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Communication Stations
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Wai Sum Cho, Anna Slovick, Jameel Muzaffar, Adnan Darr
Part 2: Ultrasound scan shows U2 multinodular goitre with no retrosternal extension and no lymphadenopathy. Thyroid function tests were within normal limits. The patient reports difficulty with exertion and lying flat. You decide that the patient requires total thyroidectomy. Explain the scan results and take consentPoints to cover: Mass is non-cancerousNeed for long-term thyroid supplementationDuring consenting process also discuss possibility of long-term calcium replacements, hoarse voice, bilateral vocal cord palsy and tracheostomy
Fever In Endocrinologic Disorders
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Ygal Gilboa, Elisabeth Horer, B. Isaac
The typical symptoms are high fever, local tenderness, and swelling of the thyroid. The infection may involve the whole gland or only a portion of it. The thyroid function tests are normal. There is a high ESR and leukocytosis. On thyroid scan, there is decreased uptake, corresponding to the involved portion.
Examine the lower limbs
Published in Hani TS Benamer, Neurology for MRCP PACES, 2019
Q: How would you investigate? Investigations will depend on the possible cause.Blood tests, such as thyroid function test.Muscle enzymes.EMG.Muscle biopsy.Genetic testing.
Reactivation of Graves’ Disease and Thyroid Eye Disease following COVID-19 Vaccination – A Case Report
Published in Ocular Immunology and Inflammation, 2023
Chien-Wei Hung, Chih-Heng Hung
A 51-year-old Asian male had a history of well-controlled GD under regular follow-up, treated with carbimazole (10 mg per day) for 10 years, and TED with post bilateral (OU) orbital decompression 7 years ago. Recent thyroid function tests showed stable results. However, two weeks after the administration of the second dose of the BNT162B2 messenger ribonucleic acid (mRNA) (Pfizer-BioNTech) COVID-19 vaccine, he presented symptoms of anxiety, persistent tiredness and weakness. Five weeks after the injection, thyroid function tests showed elevated levels of thyroxine (free T4) (2.30 ng/dL; normal range, 0.93–1.70 ng/dL) and low levels of thyroid-stimulating hormone (TSH) (< 0.01 uIU/mL; normal range, 0.27–4.20 uIU/mL). During the follow-up period, the antithyroid drug was as previously prescribed with carbimazole (10 mg per day). Five months after the second dose of the Pfizer-BioNTech COVID-19 vaccine, he received the booster shot of the mRNA-1273 (Moderna) COVID-19 vaccine. Follow-up thyroid function tests showed worsened free T4 (7.77 ng/dL) and TSH (< 0.01 uIU/mL), and carbimazole (30 mg per day) was prescribed for another 3 months. The patient subsequently experienced hypothyroidism, and the antithyroid drug was halted for one month. After that, thyroid function tests showed elevated free T4 (6.31 ng/dL) and low levels of TSH (< 0.01 uIU/mL). Since then, the patient received carbimazole (10 mg per day), and recent thyroid function tests showed stable results for 2 months. Reactivation of GD lasted for a total duration of 11 months.
Mechanical circulatory support for thyrotoxicosis-induced cardiomyopathy
Published in Baylor University Medical Center Proceedings, 2023
Nikita Dhir, Travis Haneke, Timothy Mixon
Thyrotoxicosis is a serious condition that can lead to high-output heart failure and possible cardiogenic shock.1 It usually presents with extreme symptoms of hyperthyroidism, including tachycardia, fever, hypotension, agitation, nausea, vomiting, and/or diarrhea. Thyroid function tests will show high free T4 and T3, with low thyroid-stimulating hormone. Treatment for thyroid storm includes beta-blockers, iodine solution, thionamides, and glucocorticoids.2 Complications of heart failure can potentially require temporary mechanical circulatory support (MCS) with an Impella device or extracorporeal membrane oxygenation (ECMO).1 In patients with hemodynamic instability, beta-blockers are avoided to prevent worsening of high-output cardiac failure. MCS can be a useful bridging tool during the treatment of reversible causes of cardiogenic shock, such as thyroid storm.
Fungal abscess after intra-orbital steroid injection: a case report
Published in Orbit, 2022
Mythri K. Rao, Md. Shahid Alam, Ram Gopalakrishnan, Bipasha Mukherjee
On examination, his best-corrected visual acuity (BCVA) was 6/9, N6 in the right eye and 6/6, N6 in the left eye. Examination of the right eye revealed an axial proptosis of 6 mm, along with a relative afferent pupillary defect (RAPD) and limitation of ocular movements in all directions of gaze. A firm, non-tender, indurated swelling in the right lower eyelid precluded finger insinuation between the mass and the inferior orbital rim. The conjunctiva was congested with chemosis inferiorly. Intraocular pressure (IOP) by Goldman’s applanation tonometry was 24 and 10 mm Hg in right and left eye, respectively. Fundus examination revealed choroidal folds in the right eye. Examination of the left eye was unremarkable. Systemic examination was normal. Hematological investigations including thyroid function tests were within normal limits.