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Endocrinology, Diabetes & Metabolism... Apr 2024Thyroid-stimulating hormone-secreting pituitary adenomas (TSHomas) are rare, accounting for less than 1% of all pituitary adenomas. We present a case of hyperthyroidism...
SUMMARY
Thyroid-stimulating hormone-secreting pituitary adenomas (TSHomas) are rare, accounting for less than 1% of all pituitary adenomas. We present a case of hyperthyroidism secondary to a likely TSHoma and coexisting functional thyroid adenoma. Laboratory errors and familial abnormalities in thyroid function tests were ruled out, and a diagnosis of the toxic thyroid adenoma was confirmed on a thyroid uptake scan. However, the triiodothyronine suppression test was contraindicated due to the patient's cardiovascular disease, and the thyrotropin-releasing hormone stimulation test, measurement of glycoprotein hormone alpha-subunit, and genetic testing were unavailable. Magnetic resonance imaging of the brain revealed a suprasellar pituitary macroadenoma measuring 40 mm × 20.3 mm × 17 mm. The patient was initiated on carbimazole; however, thyroid stimulating hormone and thyroxine levels remained elevated. The patient declined trans-sphenoidal surgery and was treated with radioactive iodine to manage the toxic thyroid adenoma, leading to reduced thyroxine levels and symptom improvement. Unfortunately, the patient passed away before long-acting somatostatin analogs became available. This case highlights the diagnostic and therapeutic challenges involved in managing thyrotoxicosis with dual etiology.
LEARNING POINTS
Hyperthyroidism can have multiple etiologies, which can coexist in the same patient. Persistent discordant thyroid function tests warrant further investigation. The gold standard for diagnosis of TSHomas remains immunohistochemical analysis of the tumor tissue.
PubMed: 38642582
DOI: 10.1530/EDM-23-0136 -
The American Surgeon Apr 2024Thyroid storm is a rare but potentially lethal manifestation of thyrotoxicosis. Guidelines recommend nonoperative management of thyroid storm, but thyroidectomy can be...
BACKGROUND
Thyroid storm is a rare but potentially lethal manifestation of thyrotoxicosis. Guidelines recommend nonoperative management of thyroid storm, but thyroidectomy can be performed if patients fail medical therapy or need immediate resolution of the storm. Outcomes of thyroidectomy for management of thyroid storm remain ill-defined.
METHODS
Using the National Inpatient Sample from 2016 to 2020, a retrospective analysis was conducted of patients admitted with thyroid storm. Outcomes of interest included operative complications and mortality. Multivariable logistic regression was performed to assess factors associated with receiving thyroidectomy and mortality.
RESULTS
An estimated 16,175 admissions had a diagnosis of thyroid storm. The incidence of thyroid storm increased from .91 per 100,000 people in 2016 to 1.03 per 100,000 people in 2020, with a concomitant increase in mortality from 2.9% to 5.3% ( < .001). Operative intervention was pursued in 635 (3.9%) cases with a perioperative complication rate of 30%. On multivariable regression, development of acute decompensated heart failure (adjusted odds ratio [AOR] 1.66, 95% Confidence Interval [CI] 1.03-2.68, = .037) and acute renal failure (AOR 2.10, 95% CI 1.17-3.75, = .013) increased odds of receiving surgery. The same multivariable model did not show a significant association between thyroidectomy and mortality.
DISCUSSION
The incidence of thyroid storm and associated mortality increased during the study period. Thyroidectomy is rarely performed during the same admission, with an overall perioperative complication rate of 30% and no effect on mortality. Patients with acute decompensated heart failure and renal failure were more likely to receive an operative intervention.
PubMed: 38629320
DOI: 10.1177/00031348241248704 -
JCEM Case Reports Apr 2024Fetal thyrotoxicosis is a rare condition with high morbidity and mortality. It may complicate pregnancies in women with a history of Graves disease (GD) when...
Fetal thyrotoxicosis is a rare condition with high morbidity and mortality. It may complicate pregnancies in women with a history of Graves disease (GD) when transplacental passage of maternal TSH receptor antibodies stimulate the fetal thyroid gland and cause hyperthyroidism. We report the case of a 34-year-old woman with a history of GD and prior thyroidectomy, where fetal thyrotoxicosis at 21 weeks of gestation was suspected due to prenatal ultrasound findings of cardiac failure and fetal goiter. She was treated with high-dose carbimazole and followed closely by a multidisciplinary team. Her baby was delivered in good condition at 34 weeks' gestation and developed hyperthyroidism in the days after birth, which was successfully treated medically. This case highlights the importance of awareness of the condition among women with a history of GD, as well as the necessity for prompt diagnosis and treatment of this complex disease.
PubMed: 38623533
DOI: 10.1210/jcemcr/luae060 -
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 -
The Journal of Clinical Endocrinology... Apr 2024Thyrotoxicosis requires accurate and expeditious differentiation between Graves' disease (GD) and thyroiditis to ensure effective treatment decisions.
CONTEXT
Thyrotoxicosis requires accurate and expeditious differentiation between Graves' disease (GD) and thyroiditis to ensure effective treatment decisions.
OBJECTIVE
This study aimed to develop a machine learning algorithm using ultrasonography and Doppler images to differentiate thyrotoxicosis subtypes, with a focus on GD.
METHODS
This study included patients who initially presented with thyrotoxicosis and underwent thyroid ultrasonography at a single tertiary hospital. A total of 7,719 ultrasonography images from 351 patients with GD and 2,980 images from 136 patients with thyroiditis were used. Data augmentation techniques were applied to enhance the algorithm's performance. Two deep learning models, Xception and EfficientNetB0_2, were employed. Performance metrics such as accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score were calculated for both models. Image pre-processing, neural network model generation, and neural network training results verification were performed using DEEP:PHI® platform.
RESULTS
The Xception model achieved 84.94% accuracy, 89.26% sensitivity, 73.17% specificity, 90.06% PPV, 71.43% NPV, and an F1 score of 89.66 for the diagnosis of GD. The EfficientNetB0_2 model exhibited 85.31% accuracy, 90.28% sensitivity, 71.78% specificity, 89.71% PPV, 73.05% NPV, and an F1 score of 89.99.
CONCLUSION
Machine learning models based on ultrasound and Doppler images showed promising results with high accuracy and sensitivity in differentiating GD from thyroiditis.
PubMed: 38609169
DOI: 10.1210/clinem/dgae254 -
Cureus Mar 2024Hypokalemic periodic paralysis (HPP) is an uncommon condition resulting from channelopathy, impacting skeletal muscles. It is distinguished by episodes of sudden and...
Hypokalemic periodic paralysis (HPP) is an uncommon condition resulting from channelopathy, impacting skeletal muscles. It is distinguished by episodes of sudden and temporary muscle weakness alongside low potassium levels. The normalization of potassium resolves the associated paralysis. Most of these cases are hereditary. Few cases are acquired and are associated with an etiology related to endocrine disorders (e.g., thyrotoxicosis, hyperaldosteronism, and hypercortisolism). It is characterized by acute flaccid paralysis, usually of the ascending type, affecting the proximal region more than the distal region. Herein, we report the case of a 29-year-old male who instead of the ascending type presented with descending-type acute flaccid paralysis. Potassium level at presentation was 1.7 mEq/L. The patient was managed with parenteral and oral potassium supplementation, after which the weakness was completely resolved.
PubMed: 38606215
DOI: 10.7759/cureus.55981 -
Frontiers in Oncology 2024Human chorionic gonadotropin (hCG)-induced hyperthyroidism is a rare paraneoplastic syndrome observed in non-seminomatous testicular germ cell tumors, due to a...
BACKGROUND
Human chorionic gonadotropin (hCG)-induced hyperthyroidism is a rare paraneoplastic syndrome observed in non-seminomatous testicular germ cell tumors, due to a cross-reaction between the β-subunit of hCG with the thyroid-stimulating hormone receptor. The precise prevalence of this paraneoplastic phenomenon is unclear as, in the majority of cases, hyperthyroidism remains subclinical.
CASE PRESENTATION
Here, we present two cases of advanced metastatic non-seminomatous testicular germ cell tumors where patients exhibited signs and symptoms of thyrotoxicosis at primary diagnosis due to excessive serum β-hCG elevation, with complete remission of symptomatology after the start of oncological treatments and no signs of relapse at the time of publication of this report. Additionally, we provide a comprehensive review of the existing literature concerning this uncommon occurrence.
CONCLUSION
Despite being a rare event, the presence of hyperthyroidism or thyrotoxicosis without clear etiology in a young man should lead to consider less frequent causes such as testicular tumors. Even if patients typically have mild symptoms that resolve after chemotherapy, in rare cases, it can be a life-threatening condition that requires prompt recognition and specific intervention.
PubMed: 38601761
DOI: 10.3389/fonc.2024.1338438 -
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