
CONCLUSIONS AND RELEVANCE
In this cohort study among patients 65 years and older, a low TSH level from either endogenous or exogenous thyrotoxicosis was associated with higher risk of incident cognitive disorder. Iatrogenic thyrotoxicosis is a common result of thyroid hormone therapy. With thyroid hormone among the most common prescriptions in the US, understanding the negative effects of overtreatment is critical to help guide prescribing practice.
Topics: Humans; Female; Aged; Male; Cohort Studies; Thyrotoxicosis; Cognitive Dysfunction; Thyrotropin; Thyroid Hormones; Cognition; Dementia; Iatrogenic Disease
PubMed: 37870843
DOI: 10.1001/jamainternmed.2023.5619 -
Cleveland Clinic Journal of Medicine Jul 2003Amiodarone causes thyrotoxicosis in 3% of US patients who use it. Two types of amiodarone-induced thyrotoxicosis are recognized, designated type 1 and type 2, based on... (Review)
Review
Amiodarone causes thyrotoxicosis in 3% of US patients who use it. Two types of amiodarone-induced thyrotoxicosis are recognized, designated type 1 and type 2, based on whether or not the patient had a preexisting thyroid disorder. Distinguishing between the two can be difficult, but it is important for providing appropriate therapy promptly.
Topics: Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Humans; Iodine; Practice Guidelines as Topic; Thyroidectomy; Thyrotoxicosis
PubMed: 12882384
DOI: 10.3949/ccjm.70.7.624