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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
In Graves’ disease, untreated hyperthyroidism is associated with miscarriage, premature labor, low birthweight, and pre-eclampsia. Therefore, an endocrinologist, an obstetrician, and a pediatrician should jointly manage these patients. Management entails rapid return to a euthyroid state and symptom control. Propylthiouracil is the preferred antithyroid agent in the first trimester because it has fewer teratogenic effects; however, carbimazole is preferred in the second and third trimesters due to its causing fewer liver function abnormalities. At 20 weeks, TSH-receptor antibody concentrations should be measured, and patients with significantly raised levels should be closely monitored due to transplacental transfer leading to fetal thyrotoxicosis.
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
Although therapy should be individualized and discussed with patients and their families as appropriate, most patients with hyperthyroidism due to a multinodular goiter should be treated with 131I therapy. Antithyroid agent therapy may be useful for patients with smaller glands with less severe hyperthyroidism; long-term antithyroid agent therapy should be reserved for selected patients. Surgery addresses the problem expeditiously and can be used quite effectively; it should be considered for patients with very large thyroid glands since the likelihood of such patients responding to 131I therapy is lower. Compressive symptoms such as hoarseness, superior vena cava syndrome, dysphagia, and/or dyspnea are additional indications for surgery. However, in patients who are not surgical candidates, radioiodine should be used.
Thyroid disease
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Andrew Shennan, Joanna Girling
Fetal hyperthyroidism is associated with premature delivery. Fetal cardiac failure can result, leading to hydrops fetalis and death; fetal goitre can cause polyhydramnios or an obstructed delivery. The condition is also associated with craniosynostosis and intellectual impairment. The fetus can be effectively treated in one of two ways, either by maternal administration of antithyroid agents, which cross the placenta, or by delivery. The fetal heart rate can be used to titrate the dose of antithyroid drugs. The mother can be treated with T4 to offset any hypothyroid effects, as T4 will not cross the placenta [C]. As thyroid TSH receptor stimulating antibodies have a long half-life (3 weeks), which exceeds that of placentally transferred antithyroid medication, they can also cause neonatal hyperthyroidism. The symptoms may therefore present in the baby only after a week and tend to be non-specific, such as poor weight gain, feeding and sleeping.
Acute appendicitis complicated by concomitant thyroid storm
Published in Baylor University Medical Center Proceedings, 2021
Michael M. Mohseni, Charles Graham
Thyrotoxicosis and thyroid storm (TS) can mimic an acute surgical abdomen.1 In some instances, patients undergo exploratory laparoscopy given concerns of an acute abdomen in the setting of TS and subsequently lack intraoperative findings.2 Differentiating medical from surgical causes of an acute abdomen is imperative to ensure initiation of appropriate therapies. In the setting of an emergent surgical condition, a patient with thyrotoxicosis needs premedication with beta-blockers, corticosteroids, and antithyroid agents to prevent TS in the perioperative or postoperative timeframes.3 Case reports of appendicitis with concomitant thyrotoxicosis are rare.3,4 However, clinicians must proceed cautiously to optimize patients’ thyroid status before any operative interventions, thereby minimizing risks of cardiovascular collapse or death. We present a case of acute appendicitis requiring surgical intervention in a patient simultaneously diagnosed with TS.
Investigational drugs in early stage clinical trials for thyrotoxicosis with hyperthyroidism
Published in Expert Opinion on Investigational Drugs, 2018
Various studies demonstrate that many environmental pollution molecules and small molecules are antagonist of thyroid hormone receptor, but the major strength of the studies is the availability of biochemical data as well their absent effectiveness as antithyroid agents [20].
Arecoline inhibits pineal–testis function in experimentally induced hypothyroid rats
Published in Archives of Physiology and Biochemistry, 2020
Indraneel Saha, Suman Bhusan Chakraborty, Aniruddha Chatterjee, Debajyoti Pradhan, Urmi Chatterji, B. R. Maiti
There is increasing evidence that triiodothyronin (T3) plays an important role in normal thyroid physiology. Thyroxine (T4) is supposed to exert little metabolic effect compared to that of T3 in the peripheral tissue (Abuid and Larsen 1974). Thyroid hormone deficiency resulted pineal inactivity characterised by ultrastructural degeneration of SR, confirmed from significant decrease in their mean lengths and widths. There is evidence that SR are altered with depletion of serum melatonin and serotonin levels (Vollrath et al. 1985). This finding corroborates with the findings of declined levels of pineal hormones in hypothyroid rats. In addition, abundance of degenerated and aggregated SLMV observed after PTU treatment suggest pineal inactivity including disturbance in neurotransmitter production in hypothyroid condition, because active pinealocytes show numerous SLMV containing classical neurotransmitters like Gama-amino-butyric acid and Glycine (Redecker 1999). Abnormal size of the DM with irregular cristae observed in PTU-treated rats has also been reported to occur in the cerebrum of the hypothyroid rats. Degenerated ultrastructural manifestations of the pinealocytes correlated with the fall in pineal and serum NAS and melatonin productions in hypothyroid rats. Elevation of serotonin level could be due to its accumulation following decreased synthesis and/or its conversion to NAS and/or to melatonin. N-acetyltransferase (NAT) and hydroxyinodole-o-methyl transferase (HIOMT) enzymes are known to help in the conversion, respectively, of serotonin to NAS and NAS to melatonin (Norris and Carr 2013). Thus, decreased levels of NAS and melatonin induced by PTU treatment could be due to decreased NAT and HIOMT (Boucher and Maunan 2002) activities in rats. As thyroid is pro-pineal (Rom-Bugoslavskaia and Bondarenko 1984), PTU-induced thyroid dysfunction may also be responsible for pineal dysfunction in rats. In Japanese quail (Cotunix japonica), methimazole (2-Mercapto-1-methilimidazole) an antithyroid agent, feeding in drinking water caused both gonadal (testis) and adrenal dysfunction (Weng et al. 2007). Melatonin injection, 9 h after the onset of light or darkness caused testis and accessories dysfunction with lowered plasma testosterone, LH, FSH and decreased number of pituitary GnRH receptors, reflecting delayed sexual maturation at 40 days (Lang et al. 1984). The findings further suggest that arecoline possibly has no synergistic action on pineal indoleamines production in hypothyroid animals because of no significant changes in NAS and melatonin production observed after joint treatment of arecoline and PTU.