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Systemic disease and the skin
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Cutaneous manifestations of hyperthyroidism are varied. Skin, hairs, and nails have some important clinical pointers, which can readily serve as clues to diagnose the underlying hyperthyroidism. The skin is soft, smooth, and velvety, along with increased temperature and sweating. Besides, palmar erythema and facial flushing may be seen due to hyperdynamic circulation. Other associations include hyperpigmentation, pretibial myxedema, vitiligo, goiter, urticaria, palmoplantar pustulosis, melanoderma, and melasma. Nails typically have a fast growth rate. Besides, soft nails, koilonychias, Plummer’s nails thyroid acropachy may be found. Hairs are fine and thin. Diffuse alopecia and alopecia areata have also been documented.
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Systemic complications Cardiovascular – brain injury results in a massive catecholamine release with increased sympathetic outflow and dysfunction of the autonomic nervous system. This results in a hyperdynamic circulation with increased myocardial oxygen demand and workload leading to transient myocardial ischaemia and failure.Pulmonary – 80% of patients may have impaired oxygenation due to aspiration pneumonitis, neurogenic or cardiogenic pulmonary oedema, pneumonia, acute lung injury or ARDS.Metabolic – hyperglycaemia is a marker of the severity of SAH and is associated with a worse outcome. However, tight glycaemic control may be detrimental because of the risk of hypoglycaemia.Electrolytes – hyponatraemia may be due to administration of excessive hypotonic fluids, cerebral salt wasting syndrome, or the syndrome of inappropriate antidiuretic hormone secretion (SIADH).
Rheology of Disease
Published in Gordon D. O. Lowe, Clinical Blood Rheology, 2019
Overtly increased blood viscosity in polycythemias (Chapter 9, Volume II) and paraproteinemias (Chapter 11, Volume II) may be compensated by vasodilatation and by hypervolemia; increased plasma viscosity in paraproteinemias (Chapter 11, this volume) or increased numbers of rigid cells in hemolytic anemias (Chapter 10, this volume) or leukemias (Chapter 11, this volume) may be compensated by anemia. The hyperdynamic circulation in these vasodilated, hypervolemic, and/or anemic patients maintains high shear forces, and hence minimizes the risk of rheological flow disturbance. Similarly, the local hyperdynamic circulation in inflammatory states minimizes the risk of adverse rheological flow disturbance due to local hemoconcentration, leukocyte accumulation, and hyperglobulinemia (Chapter 7, Volume I). However, in the presence of vascular disease, low-flow, low-shear conditions may greatly increase the likelihood that subtle, systemic rheological changes may promote tissue malperfusion. Such systemic rheological changes in nonhematological diseases have therefore been termed covertly abnormal,1 since they are only likely to impair flow in the presence of vascular disease. In subsequent chapters, this concept will be further developed for cardiovascular disease. However, it is useful to outline the general changes in blood rheology in disease states, before considering their interactions with vascular factors and blood flow in particular organs.
Secondary hypertension as a cause of treatment resistance
Published in Blood Pressure, 2023
Isabella Sudano, Paolo Suter, Felix Beuschlein
Deregulation of the thyroid and parathyroid function are reversible causes of secondary hypertension [28]. Thyroid disorders induce several haemodynamic changes leading to elevated blood pressure as a consequence of their interaction with endothelial function, vascular reactivity, renal haemodynamics, and renin–angiotensin system. However, in thyroid disorders, the regulation of blood pressure and the development and maintenance of variable forms of arterial hypertension are different [29]. Hyperthyroidism results in an increased endothelium-dependent responsiveness secondary to the shear stress induced by the hyperdynamic circulation and contributes to reduce vascular resistance. Conversely, hypothyroidism is accompanied by a marked decrease in sensitivity to sympathetic agonists with an increase in peripheral vascular resistance and arterial stiffness. Increased blood pressure due to thyroid disorders is usually reversible with the achievement of euthyroidism, but in some cases, the pharmacological treatment for blood pressure control is required. In hyperthyroidism, beta-blockers are the first-choice treatment to control blood pressure, but when they are contraindicated or not tolerated, angiotensin-converting enzyme inhibitors or calcium channel blockers are recommended. Hypothyroidism is a typical low-renin hypertension responding particularly well to calcium antagonists and diuretics; indeed, in hypothyroidism a low-sodium diet seems to improve blood pressure control further [1].
The outcome of the vein of Galen aneurysmal malformation cases diagnosed prenatally
Published in Journal of Obstetrics and Gynaecology, 2022
Gurcan Turkyilmaz, Resul Arisoy, Sebnem Turkyilmaz, Emre Erdogdu, Altug Semiz
Cardiac function alterations are frequent in foetuses with VGAM. In most cases, hyperdynamic circulation may increase the afterload of the heart and cause heart failure. Foetal echocardiography evaluation is mandatory in those foetuses. In our series, cardiac anomalies such as cardiomegaly or tricuspid regurgitation were evident in 66.6% of cases. Moreover, hydrops fetalis occurred in 33% of cases associated with volume overload. Pires et al. evaluated seven cases with VGAM and showed that cardiac failure was present in four (57%) cases (Pires et al. 2017). Deloison and colleagues published the outcomes of 21 cases diagnosed VGAM in the prenatal period and revealed that cardiomegaly or tricuspid regurgitation was present in more than 90% of cases (Deloison et al. 2012). Paladini et al. analysed the features of 49 cases and found that cardiac dysfunction or hydrops fetalis accompanies 71.4% and 8.2% of foetuses, respectively (Paladini et al. 2017).
Reduced neural baroreflex sensitivity is related to enhanced endothelial function in patients with end-stage liver disease
Published in Scandinavian Journal of Gastroenterology, 2018
Adrienn Sárközi, Domonkos Cseh, Zsuzsanna Gerlei, Márk Kollai
Hyperdynamic syndrome consisting of elevated HR and cardiac output reduced peripheral vascular resistance and subsequently decreased arterial pressure is frequently observed in patients with advanced cirrhosis. The underlying mechanism of hyperdynamic circulation is peripheral and splanchnic vasodilation due to increased production of endothelial vasodilator factors such as NO [37,38]. In this work, we studied brachial artery baseline diameter and dilation in response to shear stress (FMD). It was found that baseline diameter of brachial artery was unchanged, while endothelial function was enhanced in patients with end-stage liver disease, as indicated by significant elevation in FMD. Our present data are in line with earlier observations, which showed enhanced endothelium-dependent vasodilation in patients with cirrhosis [12,13].