The patient with acute endocrine problems
Peate Ian, Dutton Helen in 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.
Helping women to ovulate
David J Cahill in Practical Patient Management in Reproductive Medicine, 2019
Raised thyroid-stimulating hormone (TSH). Another pituitary cause of absent or very infrequent periods is hypothyroidism. Hypothyroidism describes inadequate thyroid gland function, generally due to autoimmune disease or inadequate dietary iodine, and rarely to radiotherapy exposure (Figure 5.4). Low triiodothyronine (T3) and thyroxine (T4) levels cause an increase in thyroid-stimulating hormone and thyrotropin-releasing hormone to drive thyroxine production harder. It was noted earlier that prolactin production is managed by the suppressant effect of dopamine. However, TRH can, in sufficient amounts, exert a stimulatory effect on prolactin secretion, causing hyperprolactinaemia and the suppressant effect on GnRH described above. This is expanded and explained further in Section 5.6.2.
Pre- and Perinatal Factors in the Etiology of Mental Retardation
Michele Kiely in Reproductive and Perinatal Epidemiology, 2019
If the role of general nutrition is ambiguous, there is no doubt of the importance of specific nutritional deficiencies in causing cerebral damage and intellectual loss. Throughout the world, the most important, and the principal cause of cretinism is endemic iodine deficiency. This has long been known to cause severe or mild mental retardation, or to diminish intelligence in higher ability groups, through its effect on thyroid development and function. Areas vary in the degree to which iodine is present in water and food, but very large populations in Asia, South America, and Africa are at risk. Two syndromes have recently been clearly distinguished by Hetzel,87 both with severe or mild intellectual impairment. “Neurological cretinism” also shows deafness, deaf-mutism, spastic diplegia, and squint, usually with no clinical signs of hypothyroidism, and is not susceptible to thyroid treatment. “Hypothyroid cretinism”, includes skeletal defects and a picture like the sporadic, autosomal recessive congenital disease more common in developed countries. It is treatable with thyroxine. The latter is found predominantly in Zaire; the former elsewhere.
Retrospective analysis of low-dose interleukin-2 therapy on chronic autoimmune thyroid disease with concurrent systemic lupus erythematosus
Published in Annals of Medicine, 2023
Naidi Wang, Yuebo Jin, Gong Cheng, Kai Zhang, Bo Huang, Yuhui Li, Jing He
Eleven SLE patients with concurrent AITD were included in the IL-2 group and eighteen patients were admitted in control group. Their baseline demographic, clinical characteristics are presented and its results of variance analysis with control group were shown in Table 1. Baseline laboratory parameters between IL-2 and control group were shown in Table S1. In IL-2 group, there were all young or middle-aged women, and their disease durations of SLE ranged from 2 to 39 years. AITD occurred before (36.4%), in the same year as (18.2%), or after (45.5%) the diagnosis of SLE. All patients had positive thyroid antibody test outcomes, but damage degree of thyroid function and its manifestations were variable. One patient (9.09%) presented as hyperthyroid at onset and switched to hypothyroid after treatment with iodine 131. Three (27.27%) of them had undergone thyroxine replacement therapy during their disease. All patients were on concomitant steroids (prednisone 5–40 mg/day) and hydroxychloroquine (HCQ, 400 mg/day) treatments. Regarding current immunosuppressive agents, four were on cyclosporin A (CsA, 50–150mg/day), three were on mycophenolate mofetil (MMF, 1000–2000 mg/day), one was on cyclophosphamide (CTX, 50 mg every other day), one was on tacrolimus (TAC, 1.5 mg/day) and one was on azathioprine (AZA, 25 mg/day). Compared with IL-2 group, significant differences could be observed between the two groups in terms of the disease duration of AITD, while other data did not reveal a remarkable difference.
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).
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.
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