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Endocrine Journal May 2024Anti-thyroglobulin antibodies (TgAb) and/or anti-thyroid peroxidase antibodies (TPOAb) positivity at baseline is a risk marker for thyroid immune-related adverse events...
Anti-thyroglobulin antibodies (TgAb) and/or anti-thyroid peroxidase antibodies (TPOAb) positivity at baseline is a risk marker for thyroid immune-related adverse events (thyroid-irAEs) in anti-programmed cell death-1 antibody (PD-1-Ab) treatment; however, it is unknown if TgAb and TPOAb titers are associated with clinical characteristics of thyroid-irAEs. Among 586 patients treated with PD-1-Ab at Nagoya University Hospital between 2 November 2015 and 30 September 2021, 57 patients developed thyroid-irAEs (thyrotoxicosis [n = 38]; hypothyroidism without prior thyrotoxicosis {isolated hypothyroidism} [n = 19]) in whom thyroid function, and TgAb and TPOAb titers were determined at baseline and at the onset. The changes in TgAb (median, 54.8 vs. 0.2 IU/mL; p = 0.002) and TPOAb titers (31.6 vs. 0 IU/mL; p = 0.032) from baseline to onset of developing thyroid-irAEs were greater in patients with thyrotoxicosis than patients with isolated hypothyroidism. Higher TgAb and TPOAb titers, and the TgAb titer at baseline were associated with an earlier onset of thyrotoxicosis and higher peak free thyroxine levels, respectively. Twenty-eight patients who developed hypothyroidism after thyrotoxicosis had higher TgAb (54.5 vs. 10.7 IU/mL; p = 0.011) and TPOAb titers at baseline (46.1 vs. 9.0 IU/mL; p < 0.001) and greater changes in TgAb (61.7 vs. 7.8 IU/mL; p = 0.025) and TPOAb titers (52.8 vs. -0.8 IU/mL; p < 0.001) than patients who did not develop hypothyroidism. The TgAb titer at baseline and changes in the TgAb and TPOAb titers were greater in patients with thyrotoxicosis than patients with isolated hypothyroidism, suggesting that the magnitude of the thyroid autoimmune response reflects the clinical types of thyroid-irAEs.
Topics: Humans; Thyrotoxicosis; Male; Female; Hypothyroidism; Autoantibodies; Middle Aged; Aged; Immune Checkpoint Inhibitors; Adult; Iodide Peroxidase
PubMed: 38599854
DOI: 10.1507/endocrj.EJ23-0480 -
Cureus Mar 2024Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism, seen predominantly in men of Asian origin. We report an unusual presentation of paralysis...
Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism, seen predominantly in men of Asian origin. We report an unusual presentation of paralysis post-lumbar laminectomy surgery, associated with shortness of breath and arrhythmia. The patient was initially thought to have nerve compression as a complication of surgery but was found to have severe hypokalemia, which responded to intravenous potassium supplements. Additional tests identified suppressed thyroid stimulating hormone (TSH). The patient was diagnosed with thyrotoxic periodic paralysis (TPP), which was treated with oral potassium supplements and antithyroid drugs, followed by a total thyroidectomy. The report discusses the epidemiology, presentation, treatment, and complications of this rare condition.
PubMed: 38590489
DOI: 10.7759/cureus.55822 -
Medical Archives (Sarajevo, Bosnia and... 2024Familial non-autoimmune hyperthyroidism is a rare disorder characterized by the absence of thyroid autoimmunity, particularly TSH receptor antibody [TRAb].
BACKGROUND
Familial non-autoimmune hyperthyroidism is a rare disorder characterized by the absence of thyroid autoimmunity, particularly TSH receptor antibody [TRAb].
OBJECTIVE
The aim of this study was to describe a novel TSHR mutation identified in a family of two siblings and their father.
METHODS
Two siblings presented for endocrine assessment at ages 7 and 14 years with mild T3 toxicosis, and the father presented at 30 years of age with non-autoimmune thyrotoxicosis. Both siblings were treated with oral antithyroid therapy to achieve reasonable symptom control and thyroid function normalization. The father was treated with oral antithyroid therapy, radioactive iodine, thyroidectomy, and thyroid replacement therapy. Peripheral blood DNA was extracted from both affected siblings and father. Mutation analysis of TSHR was carried out by PCR and Sanger sequencing of both strands of the extracted DNA.
RESULTS
Both siblings and their father were heterozygous for the missense TSHR variant c.1855G>C, p.[Asp619His], in exon 10.
CONCLUSIONS
This novel TSHR variant is associated with T3 toxicosis during childhood. Therefore, early identification and treatment may improve patient outcomes.
Topics: Humans; DNA; Hyperthyroidism; Iodine Radioisotopes; Mutation; Receptors, Thyrotropin; Thyroid Neoplasms
PubMed: 38566871
DOI: 10.5455/medarh.2024.78.154-158 -
Cureus Mar 2024The , also called Ashwagandha, is available everywhere in the world. We present a rare case of thyrotoxicosis following Ashwagandha administration, specifically painless...
The , also called Ashwagandha, is available everywhere in the world. We present a rare case of thyrotoxicosis following Ashwagandha administration, specifically painless thyroiditis (PT) in this report. The patient was a 47-year-old previously healthy Japanese man, who started taking Ashwagandha two months before his first visit to our hospital. He visited our hospital for typical thyrotoxicosis symptoms like a sense of fatigue, fever at night, and weight loss followed by diarrhea and headache. Blood tests disclosed thyrotoxicosis. Thyroid ultrasonography showed internal echo heterogeneity and no increase in blood flow. Thyroid scintigraphy revealed a deficiency in thyroid uptake. Based on these findings, he was diagnosed as PT. After stopping the administration of Ashwagandha, both his symptoms and serum thyroid markers were improved. This report may spark important debate about whether ashwagandha is safe among healthy people, especially in thyroid toxicity.
PubMed: 38559552
DOI: 10.7759/cureus.55352 -
Journal of Medical Case Reports Mar 2024Plasmapheresis represent an alternative therapeutic option for hyperthyroidism with thyroid storm or refractory cases. It provides a rapid decrease in plasma thyroid...
BACKGROUND
Plasmapheresis represent an alternative therapeutic option for hyperthyroidism with thyroid storm or refractory cases. It provides a rapid decrease in plasma thyroid hormones and anti-thyroid antibodies. The aim of this paper was to report our single center's experience in managing particular situations of hyperthyroidism using apheresis.
CASES PRESENTATION
The following case series describes three young African patients (two females, one male) aged 29, 37, and 25 years old, respectively, with Graves' disease who presented with drug ineffectiveness, drug-induced agranulocytosis, and thyroid storm with multi-organ failure. The three patients underwent plasmapheresis sessions leading to effective decline of thyroid hormone levels and offering a window for processing total thyroidectomy.
DISCUSSION/CONCLUSION
The standard management of thyrotoxicosis and thyroid storm was usually codified by the concomitant use of antithyroid medication, iodine, beta-blockers, and corticosteroids. This medical preparation can be effective in most cases. However, drug toxicity or ineffectiveness can limit the use of such therapeutics. Our paper supports the efficiency and safety of therapeutic plasma exchange in the preoperative management of thyrotoxicosis.
Topics: Female; Humans; Male; Antithyroid Agents; Graves Disease; Plasmapheresis; Thyroid Crisis; Thyroid Hormones; Thyrotoxicosis; Adult
PubMed: 38553729
DOI: 10.1186/s13256-024-04480-9 -
Medicine Mar 2024A thyroid storm is a life-threatening endocrine emergency characterized by severe hyperthyroidism and many systemic manifestations. Prompt recognition and treatment are... (Review)
Review
A thyroid storm is a life-threatening endocrine emergency characterized by severe hyperthyroidism and many systemic manifestations. Prompt recognition and treatment are essential for patient survival. This study evaluates the utility of existing diagnostic criteria and scoring systems for thyroid storm. A comprehensive literature review encompassed articles published up to December 2023. Various diagnostic criteria and scoring systems, such as the Burch-Wartofsky Point Scale and the Japanese Thyroid Association criteria, were critically assessed based on their sensitivity, specificity, and clinical applicability. Our findings reveal that existing diagnostic criteria and scoring systems, although valuable tools, exhibit limitations. They may lack sensitivity in identifying milder cases of thyroid storm or fail to differentiate it from other critical conditions. Furthermore, some criteria rely heavily on subjective clinical Judgment, which can vary among healthcare providers. Future research should focus on refining existing criteria and developing more objective and universally applicable diagnostic tools to address these limitations. Incorporating advanced laboratory markers and modern imaging techniques may enhance diagnostic accuracy. Additionally, a standardized scoring system approach could improve clinical practice consistency. In conclusion, while current diagnostic criteria and scoring systems provide a foundation for identifying thyroid storm, their utility has shortcomings. Advancements in diagnostic methods and a collaborative effort to establish standardized criteria are imperative to enhance the accuracy and reliability of thyroid storm diagnosis, ultimately improving patient outcomes.
Topics: Humans; Thyroid Crisis; Reproducibility of Results
PubMed: 38552097
DOI: 10.1097/MD.0000000000037396 -
Cureus Feb 2024Thyroiditis is a rare and serious complication for patients taking amiodarone. It can manifest with symptoms of hyperthyroidism and serious life-threatening arrhythmias....
Thyroiditis is a rare and serious complication for patients taking amiodarone. It can manifest with symptoms of hyperthyroidism and serious life-threatening arrhythmias. We present a case of a patient with amiodarone-induced thyrotoxicosis presenting with an electrical storm in which rhythm control was achieved with the utilization of amiodarone.
PubMed: 38550488
DOI: 10.7759/cureus.55082 -
Clinical Practice and Cases in... Feb 2024Thyroid storm is a rare but potentially life-threatening metabolic disorder that presents unique management challenges in the emergency department. Thionamides are...
INTRODUCTION
Thyroid storm is a rare but potentially life-threatening metabolic disorder that presents unique management challenges in the emergency department. Thionamides are commonly used as monotherapy for first-line treatment of hyperthyroidism.
CASE REPORT
In this case, a 26-year-old male presented to the emergency department with sore throat, fever, and diarrhea. He was found to have thyrotoxicosis as well as methimazole-induced bone marrow suppression resulting in agranulocytosis.
CONCLUSION
Thyroid storm is a rare condition that carries a high risk of mortality and can further compromise a patient's immune system due to complications of common treatment modalities. It can potentially be misdiagnosed as sepsis due to tachycardia, febrile state, and tachypnea. This case report includes a discussion of diagnostic studies, as well as medical and surgical treatment modalities that led to the patient's recovery.
PubMed: 38546308
DOI: 10.5811/cpcem.6609 -
Cureus Feb 2024Global data reports a low malignancy risk, whereas regional data report a variable risk of malignancy in Bethesda II thyroid nodules. The limited availability of...
BACKGROUND
Global data reports a low malignancy risk, whereas regional data report a variable risk of malignancy in Bethesda II thyroid nodules. The limited availability of surgical histopathology might have underestimated the risk of malignancy. Here, we report the prevalence of malignancy and its predictors in Bethesda II thyroid nodules for which the surgical histopathological diagnosis was available.
METHODS
This retrospective study was done at a tertiary healthcare center in South India between January 2008 and September 2015. Case records of adults with thyroid nodules who underwent surgery were collected. Patients with inadequate data were excluded from the study. The data was analyzed using SPSS version 21.0 and a p-value of < 0.05 was considered statistically significant.
RESULTS
A total of 563 patients were included in the study with a mean age of 36±12 years. Serum thyrotropin (TSH) was low in 87 (15.4%) patients whereas 362 (64.2%) patients had multinodular goiter (MNG). Sonographic evidence of suspicious cervical lymph node and microcalcification was seen in four (0.7%) and 48 (8.5%) patients, respectively. A total of 48 (8.5%) patients had thyroid carcinoma in the final histopathology. Of these, 42 (87.5%) had papillary thyroid carcinoma, five (10.4%) had follicular thyroid carcinoma and one (4.1%) had anaplastic carcinoma. Age, gender, and maximum nodule size were not associated with malignancy. Thyrotoxicosis was negatively associated with malignancy whereas multi-nodularity, thyroid calcification, or suspicious cervical lymph node on ultrasound and total thyroidectomy were positively associated with malignancy on univariate analysis. On binary logistic regression, only the former four, but not total thyroidectomy, were independent predictors of malignancy.
CONCLUSIONS
We report a high (8.5%) prevalence of malignancy among South Indian patients with Bethesda II thyroid nodules. Thyroid microcalcification, presence of suspicious cervical lymph node on ultrasound, and multinodularity were associated with high and suppressed TSH with low risk of malignancy. Further prospective studies are warranted to confirm the study observations.
PubMed: 38544601
DOI: 10.7759/cureus.54923 -
Indian Journal of Endocrinology and... 2024Accurate diagnosis of the etiology of thyrotoxicosis in pregnancy is important to guide appropriate treatment. The role of thyroid blood flow velocities by color Doppler...
INTRODUCTION
Accurate diagnosis of the etiology of thyrotoxicosis in pregnancy is important to guide appropriate treatment. The role of thyroid blood flow velocities by color Doppler to differentiate between Graves' disease (GD) in pregnancy and gestational transient thyrotoxicosis (GTT) is not well explored. This study evaluated inferior thyroid artery (ITA)-peak systolic velocity (PSV) as a marker for differential diagnosis of thyrotoxicosis in pregnancy.
METHODS
Fifty-six pregnant patients with thyrotoxicosis (30 with GTT and 26 with GD) along with 30 age-matched healthy euthyroid pregnant subjects were enrolled. Thyroid ultrasound examinations and color Doppler was performed by an ultrasound scanner. The studies of the right and left ITAs were performed with Doppler, and the PSV and End diastolic velocity (EDV) values were obtained from the right and left ITA.
RESULTS
The mean total T4 value in GD and GTT were almost similar (25.04 ± 2.43 vs 23.25 ± 2.81, value = 0.14). Beta HCG levels were significantly higher in cases of GTT as compared to GD (152946 ± 26694 vs 120608 ± 21244 mIU/ml, < 0.0001). The ITA-PSV and EDV in patients with GTT were significantly lower than those of pregnant patients with GD (right: 22.5 ± 6.8 and 8.3 ± 2.3; left: 22.97 ± 6.3 and 8.13 ± 2.01; < 0.001). receiver-operating-characteristic (ROC) curve demonstrated an optimal cutoff value of mean right ITA-PSV of 35 cm/sec to differentiate GTT from GD during pregnancy, with 84.6% and 93.3% sensitivity and specificity.
CONCLUSION
Thyroid artery velocities can help to differentiate between GD and GTT. The cutoff point of mean ITA-PSV at 35 cm/s had an excellent value in differentiating between the two, with good sensitivity and specificity.
PubMed: 38533284
DOI: 10.4103/ijem.ijem_54_23