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Benign Thyroid Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Treatment strategies for thyrotoxicosis are categorised into medical, nuclear medicine, and surgical approaches. Medical management entails antithyroid drugs ± beta blockers. Thionamines are prescribed in a ‘block and replace’ or titration regimen. The most common side-effect is pruritic rash. The most serious side-effects are agranulocytosis and liver failure. Lugol's iodine solution is variably used as a second-line control in the work-up for surgery. Radioiodine is safe and effective and is considered first-line treatment in the elderly and those with cardiac dysfunction who may not tolerate physiological stress of surgery. Surgery is the preferred option in toxic multinodular goitre, in those with compressive symptoms, and in Graves’ disease associated with eye disease.
Endocrine diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Symptoms of thyrotoxicosis include heat intolerance, weight loss, anxiety, palpitations, tachycardia, and excessive sweating, along with poor exertional tolerance and easy fatiguability. Not surprisingly, in many instances, the symptoms will be erroneously attributed to those of normal pregnancy. Physical clues to the possibility of thyrotoxicosis include goiter, proptosis, lid lag, stare, a fine resting hand tremor, warm moist palmar skin, and generalized hyperreflexia.
Thyroid disease
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
If manifesting for the first time in pregnancy, thyrotoxicosis usually occurs in late first or early second trimester and can be hard to diagnose, as many of the signs and symptoms (see Table 7.1) are common in pregnant women. Weight loss despite increased appetite, persistent tachycardia or tremor may be among the more reliable of signs and symptoms.
Prevalence and aetiology of thyrotoxicosis in patients with hyperemesis gravidarum presenting to a tertiary hospital in Cape Town, South Africa
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
T van der Made, M van de Vyver, M Conradie-Smit, Magda Conradie
At baseline, a diagnosis of thyrotoxicosis was made in the presence of a suppressed TSH level based on the NHLS laboratory reference range and a concomitant increase in circulating levels of fT4 and/or fT3. Ideally TSH levels in pregnancy should be defined by population-based normative data in iodine-replete women. Globally the use of trimester-specific TSH ranges is advocated in in the absence of population-based reference data in view of the known lowering of both the lower and upper range of TSH, especially in the latter part of the first trimester (weeks 7–12). A TSH range of 0.1–2.5 mIU/l and a TSH range of 0.2–3 mIU/l are globally regarded as acceptable to apply for the first and second trimester of pregnancy in the absence of available population-based reference values.11 Although we categorised patients as thyrotoxic or euthyroid based on the non-adjusted NHLS-TSH range, the impact of using trimester-specific TSH on the categorisation of women as thyrotoxic will be reflected on.
Pitfalls in the assessment of gestational transient thyrotoxicosis
Published in Gynecological Endocrinology, 2020
Pregnancy profoundly affects the thyroid gland and thyroid function. Hyperthyroidism during pregnancy is rare, but given the adverse outcomes that can occur in the mother and the fetus, identifying hyperthyroidism is essential [1]. Graves’ disease (GD) occurs in 0.1–1% of all pregnancies and is the most common cause of hyperthyroidism during pregnancy [2,3]. In contrast, gestational transient thyrotoxicosis (GTT), which is characterized by increased thyroid hormone levels and thyroid-stimulating hormone (TSH) suppression during normal pregnancies, causes thyrotoxicosis more frequently than GD. GTT occurs in 2–11% of all pregnancies [4]. As other causes of thyrotoxicosis during pregnancy are rare, the differential diagnosis is usually GD or GTT [5]. However, as the symptoms and signs of hyperthyroidism can be seen in normal pregnancies, diagnosing hyperthyroidism that presents for the first time in pregnancy can be challenging. While GTT usually has a short duration and resolves spontaneously [6,7], it can be associated with unusual manifestations, including a delayed onset, severe symptoms requiring specific treatments, or a prolonged course [8]. This review focuses on diagnosing GTT, and, particularly, its differentiation from GD, and unusual clinical conditions associated with GTT that require comprehensive management.
An unusual case of struma ovarii causing ovarian torsion during pregnancy
Published in Journal of Obstetrics and Gynaecology, 2019
Dalia Khalife, Joseph Nassif, Bassel Nazha, Ibrahim Khalifeh, Sally Khoury, Ali Khalil
The management of these masses in pregnancies is quite challenging, since different factors are taken into consideration, mainly the risk of malignancy, the risk of cyst rupture of torsion and the gestational age at the time of diagnosis. Struma ovarii manifests as a pelvic mass but can present as a hyperthyroid state or ascites. Histologically, it is characterised by large thyroid follicles with colloid material. The immunohistochemical staining of thyroglobulin protein confirms its thyroid nature (McCluggage and Young 2005). In undiagnosed cases undergoing surgical resection, thyrotoxicosis is a rare but potentially life-threatening complication (Matsuda et al. 2001). To-date, one case has been reported in literature of an ovarian torsion of a struma ovarii during pregnancy (Kung et al. 1990). In this report, we describe a case of a benign non-functional struma ovarii presenting as ovarian torsion during pregnancy.