Introduction: In hyperthyroidism, selective irradiation of the thyroid gland with radioactive iodine is a radical treatment and an alternative to surgery. The aim of this review is to assess the medium-term efficacy o...Introduction: In hyperthyroidism, selective irradiation of the thyroid gland with radioactive iodine is a radical treatment and an alternative to surgery. The aim of this review is to assess the medium-term efficacy of outpatient treatment of hyperthyroidism with iodine-131 in Africa. Methods: We identified the studies carried out in Africa on outpatient radiation therapy between 2016 and 2020. For each article included, we noted the country concerned and the year of publication, the numbers studied, the socio-demographic characteristics of the patients, the indications for radio iodine therapy, the dose administered, the results of the hormonal dosage 6 months after radiation. Results: 13 retrospective studies were included to constitute a total population of 925 patients. The average age was 40.77 years, the sex ratio of 1/5.4 with a clear female predominance. The 3 main etiologies of hyperthyroidism justifying outpatient radio iodine therapy were Graves’ disease (55.89%), toxic multinodular goiter (22.70%) and toxic adenoma (21.40%). The average dose of iodine 131 administered per course is 13.7 mCi. No short-and medium-term complications were reported. The radio iodine therapy was effective in 86.08% (n = 796) of the patients with extremes of 72% and 100%. Conclusion: Radio iodine therapy is effective in Africa. It is simple, inexpensive on an outpatient basis and well tolerated. The introduction of outpatient radio iodine therapy could improve the management of patients with hyperthyroidism in Burkina Faso.展开更多
BACKGROUND Hyperthyroidism often leads to tachycardia,but there are also sporadic reports of hyperthyroidism with severe bradycardia,such as sick sinus syndrome(SSS)and atrioventricular block.These disorders are a cha...BACKGROUND Hyperthyroidism often leads to tachycardia,but there are also sporadic reports of hyperthyroidism with severe bradycardia,such as sick sinus syndrome(SSS)and atrioventricular block.These disorders are a challenge for clinicians.CASE SUMMARY We describe three cases of hyperthyroidism with SSS and found 31 similar cases in a PubMed literature search.Through the analysis of these 34 cases,we found 21 cases of atrioventricular block and 13 cases of SSS,with 67.6%of the patients experiencing bradycardia symptoms.After drug treatment,temporary pacemaker implantation,or anti-hyperthyroidism treatment,the bradycardia of 27 patients(79.4%)was relieved,and the median recovery time was 5.5(2-8)d.Only 7 cases(20.6%)needed permanent pacemaker implantation.CONCLUSION Patients with hyperthyroidism should be aware of the risk of severe bradycardia.In most cases,drug treatment or temporary pacemaker placement is recommended for initial treatment.If the bradycardia does not improve after 1 wk,a permanent pacemaker should be implanted.展开更多
Lithium treatment is usually indicated in bipolar disorder. It is associated with hypothyroidism and very rarely with hyperthyroidism. We report here the results of the exploration of a case of thyrotoxicosis occurrin...Lithium treatment is usually indicated in bipolar disorder. It is associated with hypothyroidism and very rarely with hyperthyroidism. We report here the results of the exploration of a case of thyrotoxicosis occurring during treatment with lithium salts. This was a 16-year-old patient with ongoing lithium treatment for two and a half years who presented with a thyrotoxicosis syndrome without a context of iodine overload or an episode of anterior cervical pain that could suggest subacute thyroiditis or orthopathic sign. The assessment of the exploration of this patient reveals biological hyperthyroidism without anti-TSH receptor antibodies, a normal ultrasound, and white scintigraphy which makes it possible to evoke the diagnosis of subacute thyroiditis (absence of the context of iodine overload). Note the interest in a thyroid assessment before and during treatment with lithium salts. Moreover, scintigraphy occupies a place of choice in the exploration of hyperthyroidism, particularly in the context of normal thyroid ultrasound imaging.展开更多
Cardiovascular complications during hyperthyroidism are dominated by arrhythmias, heart failure and coronary heart disease. Pericardial effusion which is a common complication of hypothyroidism is extremely rare in hy...Cardiovascular complications during hyperthyroidism are dominated by arrhythmias, heart failure and coronary heart disease. Pericardial effusion which is a common complication of hypothyroidism is extremely rare in hyperthyroidism. We report the case of a 45-year-old woman admitted for management of pleuro-pericarditis associated with atrial fibrillation in the context of cardiothyreosis. The treatment consisted of a pericardial puncture associated with synthetic anti-thyroid drugs and anti-tuberculosis drugs with positive clinical and echocardiographic outcomes.展开更多
BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and...BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.展开更多
BACKGROUND Alström syndrome(AS,OMIM ID 203800)is a rare disease involving multiple organs in children and is mostly reported in non-Chinese patients.In the Chinese population,there are few reports on the clinical...BACKGROUND Alström syndrome(AS,OMIM ID 203800)is a rare disease involving multiple organs in children and is mostly reported in non-Chinese patients.In the Chinese population,there are few reports on the clinical manifestations and pathogenesis of AS.This is the first report on the association between AS and Graves’hyperthyroidism.CASE SUMMARY An 8-year-old Chinese girl was diagnosed with AS.Two years later,Graves’hyperthyroidism developed with progressive liver dysfunction.The patient’s clinical data were collected;DNA from peripheral blood of the proband,parents and sibling was collected for gene mutation detection using the second-generation sequencing method and gene panel for diabetes.The association between the patient’s genotype and clinical phenotype was analyzed.She carried the pathogenic compound heterozygous mutation of ALMS1(c.2296_2299del4 and c.11460C>A).These stop-gain mutations likely caused truncation of the ALMS1 protein.CONCLUSION The manifestation of hyperthyroidism may suggest rapid progression of AS.展开更多
Objective:To observe the changes of bone mineral density, bone metabolism indices and cell factor in patients with hyperthyroidismMethods:A total of 116 cases of hyperthyroidism patients from June 2015 to June 2016 in...Objective:To observe the changes of bone mineral density, bone metabolism indices and cell factor in patients with hyperthyroidismMethods:A total of 116 cases of hyperthyroidism patients from June 2015 to June 2016 in our hospital were selected. as the object of observation group. Then, 120 cases of healthy people were selected as the object of control group. Thyroid function indexes (TT3, TT4, FT3, FT4, TSH), bone mineral density (BMD), bone metabolism indexes (PTH, BGP, PINP) and cell factors (IL-2, IL-6) in both groups were detected and compared.Results:TT3, TT4, FT3, FT4, TSH in control group were (1.40±0.81) nmol/L, (94.36±32.10) nmol/L, (5.04±1.18) pmol/L, (15.37±4.60) pmol/L, (2.55±1.21) mU/L. TT3, TT4, FT3, FT4, TSH in observation group were (5.48±2.36) nmol/L, (405.55±71.48) nmol/L, (16.27±5.14) pmol/L, (46.83±12.66) pmol/L, (0.04±0.01) mU/L. TT3, TT4, FT3, FT4 in the observation group were higher than that in control group obviously. TSH in the observation group was lower than that in observation group obviously. The difference between two groups was considered statistically significant. BMD, PTH in observation group were (0.62±0.08) g/m2, (26.25±9.16) pg/mL, which were obviously lower than BMD (1.23±0.11) g/m2, PTH (37.13±8.05) pg/mL in control group. The difference between two groups was considered statistically significant. BGP, PINP in observation group were (14.51±6.25) ng/mL, (223.63±10.38) μg/L, which were obviously higher than BGP (5.97±1.98) ng/mL, PINP (33.18±6.15) μg/L in control group. The difference between two groups was considered statistically significant. IL-2 in observation group was (1.60±0.51) ng/L, which was obviously lower than IL-2 (4.72±1.29) ng/L, in control group. IL-6 in observation group was (1.98±0.34) pg/L, which was obviously higher than IL-6, (1.50±0.23) pg/L, in control group. The difference between two groups was considered statistically significant.Conclusion:Bone mineral density in patients with hyperthyroidism decreased and bone metabolism in patients with hyperthyroidism was active. The significant changes of IL-2, IL-6 also can be seen. In the clinical ,We should enhance the detection of these indexes, so as to take measures to prevent and cure the complications such as osteoporosis.展开更多
Hyperthyroidism is associated with many heart diseases.Thyrotoxic state has a relationship with coronary spasm.We present a case of a non-menopausal woman with hyperthyroidism who complained of chest pain.The diagnosi...Hyperthyroidism is associated with many heart diseases.Thyrotoxic state has a relationship with coronary spasm.We present a case of a non-menopausal woman with hyperthyroidism who complained of chest pain.The diagnosis of coronary spasm was confirmed by coronary angiography(CAG).She is treated well with anti-thyrotoxicosis and anti-anginal medication.We recommend not use CAG as the first diagnostic choice among the patients with medication-uncontrolled hyperthyroidism and chest pain.展开更多
Causes inducing subacute thyroiditis have been unclear, but clinically it is treated mostlywith cortical hormones. In the present paper, it was reported that one case of subacute thyroiditis withhyperthyodism at the l...Causes inducing subacute thyroiditis have been unclear, but clinically it is treated mostlywith cortical hormones. In the present paper, it was reported that one case of subacute thyroiditis withhyperthyodism at the late stage was cured with acupuncture at Renying (ST 9), Fengchi (GB 20),Jiaji ponts on the neck and other points. In the treatment, differentiation of symptoms and signs wascombined with differentiation of disease, selection of proximal acupoints was combined with selectionof distal acupoints. The patient was treated in accordance with his physique. Therefore, the therapeu-tic effects were obtained rapidly.展开更多
<正>Comparative observation was taken in 112 patients of hyperthyroidism. These patients were treated by both acupuncture and small dosage (10 mg once daily) of Methimazole. The acupuncture was given once week...<正>Comparative observation was taken in 112 patients of hyperthyroidism. These patients were treated by both acupuncture and small dosage (10 mg once daily) of Methimazole. The acupuncture was given once weekly in group 1, twice in group 2, and thrice in group 3.展开更多
BACKGROUND Gitelman syndrome(GS)is a rare inherited autosomal recessive tubulopathy,characterized clinically by hypokalemia,hypomagnesemia,hypocalciuria,and metabolic alkalosis,and is caused by an inactivating mutatio...BACKGROUND Gitelman syndrome(GS)is a rare inherited autosomal recessive tubulopathy,characterized clinically by hypokalemia,hypomagnesemia,hypocalciuria,and metabolic alkalosis,and is caused by an inactivating mutation in SLC12A3.GS is prone to misdiagnosis when occurring simultaneously with hyperthyroidism.It is important to consider the possibility of other diseases when hyperthyroidism is combined with hypokalemia,which is difficult to correct.CASE SUMMARY A female patient with hyperthyroidism complicated with limb weakness was diagnosed with thyrotoxic hypokalemic periodic paralysis for 4 mo.However,the patient’s serum potassium level remained low despite sufficient potassium replacement and remission of hyperthyroidism.GS was confirmed by whole exome and Sanger sequencing.Gene sequencing revealed compound heterozygous mutations of c.488C>T(p.Thr163Met),c.2612G>A(p.Arg871His),and c.1171_1178dupGCCACCAT(p.Ile393fs)in SLC12A3.Protein molecular modeling was performed to predict the effects of the identified missense mutations.All three mutations cause changes in protein structure and may result in abnormal protein function.All previously reported cases of GS coexisting with autoimmune thyroid disease are reviewed.CONCLUSION We have identified a novel compound heterozygous mutation in SLC12A3.The present study provides new genetic evidence for GS.展开更多
BACKGROUND Acute coronary syndrome(ACS)encompasses a spectrum of cardiovascular emergencies arising from the obstruction of coronary artery blood flow and acute myocardial ischemia.Recent studies have revealed that th...BACKGROUND Acute coronary syndrome(ACS)encompasses a spectrum of cardiovascular emergencies arising from the obstruction of coronary artery blood flow and acute myocardial ischemia.Recent studies have revealed that thyroid function is closely related to ACS.However,only a few reports of thyrotoxicosis-induced ACS with severe atherosclerosis have been reported.CASE SUMMARY A 33-year-old man,who had a history of hyperthyroidism without taking any antithyroid drugs and no history of coronary heart disease,experienced neck pain with occasional heart palpitations starting 3 mo prior that were aggravated after an activity.As the symptoms worsened at 21 d prior,he went to a hospital for treatment.The electrocardiogram examination showed a multilead ST segment elevation and pathological Q waves.Based on these findings and his symptoms,the patient was diagnosed with a suspected myocardial infarction and transferred to our hospital on July 2,2020.He was diagnosed with a rare case of ACS due to coronary artery atherosclerosis in the anterior descending artery complicated by hyperthyroidism.A paclitaxel-coated drug balloon was used for treatment to avoid the use of metal stents,thus reducing the time of antiplatelet therapy and facilitating the continued treatment of hyperthyroidism.The 9-mo follow-up showed favorable results.CONCLUSION This case highlights that atherosclerosis is a cause of ACS that cannot be ignored even in a patient with hyperthyroidism.展开更多
In recent years,due to the increasingly accelerated pace of life,the incidence of hyperthyroidism is increasing year by year,which has a serious impact on the quality of life of patients.Traditional Chinese Medicine h...In recent years,due to the increasingly accelerated pace of life,the incidence of hyperthyroidism is increasing year by year,which has a serious impact on the quality of life of patients.Traditional Chinese Medicine has a unique effect on hyperthyroidism,Professor Zhang Ning,my tutor,who has been devoting to the clinical study of traditional Chinese medicine in the prevention and treatment of thyroid diseases for a long time,has rich theoretical knowledge as well as clinical practice experience.She's also good at using classical prescriptions for syndrome differentiation treatment,and has achieved excellent clinical efficacy.Professor Zhang Ning summarized the diagnosis and treatment idea of"treating from the liver"and ran it throughout the whole treatment process.For the patients prone to abnormal liver function,it is advocated to focus on protecting the liver in terms of medication,increase the effect of anti-hyperthyroidism,and also obtain satisfactory efficacy.展开更多
Aims: Effectiveness of radioiodine for Graves’ hyperthyroidism (GD) depends on its intrathyroidal persistence, which could be enhanced by lithium by blocking the release of organic iodine and thyroid hormone from the...Aims: Effectiveness of radioiodine for Graves’ hyperthyroidism (GD) depends on its intrathyroidal persistence, which could be enhanced by lithium by blocking the release of organic iodine and thyroid hormone from the thyroid gland. The present aim focused on the effect of the addition of lithium carbonate to 131I therapy in patients with GD. Methods: 100 consecutive patients with GD were randomly assigned to two groups: group (A) patients treated with 131I and group (B) patients treated with 131I plus lithium carbonate. Patients in B group were treated with a dose of 0.5 g per day (2 × 0.25 g) of lithium carbonate for half a month before and after the administration of 131I. Thyroid weight was estimated by ultrasonography and careful palpation of the thyroid. Radiation absorbed dose rate in the front of the neck was measured on days 1530 and 45 after the administration of 131I. Serum concentrations of thyroidstimulation hormone (TSH), fee tri-iodothyrosine (T3) and free thyroxine (T4) were tested on days 30, 45, 90, 180 before and after treatment. Results: After RIT, radiation absorbed dose rate in the front of neck gradually decreased as time went on (p 0.05), free T3 and free T4 values in both groups rose significantly one month after treatment (all p 0.05). Cure rate of hyperthyroidism was achieved in 36 of the 50 patients (72%) treated with 131I alone and in 38 of the 50 patients (76%) treated with 131I plus lithium. Conclusion: We suggest that for patients withdrawing of ATD and those with short effective half-time, as well as those intolerant or invalid, the short term addition of lithium to 131I allows for a better control of thyrotoxia and the completeness of treatment.展开更多
Syndrome differentiation is the characteristic and soul of Traditional Chinese Medicine (TCM), which has certain advantages in the treatment of hyperthyroidism. TCM mainly divides its syndrome differentiation into fou...Syndrome differentiation is the characteristic and soul of Traditional Chinese Medicine (TCM), which has certain advantages in the treatment of hyperthyroidism. TCM mainly divides its syndrome differentiation into four types: exuberant liver fire type, yin deficiency and fire exuberant type, qi-yin deficiency type and phlegm stagnation type. This paper summarizes the treatment of hyperthyroidism by TCM syndrome differentiation, in order to provide some reference for the treatment of this disease.展开更多
Resistance to Thyroid Hormone (RTH) is a rare form of hormone resistance secondary to changes in the genes encoding thyroid hormone receptors. The two subtypes, Pituitary RTH (PRTH) and Generalized RTH (GRTH), cause c...Resistance to Thyroid Hormone (RTH) is a rare form of hormone resistance secondary to changes in the genes encoding thyroid hormone receptors. The two subtypes, Pituitary RTH (PRTH) and Generalized RTH (GRTH), cause clinically distinguishable patient presentations. In PRTH, typically only the pituitary gland is resistant to thyroid hormone (TH) while the rest of the body maintains sensitivity. Selective pituitary resistance to thyroid hormone results in dysregulation of thyroid hormone homeostasis with clinical presentation as either euthyroid or hyperthyroidism. PRTH is characterized by elevated thyroid hormone levels with an elevated or inappropriately normal TSH concentration. Herein we describe a case report of a 70-year-old woman who complained of weight loss of over 35 lbs., palpitations, jitters, hair loss, diarrhea, fatigue, muscle weakness, etc. over 6 months, thus, indicating the presence of iatrogenic hyperthyroidism while receiving levothyroxine 175 ug daily prescribed by her primary care provider because of a reported history of “Graves disease” treated by radioactive iodine ablation of the thyroid several years ago. The daily dose of levothyroxine had been increased gradually at an interval of 3 months over a year because of persistent elevation of serum TSH level. Laboratory tests revealed markedly elevated Free T4, Free T3 and TSH levels, along with low concentrations of all lipid fractions, serum creatinine and urea nitrogen levels, indicating TSH induced hyperthyroidism or PRTH. Further testing documented a mutation of thyroid hormone receptor beta gene 2 confirming presence of PRTH. We believe that the initial diagnosis of Graves Disease was erroneous and I-131 ablation further confounded and missed the diagnosis of PRTH. Thus, the purpose of this report is to report a patient with PRTH and describe potential pitfalls in diagnosis and management of this rare disorder.展开更多
<strong>Background:</strong> Alternating thyroid function between hypo- and hyperthyroidism is a very rare phenomenon attributed to the switch between the types of thyroid stimulating hormone receptor auto...<strong>Background:</strong> Alternating thyroid function between hypo- and hyperthyroidism is a very rare phenomenon attributed to the switch between the types of thyroid stimulating hormone receptor autoantibodies;thyroid stimulating antibody and thyroid stimulating hormone blocking antibody. <strong>Case Presentation:</strong> We report an 18 years old male who presented with hyperthyroidism attributed to Graves’ disease. He was treated with antithyroid medication. During follow up, his thyroid function was switching between hyper- and hypothyroidism which was difficult to treat with antithyroid medication. His laboratory investigations revealed high thyroid stimulating immunoglobulin and TSH binding inhibitory immunoglobulin. Due to the difficultly of managing him with antithyroid medication, he was offered a definitive management for his Graves’ disease. <strong>Conclusion:</strong> This case demonstrates a rare challenging presentation of Graves’ disease. Patients presenting with fluctuation in thyroid function between hyper-and hypothyroidism need a definitive management for Graves’ disease.展开更多
Objective:To explore whether assessment of peak systolic velocity of superior thyroid artery can predict relapse after anti-thyroid drug therapy of hyperthyroidism.Methods:Seventy patients with hyperthyroidism were re...Objective:To explore whether assessment of peak systolic velocity of superior thyroid artery can predict relapse after anti-thyroid drug therapy of hyperthyroidism.Methods:Seventy patients with hyperthyroidism were recruited and treated with antithyroid drug according to the national guideline, the thyroid and superior thyroid artery were evaluated by color Doppler ultrasound, and the blood velocity was measured and analyzed. 30 people with euthyroid were selected as control.Results: Twenty-six of 70 patients with hyperthyroidism treated with anti-thyroid drug relapse six months after remission, accounting for 37.1%. There was no significant difference between relapse patients and patients without relapse for peak systolic velocity of pretreatment. The peak systolic velocities were significant difference between remissive and relapse patients. The MV1-MV2/MV1s was significant difference between remissive and relapse patients. Area under ROC curve of peak systolic velocities of the superior thyroid arteries of relapse patients and euthyroid subjects was 0.773, the cutoff point was 40.3 cm/s, and sensitivity and specificity were 84.6% and 65.0%, respectively. Area under ROC curve of MV1-MV2/MV1s of the superior thyroid arteries of remissive patients and relapse patients was 0.870, the cutoff point was 0.525, and sensitivity and specificity were 86.4% and 69.2%, respectively.Conclusion: The determination of peak systolic velocity of superior thyroid artery and relevant parameters can help predict relapse after anti-thyroid drug therapy of hyperthyroidism.展开更多
Thyroid tumors are usually associated with euthyroidism, and hyper functioning tumors are rare. There are few reports of carcinomas associated with hyperthyroidism. The aim of this study is to describe a case of hyper...Thyroid tumors are usually associated with euthyroidism, and hyper functioning tumors are rare. There are few reports of carcinomas associated with hyperthyroidism. The aim of this study is to describe a case of hyper functioning papillary carcinoma associated with breast carcinoma. We present a 46-year-old woman that was referred for investigation of thyroid and breast nodules detected by routine ultrasound. She presented with hyperthyroidism and enlarged left thyroid lobe with fibroelastic consistency. Investigation demonstrated papillary carcinoma with follicular hyperactivity and invasive ductal carcinoma of the breast. The patient developed metastases 6 months later and died. This study demonstrates that hot thyroid nodules may harbor malignant tumors and should be punctured. The association with breast adenocarcinoma and the unfavorable outcome suggest higher aggressiveness of this tumor in the presence of hyperthyroidism.展开更多
文摘Introduction: In hyperthyroidism, selective irradiation of the thyroid gland with radioactive iodine is a radical treatment and an alternative to surgery. The aim of this review is to assess the medium-term efficacy of outpatient treatment of hyperthyroidism with iodine-131 in Africa. Methods: We identified the studies carried out in Africa on outpatient radiation therapy between 2016 and 2020. For each article included, we noted the country concerned and the year of publication, the numbers studied, the socio-demographic characteristics of the patients, the indications for radio iodine therapy, the dose administered, the results of the hormonal dosage 6 months after radiation. Results: 13 retrospective studies were included to constitute a total population of 925 patients. The average age was 40.77 years, the sex ratio of 1/5.4 with a clear female predominance. The 3 main etiologies of hyperthyroidism justifying outpatient radio iodine therapy were Graves’ disease (55.89%), toxic multinodular goiter (22.70%) and toxic adenoma (21.40%). The average dose of iodine 131 administered per course is 13.7 mCi. No short-and medium-term complications were reported. The radio iodine therapy was effective in 86.08% (n = 796) of the patients with extremes of 72% and 100%. Conclusion: Radio iodine therapy is effective in Africa. It is simple, inexpensive on an outpatient basis and well tolerated. The introduction of outpatient radio iodine therapy could improve the management of patients with hyperthyroidism in Burkina Faso.
基金the Clinical Medical Research Center Project of Hainan Province,China,No.LCYX202207Key R&D Plan Project of Hainan Province,China,No.ZDYF2020118.
文摘BACKGROUND Hyperthyroidism often leads to tachycardia,but there are also sporadic reports of hyperthyroidism with severe bradycardia,such as sick sinus syndrome(SSS)and atrioventricular block.These disorders are a challenge for clinicians.CASE SUMMARY We describe three cases of hyperthyroidism with SSS and found 31 similar cases in a PubMed literature search.Through the analysis of these 34 cases,we found 21 cases of atrioventricular block and 13 cases of SSS,with 67.6%of the patients experiencing bradycardia symptoms.After drug treatment,temporary pacemaker implantation,or anti-hyperthyroidism treatment,the bradycardia of 27 patients(79.4%)was relieved,and the median recovery time was 5.5(2-8)d.Only 7 cases(20.6%)needed permanent pacemaker implantation.CONCLUSION Patients with hyperthyroidism should be aware of the risk of severe bradycardia.In most cases,drug treatment or temporary pacemaker placement is recommended for initial treatment.If the bradycardia does not improve after 1 wk,a permanent pacemaker should be implanted.
文摘Lithium treatment is usually indicated in bipolar disorder. It is associated with hypothyroidism and very rarely with hyperthyroidism. We report here the results of the exploration of a case of thyrotoxicosis occurring during treatment with lithium salts. This was a 16-year-old patient with ongoing lithium treatment for two and a half years who presented with a thyrotoxicosis syndrome without a context of iodine overload or an episode of anterior cervical pain that could suggest subacute thyroiditis or orthopathic sign. The assessment of the exploration of this patient reveals biological hyperthyroidism without anti-TSH receptor antibodies, a normal ultrasound, and white scintigraphy which makes it possible to evoke the diagnosis of subacute thyroiditis (absence of the context of iodine overload). Note the interest in a thyroid assessment before and during treatment with lithium salts. Moreover, scintigraphy occupies a place of choice in the exploration of hyperthyroidism, particularly in the context of normal thyroid ultrasound imaging.
文摘Cardiovascular complications during hyperthyroidism are dominated by arrhythmias, heart failure and coronary heart disease. Pericardial effusion which is a common complication of hypothyroidism is extremely rare in hyperthyroidism. We report the case of a 45-year-old woman admitted for management of pleuro-pericarditis associated with atrial fibrillation in the context of cardiothyreosis. The treatment consisted of a pericardial puncture associated with synthetic anti-thyroid drugs and anti-tuberculosis drugs with positive clinical and echocardiographic outcomes.
文摘BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.
文摘BACKGROUND Alström syndrome(AS,OMIM ID 203800)is a rare disease involving multiple organs in children and is mostly reported in non-Chinese patients.In the Chinese population,there are few reports on the clinical manifestations and pathogenesis of AS.This is the first report on the association between AS and Graves’hyperthyroidism.CASE SUMMARY An 8-year-old Chinese girl was diagnosed with AS.Two years later,Graves’hyperthyroidism developed with progressive liver dysfunction.The patient’s clinical data were collected;DNA from peripheral blood of the proband,parents and sibling was collected for gene mutation detection using the second-generation sequencing method and gene panel for diabetes.The association between the patient’s genotype and clinical phenotype was analyzed.She carried the pathogenic compound heterozygous mutation of ALMS1(c.2296_2299del4 and c.11460C>A).These stop-gain mutations likely caused truncation of the ALMS1 protein.CONCLUSION The manifestation of hyperthyroidism may suggest rapid progression of AS.
文摘Objective:To observe the changes of bone mineral density, bone metabolism indices and cell factor in patients with hyperthyroidismMethods:A total of 116 cases of hyperthyroidism patients from June 2015 to June 2016 in our hospital were selected. as the object of observation group. Then, 120 cases of healthy people were selected as the object of control group. Thyroid function indexes (TT3, TT4, FT3, FT4, TSH), bone mineral density (BMD), bone metabolism indexes (PTH, BGP, PINP) and cell factors (IL-2, IL-6) in both groups were detected and compared.Results:TT3, TT4, FT3, FT4, TSH in control group were (1.40±0.81) nmol/L, (94.36±32.10) nmol/L, (5.04±1.18) pmol/L, (15.37±4.60) pmol/L, (2.55±1.21) mU/L. TT3, TT4, FT3, FT4, TSH in observation group were (5.48±2.36) nmol/L, (405.55±71.48) nmol/L, (16.27±5.14) pmol/L, (46.83±12.66) pmol/L, (0.04±0.01) mU/L. TT3, TT4, FT3, FT4 in the observation group were higher than that in control group obviously. TSH in the observation group was lower than that in observation group obviously. The difference between two groups was considered statistically significant. BMD, PTH in observation group were (0.62±0.08) g/m2, (26.25±9.16) pg/mL, which were obviously lower than BMD (1.23±0.11) g/m2, PTH (37.13±8.05) pg/mL in control group. The difference between two groups was considered statistically significant. BGP, PINP in observation group were (14.51±6.25) ng/mL, (223.63±10.38) μg/L, which were obviously higher than BGP (5.97±1.98) ng/mL, PINP (33.18±6.15) μg/L in control group. The difference between two groups was considered statistically significant. IL-2 in observation group was (1.60±0.51) ng/L, which was obviously lower than IL-2 (4.72±1.29) ng/L, in control group. IL-6 in observation group was (1.98±0.34) pg/L, which was obviously higher than IL-6, (1.50±0.23) pg/L, in control group. The difference between two groups was considered statistically significant.Conclusion:Bone mineral density in patients with hyperthyroidism decreased and bone metabolism in patients with hyperthyroidism was active. The significant changes of IL-2, IL-6 also can be seen. In the clinical ,We should enhance the detection of these indexes, so as to take measures to prevent and cure the complications such as osteoporosis.
文摘Hyperthyroidism is associated with many heart diseases.Thyrotoxic state has a relationship with coronary spasm.We present a case of a non-menopausal woman with hyperthyroidism who complained of chest pain.The diagnosis of coronary spasm was confirmed by coronary angiography(CAG).She is treated well with anti-thyrotoxicosis and anti-anginal medication.We recommend not use CAG as the first diagnostic choice among the patients with medication-uncontrolled hyperthyroidism and chest pain.
文摘Causes inducing subacute thyroiditis have been unclear, but clinically it is treated mostlywith cortical hormones. In the present paper, it was reported that one case of subacute thyroiditis withhyperthyodism at the late stage was cured with acupuncture at Renying (ST 9), Fengchi (GB 20),Jiaji ponts on the neck and other points. In the treatment, differentiation of symptoms and signs wascombined with differentiation of disease, selection of proximal acupoints was combined with selectionof distal acupoints. The patient was treated in accordance with his physique. Therefore, the therapeu-tic effects were obtained rapidly.
文摘<正>Comparative observation was taken in 112 patients of hyperthyroidism. These patients were treated by both acupuncture and small dosage (10 mg once daily) of Methimazole. The acupuncture was given once weekly in group 1, twice in group 2, and thrice in group 3.
基金Supported by the Science and Technology Plan of Health Commission of Jiangxi Province,No.202130648the Science and Technology Research Project of Department of Education of Jiangxi Province,No.GJJ201522.
文摘BACKGROUND Gitelman syndrome(GS)is a rare inherited autosomal recessive tubulopathy,characterized clinically by hypokalemia,hypomagnesemia,hypocalciuria,and metabolic alkalosis,and is caused by an inactivating mutation in SLC12A3.GS is prone to misdiagnosis when occurring simultaneously with hyperthyroidism.It is important to consider the possibility of other diseases when hyperthyroidism is combined with hypokalemia,which is difficult to correct.CASE SUMMARY A female patient with hyperthyroidism complicated with limb weakness was diagnosed with thyrotoxic hypokalemic periodic paralysis for 4 mo.However,the patient’s serum potassium level remained low despite sufficient potassium replacement and remission of hyperthyroidism.GS was confirmed by whole exome and Sanger sequencing.Gene sequencing revealed compound heterozygous mutations of c.488C>T(p.Thr163Met),c.2612G>A(p.Arg871His),and c.1171_1178dupGCCACCAT(p.Ile393fs)in SLC12A3.Protein molecular modeling was performed to predict the effects of the identified missense mutations.All three mutations cause changes in protein structure and may result in abnormal protein function.All previously reported cases of GS coexisting with autoimmune thyroid disease are reviewed.CONCLUSION We have identified a novel compound heterozygous mutation in SLC12A3.The present study provides new genetic evidence for GS.
基金Supported by Science and Technology Planning Project of Hunan Province,No.2018JJ2304the Research Foundation of Hunan University of Chinese Medicine,No.2019XJJJ042.
文摘BACKGROUND Acute coronary syndrome(ACS)encompasses a spectrum of cardiovascular emergencies arising from the obstruction of coronary artery blood flow and acute myocardial ischemia.Recent studies have revealed that thyroid function is closely related to ACS.However,only a few reports of thyrotoxicosis-induced ACS with severe atherosclerosis have been reported.CASE SUMMARY A 33-year-old man,who had a history of hyperthyroidism without taking any antithyroid drugs and no history of coronary heart disease,experienced neck pain with occasional heart palpitations starting 3 mo prior that were aggravated after an activity.As the symptoms worsened at 21 d prior,he went to a hospital for treatment.The electrocardiogram examination showed a multilead ST segment elevation and pathological Q waves.Based on these findings and his symptoms,the patient was diagnosed with a suspected myocardial infarction and transferred to our hospital on July 2,2020.He was diagnosed with a rare case of ACS due to coronary artery atherosclerosis in the anterior descending artery complicated by hyperthyroidism.A paclitaxel-coated drug balloon was used for treatment to avoid the use of metal stents,thus reducing the time of antiplatelet therapy and facilitating the continued treatment of hyperthyroidism.The 9-mo follow-up showed favorable results.CONCLUSION This case highlights that atherosclerosis is a cause of ACS that cannot be ignored even in a patient with hyperthyroidism.
基金Capital health development scientific research project(No.First Issue 2020-2-4162)Capital building project for sustainable utilization of valuable Chinese medicine resources(No.2060302)
文摘In recent years,due to the increasingly accelerated pace of life,the incidence of hyperthyroidism is increasing year by year,which has a serious impact on the quality of life of patients.Traditional Chinese Medicine has a unique effect on hyperthyroidism,Professor Zhang Ning,my tutor,who has been devoting to the clinical study of traditional Chinese medicine in the prevention and treatment of thyroid diseases for a long time,has rich theoretical knowledge as well as clinical practice experience.She's also good at using classical prescriptions for syndrome differentiation treatment,and has achieved excellent clinical efficacy.Professor Zhang Ning summarized the diagnosis and treatment idea of"treating from the liver"and ran it throughout the whole treatment process.For the patients prone to abnormal liver function,it is advocated to focus on protecting the liver in terms of medication,increase the effect of anti-hyperthyroidism,and also obtain satisfactory efficacy.
文摘Aims: Effectiveness of radioiodine for Graves’ hyperthyroidism (GD) depends on its intrathyroidal persistence, which could be enhanced by lithium by blocking the release of organic iodine and thyroid hormone from the thyroid gland. The present aim focused on the effect of the addition of lithium carbonate to 131I therapy in patients with GD. Methods: 100 consecutive patients with GD were randomly assigned to two groups: group (A) patients treated with 131I and group (B) patients treated with 131I plus lithium carbonate. Patients in B group were treated with a dose of 0.5 g per day (2 × 0.25 g) of lithium carbonate for half a month before and after the administration of 131I. Thyroid weight was estimated by ultrasonography and careful palpation of the thyroid. Radiation absorbed dose rate in the front of the neck was measured on days 1530 and 45 after the administration of 131I. Serum concentrations of thyroidstimulation hormone (TSH), fee tri-iodothyrosine (T3) and free thyroxine (T4) were tested on days 30, 45, 90, 180 before and after treatment. Results: After RIT, radiation absorbed dose rate in the front of neck gradually decreased as time went on (p 0.05), free T3 and free T4 values in both groups rose significantly one month after treatment (all p 0.05). Cure rate of hyperthyroidism was achieved in 36 of the 50 patients (72%) treated with 131I alone and in 38 of the 50 patients (76%) treated with 131I plus lithium. Conclusion: We suggest that for patients withdrawing of ATD and those with short effective half-time, as well as those intolerant or invalid, the short term addition of lithium to 131I allows for a better control of thyrotoxia and the completeness of treatment.
文摘Syndrome differentiation is the characteristic and soul of Traditional Chinese Medicine (TCM), which has certain advantages in the treatment of hyperthyroidism. TCM mainly divides its syndrome differentiation into four types: exuberant liver fire type, yin deficiency and fire exuberant type, qi-yin deficiency type and phlegm stagnation type. This paper summarizes the treatment of hyperthyroidism by TCM syndrome differentiation, in order to provide some reference for the treatment of this disease.
文摘Resistance to Thyroid Hormone (RTH) is a rare form of hormone resistance secondary to changes in the genes encoding thyroid hormone receptors. The two subtypes, Pituitary RTH (PRTH) and Generalized RTH (GRTH), cause clinically distinguishable patient presentations. In PRTH, typically only the pituitary gland is resistant to thyroid hormone (TH) while the rest of the body maintains sensitivity. Selective pituitary resistance to thyroid hormone results in dysregulation of thyroid hormone homeostasis with clinical presentation as either euthyroid or hyperthyroidism. PRTH is characterized by elevated thyroid hormone levels with an elevated or inappropriately normal TSH concentration. Herein we describe a case report of a 70-year-old woman who complained of weight loss of over 35 lbs., palpitations, jitters, hair loss, diarrhea, fatigue, muscle weakness, etc. over 6 months, thus, indicating the presence of iatrogenic hyperthyroidism while receiving levothyroxine 175 ug daily prescribed by her primary care provider because of a reported history of “Graves disease” treated by radioactive iodine ablation of the thyroid several years ago. The daily dose of levothyroxine had been increased gradually at an interval of 3 months over a year because of persistent elevation of serum TSH level. Laboratory tests revealed markedly elevated Free T4, Free T3 and TSH levels, along with low concentrations of all lipid fractions, serum creatinine and urea nitrogen levels, indicating TSH induced hyperthyroidism or PRTH. Further testing documented a mutation of thyroid hormone receptor beta gene 2 confirming presence of PRTH. We believe that the initial diagnosis of Graves Disease was erroneous and I-131 ablation further confounded and missed the diagnosis of PRTH. Thus, the purpose of this report is to report a patient with PRTH and describe potential pitfalls in diagnosis and management of this rare disorder.
文摘<strong>Background:</strong> Alternating thyroid function between hypo- and hyperthyroidism is a very rare phenomenon attributed to the switch between the types of thyroid stimulating hormone receptor autoantibodies;thyroid stimulating antibody and thyroid stimulating hormone blocking antibody. <strong>Case Presentation:</strong> We report an 18 years old male who presented with hyperthyroidism attributed to Graves’ disease. He was treated with antithyroid medication. During follow up, his thyroid function was switching between hyper- and hypothyroidism which was difficult to treat with antithyroid medication. His laboratory investigations revealed high thyroid stimulating immunoglobulin and TSH binding inhibitory immunoglobulin. Due to the difficultly of managing him with antithyroid medication, he was offered a definitive management for his Graves’ disease. <strong>Conclusion:</strong> This case demonstrates a rare challenging presentation of Graves’ disease. Patients presenting with fluctuation in thyroid function between hyper-and hypothyroidism need a definitive management for Graves’ disease.
文摘Objective:To explore whether assessment of peak systolic velocity of superior thyroid artery can predict relapse after anti-thyroid drug therapy of hyperthyroidism.Methods:Seventy patients with hyperthyroidism were recruited and treated with antithyroid drug according to the national guideline, the thyroid and superior thyroid artery were evaluated by color Doppler ultrasound, and the blood velocity was measured and analyzed. 30 people with euthyroid were selected as control.Results: Twenty-six of 70 patients with hyperthyroidism treated with anti-thyroid drug relapse six months after remission, accounting for 37.1%. There was no significant difference between relapse patients and patients without relapse for peak systolic velocity of pretreatment. The peak systolic velocities were significant difference between remissive and relapse patients. The MV1-MV2/MV1s was significant difference between remissive and relapse patients. Area under ROC curve of peak systolic velocities of the superior thyroid arteries of relapse patients and euthyroid subjects was 0.773, the cutoff point was 40.3 cm/s, and sensitivity and specificity were 84.6% and 65.0%, respectively. Area under ROC curve of MV1-MV2/MV1s of the superior thyroid arteries of remissive patients and relapse patients was 0.870, the cutoff point was 0.525, and sensitivity and specificity were 86.4% and 69.2%, respectively.Conclusion: The determination of peak systolic velocity of superior thyroid artery and relevant parameters can help predict relapse after anti-thyroid drug therapy of hyperthyroidism.
文摘Thyroid tumors are usually associated with euthyroidism, and hyper functioning tumors are rare. There are few reports of carcinomas associated with hyperthyroidism. The aim of this study is to describe a case of hyper functioning papillary carcinoma associated with breast carcinoma. We present a 46-year-old woman that was referred for investigation of thyroid and breast nodules detected by routine ultrasound. She presented with hyperthyroidism and enlarged left thyroid lobe with fibroelastic consistency. Investigation demonstrated papillary carcinoma with follicular hyperactivity and invasive ductal carcinoma of the breast. The patient developed metastases 6 months later and died. This study demonstrates that hot thyroid nodules may harbor malignant tumors and should be punctured. The association with breast adenocarcinoma and the unfavorable outcome suggest higher aggressiveness of this tumor in the presence of hyperthyroidism.
