Previous History Of Hyperthyroidism Research Articles

Artificial intelligence-based CT-free quantitative thyroid SPECT for thyrotoxicosis: study protocol of a multicentre, prospective, non-inferiority study

IntroductionTechnetium thyroid uptake (TcTU) measured by single-photon emission CT/CT (SPECT/CT) is an important diagnostic tool for the differential diagnosis of Graves’ disease and destructive thyroiditis. Artificial intelligence (AI) may reduce...

ODP535 Thyrotoxic Periodic Paralysis (TPP) in A Young African American Male: Post Exercise

Abstract Thyrotoxic periodic paralysis (TPP) is a rare fatal disorder with hypokalemia as the hallmark feature associated with thyrotoxicosis. Compared with existing studies that TPP is prevalent among younger men of Asian descent, this study intends to complement this area of study by addressing aspects currently not fully covered involving the existence of TPP among men of African descent. This study documents the case of a 37year old African American Man with no previous history of hyperthyroidism who presented with sudden onset lower extremity paralysis and hypokalemia. It is particularly important to note that while majority of patients with TPP have preexisting hyperthyroidism, our patient presented with no history of overactive thyroid. The finding of this work fills a gap in literature highlighting the importance of separating Familial Hypokalemic periodic paralysis (FPP) and TPP at its earliest detection. We find strong and robust evidence suggesting that patients may be easily termed FPP in view of its similarity to TPP thereby leading to a delay in the diagnosis and treatment. TPP has been linked with genetic mutations in specific ion channels (calcium channels and KIR) and increased Na-K ATPase pump activity. This leads to a massive intracellular shift in potassium causing hypokalemia under the influence of excess thyroid hormone. We find that both TPP and FPP have similar clinical presentations and same precipitants hence the need for a high index of suspicion in patients with hypokalemia and sudden onset paralysis with no history of hyperthyroidism to prevent lethal complications. Our results suggest that prompt correction of hypokalemia and treatment of hyperthyroidism is key in resolving attacks and preventing lethal complications. Presentation: No date and time listed

Previous history of hyperthyroidism in emergency department patients with atrial fibrillation does not increase the risk of thromboembolism and death

Dear Editor, Atrial fibrillation (AF) is frequently encountered in the emergency department (ED) and is a major risk factor for thromboembolic events. The clinical decision for anticoagulation is guided by risk scoring systems that include factors such as age, sex and comorbidities.1,2 AF can sometimes occur in patients with active hyperthyroidism, but because the condition

Monitoring Foetus and Neonatal Outcomes in Patients With Current or Previous History of Hyperthyroidism

Aim: Graves’ hyperthyroidism can be associated with persistent TSH-receptor antibody (TRAB) and need for anti-thyroid drugs (ATD) during pregnancy warranting careful monitoring during pregnancy and the neonatal period. The aim of this retrospective observational study was to assess the outcomes of babies born of women with current or previous history of hyperthyroidism. Method: All women with previous or current hyperthyroidism were reviewed in the joint antenatal-endocrine clinic. Neonatal alert was instituted for all patients with positive TRAB at 20 weeks and/or requiring ATD into third trimester and included serial growth scans in third trimester, fetal medicine(FM) scan, review of neonate by paediatrician, thyroid function test(TFT) for the neonate on day 2(D2) and further tests as needed. Results: Of the 56 patients treated over a 2 year period, 31 qualified for this study. Thyroid statuses of patients were: active hyperthyroidism at conception=20; Post radioactive iodine (RAI)=4; post thyroidectomy =2; hyperthyroidism in remission prenatally=5. 24 patients were TRAB positive at 20 weeks (Strongly positive(>3xnormal) =10) & 7 were TRAB negative. 16 patients required ATD into 3rd trimester, of whom 11 required until delivery. Presence of any TRAB positivity did not statistically predict continuation or withdrawal of treatment. FM scan was normal in all patients (one patient had hydronephrosis which was deemed not related to thyroid status and resolved spontaneously after birth). Growth Scans were normal in 26 patients. One patient had a large for gestational age fetus which was not related to thyroid status (patient in Graves’ remission, TRAB weakly positive, normal FM scan, normal D2 and D14 TSH in the neonate). 4 patients had small for gestational age fetuses -2 had weakly positive and 1 strongly positive TRAB; all had normal FM scans; 1 neonate had high TSH at D2 and others normal; all neonates had normal TFT at D14. None of the neonates had clinical or biochemical hyperthyroidism on D2. 12 had high TSH on D2 - 10 normalized at D14; the other 2 were discussed with tertiary referral centre, no further medical treatment was advised and normalized spontaneously. 22 had high T4 at D2; at D14, 14 normalized, 4 had persistent high T4 but normal TSH (T4 data not available on 4 but all had normal TSH). Neonates born to mothers who were using ATD at time of delivery had higher probability of having high TSH at D2 compared to those who were not (8/11 vs 4/20, p<0.005). This difference was not statistically significant based on use of ATD at onset of pregnancy (10/20 vs 2/11, p=0.08). Conclusion: Our study showed that no neonates developed overt hyperthyroidism. Use of ATD, especially in third trimester, could be associated with risk of transient biochemical hypothyroidism in neonate. A coordinated multidisciplinary care pathway is required to monitor and manage this complex cohort of patients and neonates.

Two Cases of Severe Autoimmune Thyrotoxicosis Following SARS-CoV-2 Infection

Since the start of the COVID-19 pandemic, there have been multiple reports of related thyroid dysfunction, most commonly, thyroiditis. The exact mechanism for this has not been elucidated, but it is known that thyroid gland cells have both angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) receptors, which the SARS-CoV-2 virus uses to enter cells. While SARS-CoV-2 has also been shown to precipitate other autoimmune diseases, there are only a few reported cases of new onset Graves’ disease in the setting of SARS-CoV-2 infection. We report 2 patients who presented with severe thyrotoxicosis (thyroid storm and impending storm) that was likely precipitated by SARS-CoV-2 infection. Both patients had no previous history of hyperthyroidism, and potentially also developed Graves’ disease after getting COVID-19. The addition of these cases to the medical literature will further highlight the fact that SARS-CoV-2 infection should be considered a causative agent for thyrotoxicosis when no other cause can be found, and that SARS-CoV-2 may be a potential trigger for autoimmune thyroid disease. It is important to know the SARS-CoV-2 status of such patients for infection control purposes, and to identify patients who may have their hospital course complicated by this disease. These cases may also help further our understanding of the etiology of autoimmune thyroid disease following a viral infection.

Hashimoto’s Encephalopathy Presenting with Acute Behavioral Disturbances: A Case Report

Hashimoto’s encephalopathy (HE) is a rare and poorly understood neuropsychiatric illness of presumed autoimmune origin, with elevated titres of anti-thyroid antibodies. Its clinical presentation is highly variable that mimic a variety of neurologic and/or psychiatric disorders. Clinical presentation often suggests an infectious etiology which often leads to a mistaken diagnosis. We present the case of 35 year-old female who presented with acute onset behavioural disturbance of one day duration. On examination she was unkempt, emotionally labile, appeared withdrawn and unable to respond to questions. She had no focal neurological deficits. CNS infection was suspected and lumbar puncture was suggested, which the family members refused.She was empirically treated with intravenous acyclovir and ceftriaxone.Metabolic disorder, infectious and toxic issues were ruled out through laboratory testing.In view of her previous history of hyperthyroidism, suspicion of Hashimoto encephalopathy arose.The diagnosis was supported by the elevated level of anti-thyroglobulin (TG) antibody.We report this case to increase its awareness as it is one of the few treatable and easily reversible causes of acute encephalopathy. It should be considered in the differential diagnoses in any patient who presents with acute behavioural disturbance and has concurrent thyroid disorder.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 309-312

Severe Mitral Regurgitation by Hyperthyroidism in the Absence of Left Ventricular Dilatation

Introduction Graves’ disease (GD) is an autoimmune disease and the most common cause of thyrotoxicosis,, with multisystem involvement, that mainly affects women between 40 and 60 years of age. It is the most prevalent cause of autoimmune hyperthyroidism in pregnancy,, and it can be distinguished from gestational thyrotoxicosis due to the presence of diffuse goiter and previous history of hyperthyroidism. Clinical hyperthyroidism occurs in 0.2% of pregnant women. Heart failure (HF) is a rare manifestation of decompensated GD and it [...]

PERIOPERATIVE MANAGEMENT OF MANDIBULAR FRACTURES IN A PATIENT WITH SEVERE HYPERTHYROIDISM: A CASE REPORT

Purpose: In this report, we had managed to perioperative of mandibular fractures in a patient with severe hyperthyroidism. Methods: A 26-year-old man required emergency admission to the hospital after having a fall and losing consciousness. A computed tomography (CT) scan revealed a fracture line in the mental region and both sides of the condyle. He had a previous history of hyperthyroidism and was prescribed thiamazole, propranolol hydrochloride, and potassium iodide, but he did not take medicine by self-judgement. His laboratory findings were as follows: FT3, 7.53[Formula: see text]pg/mL; FT4, 4.26[Formula: see text]ng/mL; and TSH, undetectable. Therefore, we planned for surgery immediately after his condition improved. We also postponed his maxilla-mandibular fixation (MMF) procedure because there was a probability that MMF procedure caused thyroid crisis. Result: Seventeen days after his injury, he had greatly reduced his risk of having thyroid crisis, he underwent open reduction of his mandibular fractures under general anesthesia. As perioperative management, the patient underwent an opening training and oral care before and after surgery in addition to thyroidal treatment. Conclusion: The procedures prevented adhesion of temporomandibular joint and recovered aperture size. Moreover, we diagnosed agranulocytosis from intraoral lesion and obtained good course in response to early.

Mortality from thyroid cancer in patients with hyperthyroidism: the Theagenion Cancer Hospital experience

Thyroid carcinoma has been reported in patients operated for different types of hyperthyroidism and the probability of a hot nodule being malignant seems to be low. The aim of the present study was to explore the relationship between thyroid cancer, hyperthyroidism and outcome in a large cohort of patients who presented to a tertiary cancer centre in Northern Greece. Among 720 patients treated for thyroid cancer, 60 had a concomitant diagnosis of hyperthyroidism due to Graves' disease (n=14), solitary autonomous adenoma (n=17), or multinodular goiter (n=29). Adverse prognostic factors were common in patients with a previous history of hyperthyroidism at the time of diagnosis of thyroid cancer, including cases where the cancer was discovered coincidentally after thyroid surgery for hyperthyroidism and cases where tumor size was more than 10 mm. In 10 out of 17 patients with hyperthyroidism due to solitary autonomous adenomas, the tumor was located within the hot nodule and two of these patients developed local and distant metastases and died from the disease 4 and 15 years after thyroidectomy. Clinicians managing patients with hyperthyroidism need to be aware of the possible increased risk of thyroid cancer in this patient group.

Bone mineral density in hyperthyroidism.

To investigate whether previous hyperthyroidism is a cause of permanent secondary osteoporosis. In this cross-sectional study, 164 women with untreated or previously treated overt and symptomatic hyperthyroidism were examined 0-31 years after the initial episode of hyperthyroidism and its treatment, and were compared with a control group of 79 age-matched women without previous history of hyperthyroidism. Subjects with current or previous metabolic bone disease, any antiresorptive treatment for osteoporosis or treatments and habits known to affect bone metabolism were excluded. The age of the first manifestation of the disease, the age at the measurement of bone mineral density (BMD) at the spine and femoral neck and the interval between diagnosis and treatment of hyperthyroidism and BMD measurement were recorded and the Z-scores and T-scores of BMD were analysed. Untreated hyperthyroidism and hyperthyroidism up to 3 years after its diagnosis and treatment were associated with decreased BMD. Three or more years after the first episode of the disease the mean Z-score at both skeletal sites was near zero and not different from the controls. The age at which hyperthyroidism was manifested for the first time had no effect on the final outcome. Women affected at a young age (13-30 years) had a more pronounced loss of BMD when examined untreated or early (< 3 years) after diagnosis, but a BMD significantly above zero if examined later (> 3 years). Older women (aged 51-70 years) showed a similar pattern, although the differences were not significant. Middle-aged subjects (31-50 years) had the smallest loss of BMD during the first 3 years. Analysis of T-scores of former hyperthyroid women aged > or = 51 years showed no significantly different relative risk (RR) for osteoporosis in comparison with the controls. However, the study was not powered enough to give meaningful RR results. Overt symptomatic hyperthyroidism is associated with decreased BMD during the first 3 years after diagnosis and treatment of the disease. After this interval, former hyperthyroid women have a Z-score near zero and not different from women without a history of the disease, apparently because of recovery of the bone density lost early during the course of the disease. Symptomatic hyperthyroidism does not seem to be a cause of long-lasting osteoporosis, and the age of the patient during the first episode is irrelevant.

Chronic recurrent stress due to panic disorder does not precipitate Graves' disease.

A role of psychic stress in precipitating hyperthyroid Graves' disease has been suggested, but the evidence in support of this pathogenetic mechanism is conflicting. In this study we investigated the possible occurrence of Graves' disease in patients with panic disorder, a psychiatric condition characterized by recurrent endogenous stress. The study group included 87 consecutive patients suffering from panic disorder since 1 to 30 years: 17 males (mean age 31.3, range 26-43 years) and 70 females (mean age 37.6, range 15-73 years). Two hundred and sixty-two normal subjects with no present or past history of psychiatric disorder served as controls. Patients were submitted to a full evaluation of the thyroid that included physical examination, assays for free thyroid hormones, TSH, thyroglobulin (TgAb), thyroperoxidase (TPOAb) and TSH receptor (TRAb) antibodies, and thyroid echography. The prevalence of circulating TgAb and/or TPOAb in patients with panic disorder did not differ from that in the control group. Twelve patients with panic disorder (13.7%) had circulating TgAb and/or TPOAb, but none had TRAb. Three out of 12 patients with thyroid antibodies, indicating a genetic susceptibility to autoimmune thyroid disease, had a family history of clinical thyroid autoimmunity, and 4 of them had a hypoechogenic pattern of the thyroid at ultrasound suggesting autoimmune thyroiditis. None of the patients with panic disorder had a previous history of hyperthyroidism. On examination, clinical hyperthyroidism or endocrine ophthalmopathy were not found in any of them. A small goiter was appreciated by palpation in 16 patients (18.3%). Free thyroid hormones and TSH were within the normal range in all patients but one: a 55-year old lady with normal serum free thyroid hormones and undetectable TSH. During an 18-month follow-up she did not develop hyperthyroidism and her TSH spontaneously returned in the normal range. Considering the individual duration of panic disorder, evidence for previous or present Graves' hyperthyroidism was not found for a total of 478 patient-years of exposure to recurrent endogenous stress in the whole study group, and for a total of 39 patient-years in patients with a genetic susceptibility to autoimmune thyroid disease. In conclusion, we found that recurrent endogenous stress did not precipitate Graves' hyperthyroidism in a series of 87 patients with panic disorder, encompassing a total of 478 patient-years of exposure to stress. Failure to activate the hypothalamic-pituitary-adrenal axis by endogenous stress due to panic disorder as opposed to exogenous stress due to life-events might explain why panic disorder does not precipitate Graves' hyperthyroidism.

Is previous hyperthyroidism still a risk factor for osteoporosis in post-menopausal women?

Hyperthyroidism is a risk factor for osteoporosis, but the relative contributions of the episode of hyperthyroidism and thyroxine replacement for subsequent hyperthyroidism remain uncertain. In this study we have measured bone mineral density (BMD) in post-menopausal women with a previous history of hyperthyroidism, comparing those requiring thyroxine therapy with those remaining euthyroid and with an historical local control population. Cross-sectional study. One hundred and six post-menopausal women with a previous history of hyperthyroidism. These were divided into four groups: treated with radioiodine, remaining euthyroid (group RU, n = 15); treated with radioiodine, receiving thyroxine for at least 5 years (group RT, n = 46); treated with surgery, remaining euthyroid (group SU, n = 21); treated with surgery, receiving thyroxine for at least 5 years (group ST, n = 24). There were 102 control subjects. Forearm bone mineral density at distal and ultradistal sites as measured by single-photon absorptiometry. Results were expressed as 'Z-scores' i.e. number of standard deviations from the mean of a 5-year age-band from the local control population. Mean Z-scores at distal and ultradistal sites were as follows: -0.61 and -0.81 in group RU; -0.58 and -0.56 in group RT; -0.27 and -0.30 in group SU; -0.81 and -0.57 in group ST. Patients in groups RU, RT and ST but not SU had significantly lower BMD than controls. Post-menopausal women with previous hyperthyroidism treated with radioiodine have reduced BMD, whether or not receiving thyroxine. They should be targeted for densitometry and protective therapy with oestrogen should be considered. Those treated with surgery appear to be at less risk; this may be because most are diagnosed and treated whilst premenopausal. Thyroxine may have a deleterious effect in this group; longitudinal studies would provide further clarification.

Improvement of infiltrative ophthalmopathy in parallel with decrease of thyroid-stimulating antibody (TSAb) activity in two patients with hypothyroid Graves’ disease

Two patients with primary hypothyroidism associated with infiltrative ophthalmopathy without previous history of hyperthyroidism are presented. Anti-TSH receptor antibodies (TRAb) were detected by radioreceptor assay (TBII), and unexpectedly their biological activity was not of a blocking (TSBAb), but of a thyroid-stimulating type (TSAb). After the initiation of levothyroxine therapy, the TBII and TSAb activities both decreased gradually with normalization of the elevated TSH level. The inflammatory eye signs improved strikingly in parallel with decrease of these antibody activities. These data indicate that (1) TRAb in primary hypothyroidism do not always show TSAb activity, (2) the decrease in TRAb following levothyroxine therapy in these patients appeared to correlate with suppression of TSH, (3) changes in infiltrative ophthalmopathy were associated with that of TSAb even in primary hypothyroidism, and (4) the hypothyroidism in these patients is justifiably diagnosed as "hypothyroid Graves' disease". TSAb might be somewhat related to the pathogenesis of ophthalmopathy in autoimmune thyroid diseases.

Thyroid function in patients with hyperemesis gravidarum

An increased free thyroxine (T4) index was observed in 73% of 33 consecutive pregnancies complicated by severe hyperemesis gravidarum. The free triiodothyronine (T3) index was increased in only four of 11 hyperthyroxinemic patients. In five hyperthyroxinemic patients tested, no increase in serum thyrotropin was observed after the injection of thyrotropin-releasing hormone (TRH). Goiter, exophthalmos, or previous history of hyperthyroidism was absent in all patients. The thyroxinemia returned to normal in one to several weeks, whether or not it was treated with antithyroid drugs. The thyroid function during the period of hyperemesis had no influence on the subsequent rate of abortion or duration of pregnancy. A lower birth weight, however, was observed in children born to hyperthyroxinemic mothers. Hyperemesis gravidarum should be included in the differential diagnosis of elevations in free T4 index during pregnancy and included in the differential diagnosis of hyperthyroidism.

Neonatal thyrotoxicosis associated with the hyperviscosity syndrome

Baby S.M. was the 2,230-gram, 36-week product of a 28-yearold gravida 1 para 0 black woman with a previous history of hyperthyroidism, treated by subtotal thyroidectomy one year prior to her pregnancy. Clinically, she was euthyroid, with a normal T, value and a negative long-acting thyroid stimulator titer. No thyroid or anti-thyroid medications were taken during pregnancy. Labor and delivery were uneventful Shortly after birth, however, the infant developed acrocyanosis, tachypnea (100/ minute), tachycardia (180/minute), and hyperactivity with marked irritability and tremulousness. At 13 hours of age, his blood glucose value, measured by Dextrostix, was 25 mg/dl; 10% dextrose solution was administered intravenously, and he was transferred to St. Louis Children's Hospital. On arrival, he was moderately icteric (total bilirubin 10.4 rng/dl; direct bilirubin 2.52 mg/dl) and was noted to have generalized petechiae, purpura, and hepatosplenomegaly. Diffuse cardiomegaly was noted radiographically; right heart enlargement was shown electrocardiographically. Sixty percent inspired oxygen was required to maintain normal arterial blood gas values. Serum calcium was decreased to 6.8 mg/dl, but the concentrations of the other electrolytes were normal. Venous microhematocrit was 73%. Initial platelet count was 170,000/ mm', but it fell to 56,000/mm :~. Blood smear revealed 2,880 nucleated red blood cells/mrn ~, but was otherwise unremarkable.