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Endocrine Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Be aware of factitious hypothyroidism in those with access to thyroxine. Lithium reduces thyroxine release, causing hypothyroidism, and amiodarone frequently disturbs thyroid function.
The patient with acute endocrine problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Effects of thyroxine include:Stimulates basal metabolic rate, resulting in increased oxygen consumption and heat production (thermogenesis).CNS and cardiovascular sensitivity to catecholamines, e.g., increased heart rate and contractility.Enzyme synthesis, which promotes protein, fat and carbohydrate metabolism.Growth and development, e.g., of the nervous system.
Thyroid disease
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Management depends on cause and symptoms. Thyroxine treatment has limited efficacy, but studies suggest a 15%–40% reduction can be achieved. If the thyroxine is withdrawn the gland returns to pretreatment size [10].
The Association Between Hypothyroidism Treatment and Mortality in Patients Hospitalized in Surgical Wards
Published in Endocrine Research, 2023
Hiba Masri-Iraqi, Yaron Rudman, Carmel Friedrich Dubinchik, Idit Dotan, Talia Diker-Cohen, Liat Sasson, Tzipora Shochat, Ilan Shimon, Eyal Robenshtok, Amit Akirov
Electronic records of study subjects were manually searched for TSH measurements up to 6 months before admission. Chemiluminescence assay (Immulite 2000, Siemens Corp, Los Angeles, California) was used for measuring TSH levels, for which the normal range limits are 0.55 to 4.78 mIU/L. Free thyroxine (FT4) lower and upper limits are 10 to 20 pmol/L. Thyroid function blood tests were performed in the ambulatory setting, between 7:00 and 9:00 am (patients were given information on the timing of taking levothyroxine at the discretion of the treating physician). These are the normal values defined by the central laboratory at Clalit Health Services. TSH levels were classified into four categories: (1) ≤0.5, (2) 0.5–5.0, (3) ≥5.0 and ≤ 10.0, and (4) >10.0 mIU/L. FT4 levels were classified into three categories: (1) low (<10 pmol/L), (2) normal (10–20 pmol/L), and (3) high (>20 pmol/L).
A case of Hashimoto’s thyroiditis presented with heliotrope-like skin rash
Published in Scandinavian Journal of Rheumatology, 2022
Y Ogata, Y Fujieda, K Oku, A Tsutsumi
Fat-suppressed T2-weighted magnetic resonance imaging (MRI) revealed speckled hyperintensities in both upper eyelids (Figure 1B) with no signal abnormalities in her thighs. A skin biopsy of her right upper eyelid revealed focal infiltration consisting of CD3-positive T lymphocytes, from reticular dermis to subcutaneous fatty tissue, without vacuolar degeneration or mucin deposition (Figure 1C). In addition, a thyroid function examination revealed low serum-free thyroxine (0.12 ng/dL; normal 1.00–1.80 ng/dL) and high thyroid-stimulating hormone levels (194.30 µIU/mL; normal 0.27–4.20 µIU/mL). Thyroid echography revealed atrophic thyroiditis and the patient tested positive for anti-microsomal antibodies. Owing to this, the patient was diagnosed with Hashimoto’s thyroiditis. Her eyelid oedema and erythema disappeared after 2 months of thyroxine replacement therapy. Her thyroid function has remained normal, with no recurrence of oedematous erythema of either upper eyelid.
Infantile nephrotic syndrome secondary to cytomegalovirus infection in a 7-month-old girl: resolution with ganciclovir
Published in Paediatrics and International Child Health, 2021
Jasleen Kaur, Bobbity Deepthi, Rachita Singh Dhull, M. D. Faruq, Abhijeet Saha
Investigations. A spot urine protein:creatinine ratio was 4.03 mg/mg (<0.2), serum albumin 22 g/L (35–55), serum cholesterol 6.2 mmol/L (<4.39) and serum creatinine 56.6 µmol/L (18–35). Ultrasound demonstrated mild ascites. Other investigations are outlined in Table 1. She was commenced on daily prednisolone 2 mg/kg; the parents were counselled for genetic evaluation of nephrotic syndrome and the infant was discharged after 1 week in hospital. After 6 days she was re-admitted with fever, abdominal distension, cough and respiratory distress. Chest radiograph demonstrated bilateral lower zone opacities, suggestive of pneumonia. Thyroid-stimulating hormone (TSH) was 42.8 mIU/L (0.5–5.5), suggesting hypothyroidism for which thyroxine was commenced. TORCH profile demonstrated a positive IgG for CMV and negative IgM for CMV, toxoplasmosis, rubella, hepatitis B and syphilis. CMV PCR was positive with copies of 7.7 × 103/µL. A repeat spot urine protein:creatinine ratio was 11.2. The prednisolone was tapered and stopped and ganciclovir was commenced, 5 mg/kg twice a day for 2 weeks, followed by 5 mg/kg once a day for 4 weeks, then changed to oral valganciclovir 30 mg/kg in two divided doses for 10 weeks. After 1 month, repeat CMV PCR was negative and the urine protein:creatinine ratio gradually decreased from 11.2 before treatment to 0.07 on follow-up. Genetic mutation analyses for the NPHS1, NPHS 2 and WT1 genes were negative. TSH levels normalised to 0.5 mIU/L on thyroxine supplementation. After 18 months of follow-up, she remains in remission.