Endocrine problems in pregnancy
Philip E. Harris, Pierre-Marc G. Bouloux in Endocrinology in Clinical Practice, 2014
Thyrotoxicosis is a constellation of symptoms, signs, and risks resulting from excessive amounts of thyroid hormones. Thyrotoxicosis occurs in approximately 0.2% of all pregnancies.13 Autoimmune thyroid disease (AITD) or Graves’ disease accounts for the majority of these cases in areas with sufficient iodine intake,14 especially in women of reproductive age. Other causes of hyperthyroidism include multinodular goiter and autonomously functioning nodules; hyperthyroidism may be seen early in a destructive thyroiditis such as postviral, Hashimoto’s, or postpartum thyroiditis. In cases of a low or suppressed serum TSH, the distinction between normal physiological changes of pregnancy and hyperemesis gravidarum and hyperthyroidism must be made.12
Fever In Endocrinologic Disorders
Benedict Isaac, Serge Kernbaum, Michael Burke in Unexplained Fever, 2019
The thyroid gland secretes thyroxine (T4) and small amounts of triiodothyronine (T3). Most of the T3 is derived from peripheral conversion of T4 to T3 and is considered the active hormone of the thyroid although T4 has biological activity of its own. Hyperfunction of the gland is due to excessive production of these hormones leading to thyrotoxicosis which can appear in different clinical forms such as Graves’ disease, toxic multinodular goiter, autonomous toxic adenoma, factitious thyrotoxicosis, iatrogenic thyrotoxicosis, TSH secreting pituitary tumors, struma ovarii, hyperfunctioning thyroid carcinoma, and thyroiditis. The symptoms and signs of thyrotoxicosis are the direct result of the metabolic effects of the thyroidal hormones and present as weight loss with increased appetite, nervousness, tachycardia, rhythm disturbances, muscle weakness, diarrhea, tremor, emotional instability, excessive perspiration, to mention only a few.
Benign Thyroid Disease
R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne in 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.
Evaluation of malpractice litigation in thyroid disease in the National Health Service
Published in Postgraduate Medicine, 2019
Tharindri D. Wijekoon, Daniel E. Gonzalez-Pena, Sabapathy P. Balasubramanian
In the United Kingdom, thyroid disease is managed by primary and a wide range of secondary care specialities, inclusive of endocrinologists, general, endocrine, and ENT surgeons. The most common cause of thyroid disease worldwide is iodine deficiency, while in iodine-replete areas, autoimmune disease is prevalent, ranging from hypothyroidism due to Hashimoto’s thyroiditis to hyperthyroidism due to Graves’ disease [1,2]. The mainstay of treatment for hypothyroidism involves levothyroxine replacement, while treatment options for hyperthyroidism include anti-thyroid drugs, radioiodine, and surgery [3]. Thyroid cancers constitute over 90% of endocrine cancers but comprise of <1% of all malignancies in UK and are treated primarily surgically [2,3]. In anaplastic thyroid carcinoma, a tumor characterized by poor prognosis, risk of recurrence and local invasiveness, surgery has an important palliative role to improve local control, treat compressive symptoms and improve quality of life; alone or as part of a multimodal approach dependent on multiple factors including tumor size [4].
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.
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.
Related Knowledge Centers
- Heat Intolerance
- Tachycardia
- Thyroid Hormones
- Tremor
- Weight Loss
- Diarrhea
- Thyroid
- Pregnancy
- Goitre
- Thyroid Storm