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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
Toxic multinodular goitre is the most common cause of hyperthyroidism in the elderly in iodine-deficient regions. Atrial fibrillation is the principal sign. Definitive treatment is with radioiodine, resulting in permanent hypothyroidism in most patients. Surgery (total thyroidectomy/thyroid lobectomy) is reserved for patients with compressive symptoms, patients with large goitre and cosmetic concerns, or patients with contraindications to radioiodine.
Endocrinology
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Other causes of hyperthyroidism include: Toxic multinodular goitre: Nodules that secrete thyroid hormone, treated with radioiodine/surgery.Toxic adenoma: Solitary nodule producing thyroid hormone. Appears ‘hot’ on isotope scan. Treated with radioiodine.Ectopic thyroid tissue (e.g. from choriocarcinoma, ovarian teratoma).Exogenous thyroid (diet, excess levothyroxine).Subacute (de Quervain's) thyroiditis: Postviral hyperthyroidism with a painful goitre. Investigations show a raised ESR and low isotope uptake on scan. Treated with NSAIDs.Iatrogenic: Amiodarone, lithium.Postpartum thyroiditis: Occurs in 7% of women a year after giving birth.
The diagnostic evaluation and management of hyperthyroidism due to Graves’ disease, toxic nodules, and toxic multinodular goiter
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
A toxic multinodular goiter is a thyroid gland that contains at least two autonomous functioning thyroid nodules that secrete excessive amounts of thyroid hormone, suppressing serum TSH and often causing typical symptoms and signs of hypermetabolism (235). These nodules may be more or less distinct on clinical examination and scan. Autonomous nodules require many years to develop and transition through a phase when the TSH is normal and then subnormal with minimal clinical evidence of hyperthyroidism (subclinical hyperthyroidism). Because of the time required for this process to develop, most patients with toxic multinodular goiter are over the age of 50 (Figure 2.7). Many clinical aspects of patients with toxic multinodular goiters are similar to those found in those with solitary autonomous nodules. For example, exogenous iodine exposure can precipitate or aggravate thyrotoxicosis (235, 254).
Thyrotoxic periodic paralysis: a presentation of hyperthyroidism increasing in frequency around the world
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2023
Laboratory results include a very low serum potassium level without any acid-base disturbance.21,22 Renal excretion of potassium is also low, thus excluding renal potassium wasting. A high urinary calcium-to-phosphate ratio has been proposed to distinguish thyrotoxic periodic paralysis patients from those with familial hypokalaemic periodic paralysis.5 Suppressed thyroid stimulating hormone levels with raised T3 and T4 levels are pathognomonic of the disease. Unsurprisingly, Graves’ disease is most commonly diagnosed in patients with thyrotoxic periodic paralysis; however, thyroiditis, toxic multinodular goitre and TSH-producing pituitary tumours have also been reported.21,22,24 The ECG may show U-waves, prolonged PR interval and both supraventricular and ventricular ectopic beats. The risk for life-threatening ventricular tachycardias or fibrillation remains high until the hypokalaemia is corrected.25,26
Association between circulating irisin levels and epicardial fat in patients with treatment-naïve overt hyperthyroidism
Published in Biomarkers, 2018
Mustafa Şahin, Asena Gökçay Canpolat, Demet Çorapçioğlu, Uğur Canpolat, Rıfat Emral, Ali Rıza Uysal
All consecutive patients and healthy controls were screened for the eligibility criteria in our cross-sectional observational study. A total of 25 untreated subjects with hyperthyroidism and 24 age-, sex-, body mass index (BMI)- and physical activity-matched healthy controls admitted to our tertiary care outpatient clinics (Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey) were enrolled between July and October 2014 (Figure 1, flow chart). Twenty-three patients with hyperthyroid were diagnosed with Graves disease, while two others had toxic multinodular goiter with laboratory findings of low thyroid stimulating hormone (TSH) level (<0.1 mIU/L; normal reference range, 0.3–4.5 mIU/L), increased free thyroxine (fT4 reference range, 7–16 pmol/L) and/or increased free triiodothyronine (fT3 reference range, 3–6 pmol/L). None of the participants had a history of cardiovascular disease, diabetes, hypertension, malignancy or renal or hepatic failure. All participants were nonsmokers and did not take any medications, which may affect weight or lipid parameters. Demographic characteristics including age, sex and BMI were recorded for all subjects. Body compositions were analyzed with the bioelectrical impedance analysis technique using a Tanita BC-420MA body composition analyzer (Tanita Corp., Tokyo, Japan).
Thyrotropin receptor antibodies and a genetic hint in antithyroid drug-induced adverse drug reactions
Published in Expert Opinion on Drug Safety, 2018
Lin-Chau Chang, Chien-Ching Chang, Pei-Lung Chen, Shun-Huo Wang, Yi-Hsuan Chen, Yung-Hsin Tsai, Shyang-Rong Shih, Wei-Yih Chiu, Cathy Shen-Jang Fann, Wei-Shiung Yang, Tien-Chun Chang
Although concomitant use of antihistamines can sometimes alleviate the cutaneous reactions, thereby enabling the continued use of ATDs [1,13], in many cases the use of these drugs must be discontinued and another category of ATD or treatment with radioactive iodine be administered instead [6,11]. A retrospective case–control study indicated that allergic reactions to ATDs are associated with autoimmunity [13]. Chivu et al. found that among 72 patients with the autoimmune Basedow–Graves’ disease who were treated with thiamazole, six developed allergic reactions [13]. In contrast, none of the 56 patients with the non-autoimmune toxic multinodular goiter who were treated with thiamazole experienced allergic reactions [13]. Furthermore, the genetic predisposition of patients could have an impact on both the predictable (type A) and unpredictable (type B) types of ADRs [14,15].