Types Of Hyperthyroidism Research Articles

8288 Navigating Diagnostic Challenges of Amiodarone Induced Thyrotoxicosis in a Psychiatrically Complex Patient within a Community Hospital Setting

Abstract Disclosure: M.S. Shah: None. K.P. Sanu: None. S. Humayon: None. R. Chawla: None. N.K. Bains: None. This case delves into the intricate diagnostic and therapeutic journey of a 64-year-old male who presented to a community hospital with psychosis. Medical history was pertinent for ventricular arrhythmias treated with amiodarone 400 mg once daily, bipolar disorder with medication non-compliance and heart failure with reduced ejection fraction status post automatic implantable cardioverter-defibrillator placement. Collaboration with the patient's family revealed a history of repeated hospitalizations for similar presentations as well as recent weight loss. The challenge lay in distinguishing between manic episodes and other potential underlying medical causes. The patient's recent weight loss and amiodarone use prompted a thyroid panel, revealing a TSH of 0.01 mlU/L (n = 0.27 to 4.20 mIU/L), free T4 of >7.77ng/dL (n = 0.93 to 1.70 ng/dL), and free T3 of >7.51ng/dL (n = 2.00 to 4.40 pg/mL). Inadequate facilities for a radioactive iodine uptake (RAIU) scan and thyroid doppler ultrasound heightened the diagnostic challenge, making the history and physical exam pivotal in steering the course of this patient's care. The Burch-Wartofsky score was found to be elevated at 30 due to delirium and abdominal pain reported in the emergency department. Amiodarone use for over two years with no prior history of thyroid dysfunction, along with the absence of a goiter or thyroid antibodies suggestive of Graves disease heightened the suspicion for amiodarone-induced thyrotoxicosis type 2 (AIT type 2). Due to the lack of RAIU scan and thyroid ultrasound to better differentiate between AIT type 1 and type 2, the patient was treated with methimazole and prednisone along with an antipsychotic medication regimen. The discontinuation of antipsychotic medications became necessary due to QTc prolongation and subsequent defibrillator discharge. The patient's further improvement without psychiatric medications highlighted the success of the tailored treatment strategy, emphasizing the importance of accurate diagnosis in patients with psychiatric comorbidities. The patient’s relatively rapid clinical response also aids in differentiating AIT type 1 from type 2. This case brings awareness to the importance of a comprehensive history and physical exam, particularly in the setting of a community hospital with limited diagnostic resources. Despite the inability to obtain history directly from the patient and having diagnostic constraints, the judicious use of available resources and clinical acumen led to the diagnosis of Amiodarone-induced thyrotoxicosis type 2. Clinicians should keep a broad differential to avoid confirmation bias in treating psychiatric patients with a complex medical history. This case serves as a testament to the importance of a holistic approach to patient care and the need for ongoing advancements in diagnostic capabilities within community healthcare settings. Presentation: 6/2/2024

Amiodarone-induced thyrotoxicosis type 1 during the treatment of cardiovascular diseases: features of a clinical case

Amiodarone-induced thyrotoxicosis type 1 during the treatment of cardiovascular diseases: features of a clinical case

Amiodarone-induced thyrotoxicosis type 2: the role of differential diagnosis in patient management

The antiarrhythmic drug amiodarone can affect the function of the thyroid gland, contributing to the development of thyrotoxicosis or hypothyroidism. The development of thyrotoxicosis exacerbates the cardiovascular pathology present in patients: it leads to the progression of left ventricular dysfunction, recurrence of rhythm disturbances, increasing the risk of adverse outcomes. Timely diagnosis of thyrotoxicosis in the treatment of amiodarone is of fundamental importance in choosing the right therapeutic tactics, which is determined by the type of amiodarone-induced thyrotoxicosis (AmIT), the state of the cardiovascular system, and the risk of recurrent arrhythmias. In type 1 AMIT, the main method of controlling the relief of thyrotoxicosis is thyroostatic therapy with the possibility of subsequent radical treatment (radioiodine therapy, thyroidectomy). Type 2 AmIT is a self-limiting process, however, for the treatment of patients with moderate to severe amiodarone-induced thyrotoxicosis type 2, glucocorticoids are the first-line drugs. With a mixed version of AmIT, a combination of antithyroid drugs and glucocorticoids is recommended. This review presents a clinical case of a patient with type 2 AmIT who was treated with thyrostatic drugs for a long time without achieving an effect.

Appraising the causal relationship between thyroid function and rheumatoid arthritis: a two-sample bidirectional Mendelian randomization study.

Hypothyroidism and hyperthyroidism are observationally associated with rheumatoid arthritis (RA), but causality is unclear. To evaluate the causal relationship between thyroid function and RA, we conducted a two-Sample bidirectional Mendelian Randomization (MR) study. Single nucleotide polymorphisms associated with six phenotypes were selected from the FinnGen biobank database, The ThyroidOmics Consortium database, and the IEU Open GWAS database. For the forward MR analysis, we selected hypothyroidism (N=213,390), Graves' disease (GD) (N=199,034), other types of hyperthyroidism (N=190,799), free thyroxine (FT4, N=49,269), and thyroid-stimulating hormone (TSH, N=54,288) as the five related thyroid function phenotypes for exposure, with RA (N=58,284) as the outcome. Reverse MR analysis selected RA as the exposure and five phenotypes of thyroid function as the outcome. The Inverse variance weighting (IVW) method was used as the primary analysis method, supplemented by weighted median (WM) and MR-Egger methods. Cochran's Q test, MR-PRESSO, MR-Egger regression methods, and leave-one-out analysis were employed to assess sensitivity and pleiotropy. Forward MR evidence indicates that genetic susceptibility to hypothyroidism is associated with an increased risk of RA (ORIvw=1.758, P=7.61×10-5). Reverse MR evidence suggests that genetic susceptibility to RA is associated with an increased risk of hypothyroidism (ORIvw=1.274, P=3.88×10-20), GD (ORIvw=1.269, P=8.15×10-05), and other types of hyperthyroidism (ORIvw=1.141, P=1.80×10-03). There is no evidence to support a forward or reverse causal relationship between genetic susceptibility to RA and FT4, TSH. Our results provide genetic evidence supporting bidirectional causal relationships between thyroid function and RA. These findings inform preventive strategies and interventions targeting RA and thyroid dysfunction.

A Case of Amiodarone Induced Thyrotoxicosis Type 2

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

A case of Amiodarone induced thyrotoxicosis Type 1

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Abstract 10988: The Dynamic Duo of Electrical and Thyroid Storm Caused by Amiodarone

Case description: A 61 year-old male with a hx of CAD s/p CABG and HFrEF s/p AICD presents with a 4-day history of dizziness and shortness of breath; he was found to be in ventricular tachycardia (VT) storm. ICD interrogation was found to have 13 shocks in 24 hours. His thyroid function tests (TFT) were abnormal: TSH undetectable, elevated FT4 7.7 (0.93-1.7) and T3 246.6 (84-202) ng/dL, respectively. He was diagnosed with severe thyrotoxicosis, likely due to amiodarone-induced thyrotoxicosis (AIT) type 2 and a Burch-Wartofsky score of 50, highly suggestive of thyroid storm (TS). He was started on hydrocortisone, prednisone, propylthiouracil, and metoprolol for the TS. Procainamide drip had been initiated for VT and titrated until VT was controlled. Repeat TFTs in 48 hours showed no changes in TSH or FT4, but T3 had normalized. Procainamide and hydrocortisone were discontinued after VT frequency had decreased. Discussion: An electrical storm (ES) is a state of electrical instability characterized by multiple episodes of VT in 24 hours. In patients with ICD, it is defined as >3 anti-tachycardic pacing therapies or shock. Most patient with ES have severe underlying structural heart disease with various inciting events such as thyrotoxicosis. Amiodarone is the drug of choice in VT; however, complications such as AIT should be recognized. Thyroid hormone has a direct arrhythmogenic effect on the heart through various cellular mechanisms. In our patient, amiodarone was discontinued after the diagnosis of AIT. Procainamide and antithyroid therapy were started, which subsequently controlled the VT. Resistance to therapy can occur, and more elaborate interventions such as plasmapheresis are an option to remove amiodarone, its metabolites, and free thyroid hormones. Conclusion: Amiodarone is the most efficacious medication for VT. However, it is important to recognize possible life-threatening complications of this medication, such as AIT, which itself can exacerbate VT.

AMIODARONE AND THYROID DYSFUNCTION.

Thyroid gland has a key role in maintaining the body homeostasis. Thyroxine is the main hormone secreted from the thyroid gland, its effect being predominantly achieved after the intracellular conversion of thyroxine to triiodothyronine, which exhibits a higher affinity for the receptor complex, thus modifying gene expression of the target cells. Amiodarone is one of the most commonly used antiarrhythmics in the treatment of a broad spectrum of arrhythmias, usually tachyarrhythmias. Amiodarone contains a large proportion of iodine, which is, in addition to the intrinsic effect of the medication, the basis of the impact on thyroid function. It is believed that 15%-20% of patients treated with amiodarone develop some form of thyroid dysfunction. Amiodarone may cause amiodarone-induced hypothyroidism (AIH) or amiodarone-induced thyrotoxicosis (AIT). AIT is usually developed in the areas with too low uptake of iodine, while AIH is developed in the areas where there is a sufficient iodine uptake. Type 1 AIT is more common among patients with an underlying thyroid pathology, such as nodular goiter or Graves' (Basedow's) disease, while type 2 mostly develops in a previously healthy thyroid. AIH is more common in patients with previously diagnosed Hashimoto's thyroiditis. Combined types of the diseases have also been described. Patients treated with amiodarone should be monitored regularly, including laboratory testing and clinical examinations, to early detect any deviations in the functioning of the thyroid gland. Supplementary levothyroxine therapy is the basis of AIH treatment. In such cases, amiodarone therapy quite often need not be discontinued. Type 1 AIT is treated with thyrostatic agents, like any other type of thyrotoxicosis. If possible, the underlying amiodarone therapy should be discontinued. In contrast to type 1 AIT, the basic pathophysiological substrate of which is the increased synthesis and release of thyroid hormones, the basis of type 2 AIT is destructive thyroiditis caused by amiodarone, desethylamiodarone as its main metabolite, and an increased iodine uptake. Glucocorticoid therapy is the basis of treatment for this type of disease.

Evaluation of Anemia in Thyroid Dysfunctions Anemia in Thyroid Dysfunctions: Retrospective Cross-Sectional Study

Objective: Evaluation of Anemia in Thyroid Dysfunctions Anemia in Thyroid. Materials and Methods: The study analyzed 145 medical records of patients diagnosed with thyroid disorders (102 women and 43 men), receiving care between January 2011 and February 2018 at the University Hospital of Florianópolis, Brazil, selected with thyroid disorder ICD. Results: Obtained by analyzing the medical records and assessing laboratory parameters: thyroid-stimulating hormone (TSH), free thyroxine (FT4), mean corpuscular volume (MCV), red blood cell distribution width (RDW), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), hemoglobin values (Hb), red blood cell count (RBC), hematocrit values (Hct), cytomorphological erythrocyte changes, serum iron, and ferritin. Most patients were diagnosed with primary hypothyroidism, followed by primary hyperthyroidism. Hemoglobin values were present in 95.9% of patients with hypothyroidism and 89.6% of those with hyperthyroidism. Patients whose hemoglobin values were below 12 (for women) or 13 g/dl (for men) were classified as anemic. The frequency of anemia was 41.0% of patients – 76.3% had some type of hypothyroidism, while 29.7% had some type of hyperthyroidism. Conclusion: Normocytic and normochromic anemia was observed in both thyroid disorders. In hyperthyroidism, values neared microcytosis. Red blood cell counts were statistically different between males with hypothyroidism and hyperthyroidism. Hypothyroidism was statistically related to diabetes, systemic arterial hypertension, and cardiovascular diseases.

UNUSUAL SCINTIGRAPHIC FINDING IN A PATIENT WITH AMIDOARONE-INDUCED THYROTOXICOSIS: A CASE REPORT

Amiodarone, an antiarrhythmic drug with 37% iodine of its weight, is often used for treatment of severe cardiac arrhythmias. Enormous iodine content and structural similarity to thyroxine leads to thyroid dysfunction in 14-18% of patients. A 64-year-old man presented at our department with signs of thyrotoxicosis for further work up. He reported taking amiodarone for treatment of atrial fibrillation for two years. The patient denied any thyroid dysfunctions in the past. Full thyroid examination revealed elevated FT4 and suppressed TSH, with undetectable level of thyroid antibodies, increased iodine urinary concentration and normal thyroid ultrasound features. Although the above mentioned was indicative for amiodarone-induced thyrotoxicosis (AIT) type 2, 99mTc-pertechnetate scan showed normal thyroid uptake, highly unusual for iodine contamination and destructive thyroiditis. We presumed that this was a mixed form of AIT. Amiodarone administration was stopped and the patient was put on antithyroid drug therapy with thiamazole. During the follow up period he became clinically and biochemically euthyroid and thiamazole was discontinued. Thyroid screening should be performed in all patients undergoing amiodarone treatment. The presented case highlights the challenge of differentiation and management of a form of AIT with mixed features of both types.  Keywords: iodine excess, amiodarone induced thyrotoxicosis, mixed form

Bioinformation Algorithm for Selecting a Method for Premedication of Patients with Arterial Hypertension with Amiodarone-Associated Thyrotoxicosis Type I during Neurosurgical Operations

Signs associated with adverse cardiovascular reactions after surgery were established in 46 patients with arterial hypertension, cardiac arrhythmias and type I amiodarone-associated thyrotoxicosis. These signs included an increase in the circadian index above 1.52, the presence of pauses in the heart rate for more than 3 seconds, the number of group ventricular extrasystoles per day exceeding 30, an increase in LF/HF with RR-intervalometry more than 1.3. In order to reduce the risk of cardiac arrhythmias in the postoperative period, a premedication with long-acting benzodiazepines in combination with magnesium preparations over a prolonged course is recommended.

Clinicopathological Characteristics of Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area

Papillary thyroid microcarcinoma (PTMC) is a common malignant disease of the endocrine system, which has rapidly increased in incidence and prevalence in recent decades. The aim of our paper was to identify correlations between pathological and clinical features of cases of PTMC. A total of 612 patients of both genders, who were operated on for benign thyroid diseases in the 3rd Surgical Unit of St. Spiridon University Hospital of Iasi, were monitored for a period of 2 years. According to pathological reports, PTMC was diagnosed in 144 cases. Of those cases, 81.2% were female and 18.8% were male, with an overall mean age of 54.77 ± 11.9 years. The mean diameter of tumors was 3.04 ± 2.2 mm (75.7% were under 5 mm), and 35.4% were multifocal tumors. Of all tumors studied, 76.4% were the follicular variant, 13.2% were conventional, and 10.4% of cases included tall cell, hobnail, or columnar variants. The underlying diseases were multinodular goiters (73.6%), adenomas (25%), Hashimoto thyroiditis (17.4%), Basedow’s disease, and other types of hyperthyroidism (4.9%), primarily hyperparathyroidism (7.6%), with a small percentage presenting a combination thereof. Extracapsular invasion was present in 14.6% while 5.6% presented perineural invasion and 0.7% of cases had vascular invasion. Lymphatic emboli were found in 9% of cases and lymph node metastasis in 5.6% of cases. PTMC is not as innocent as believed, and further studies, performed on larger batches, would be necessary in order to identify high oncological risk cases and to determine when a more aggressive surgical approach is indicated.

Sistem Pakar Diagnosa Hipertiroid Menggunakan Certainty Factor dan Logika Fuzzy

Hyperthyroidism is a condition when the function of thyroid gland becomes excessive. The excess function of thyroid gland increases thyroid hormone production which affect body metabolism and physiological activity. This study aims to make an expert system diagnose hyperthyroidism with certainty factor and fuzzy logic. The stages of the process of diagnosing hyperthyroidism including problem identification, needs analysis of symptoms and types of hyperthyroidism, determination of rules, system design, case examples implementation, system testing, and evaluation. Variables used were systolic blood pressure, triiodothyronine (T3) levels, thyroxine (T4) levels, thyroid stimulating hormones (TSH) levels, goiter, tremors, and excessive sweating. All variables are processed using fuzzy logic with fuzzyfication stages, rule determination, min implications, max rule composition, and defuzzyfication which then proceed with certainty factor with sequential CF and CF stages. The system output is diagnosis the condition of hyperthyroidism such as hyperthyroidism, subclinical hyperthyroidism, and normal accompanied by a certainty factor. Based on the evaluation result, the accuracy of the expert system according to expert diagnostics is 86.7%

SUN-520 Graves Disease and T3 Thyrotoxicosis: A Case Report

Introduction: Hyperthyroidism is one of the common problems in the world of endocrinology. Identifying the type of thyrotoxicosis is crucial before starting treatment. We present a case of a 37-year-old woman presented with hyperthyroidism and was started on methimazole. Her symptoms persisted and further workup showed T3 thyrotoxicosis. Her symptoms improved after switching her to PTU. She eventually underwent thyroidectomy.Case description: Thirty-seven-year old African American woman presented to her primary care physician(PCP) with symptoms suggestive of hyperthyroidism for three months. Her past medical history is significant for recent delivery one year ago. Her Physical exam is pertinent for hypertension of 160/80 with a heart rate of 120. Her neck is diffusely enlarged with bilateral bruits. Bilateral lid retraction with lid lag was noted along with left lid proptosis. There were no tremors or leg swelling noted. Her Initial workup showed sinus tachycardia in the electrocardiogram. Her TSH level was <0.010 and a free T4 level of 3.48. Ultrasound showed diffuse enlargement of the thyroid gland with no focal nodule. She was started on methimazole 10mg twice daily and metoprolol 25mg twice daily.Three months later, she presented to the emergency room(ER) with tachycardia of 130 and hypertension of 170/85. Work up showed a TSH level of <0.010 and a free T4 level of 3.94. She was compliant with medications. When free T3 levels were checked it turned out to be >30. She was diagnosed with T3 Thyrotoxicosis and was started on propylthiouracil 150mg every 8 hours. Her metoprolol was increased to 50mg every 12 hours. Her symptoms improved and she finally underwent surgery for thyroidectomy.Discussion: Hyperthyroidism is seen in about 1 in 5000 with a strong female predominance. Graves disease, the most common cause of hyperthyroidism is due to excess production of TSH receptor stimulating antibodies. Hyperthyroid patients with graves disease sometimes have a disproportionate increase in serum T3 levels when compared to serum T4. This is thought to be due to increased T3 production or extrathyroidal conversion of T4 to T3. It is very crucial to identify the free hormone levels in a new patient with hyperthyroidism because of the difference in management. Antithyroid drugs are traditionally the first-line treatment option along with beta-blockers prior to definitive therapy like radioactive iodine or thyroidectomy. The main drugs used are methimazole and propylthiouracil(PTU). Methimazole is more commonly used than PTU because of its rapid efficacy, longer duration of action and less adverse effects. For patients with T3 thyrotoxicosis, PTU is preferred as it is known to reduce the peripheral conversion of T4 to T3. Our patient medication was changed from methimazole to PTU, after which she started to notice improvement. She eventually underwent definitive treatment with thyroidectomy.

Abstract #794867: A Case of Surgical Management of Refractory Amiodarone Induced Thyrotoxicosis Type 2

Abstract #794867: A Case of Surgical Management of Refractory Amiodarone Induced Thyrotoxicosis Type 2

Hyperthyroidism

Thyrotoxicosis is a general term for excess circulating and tissue thyroid hormone levels, whereas hyperthyroidism specifically denotes disorders involving a hyperactive thyroid gland (Graves disease, toxic multinodular goiter, toxic adenoma). Diagnosis and determination of the cause rely on clinical evaluation, laboratory tests, and imaging studies. Hyperthyroidism is treated with antithyroid drugs, radioactive iodine ablation, or thyroidectomy. Other types of thyrotoxicosis are monitored and treated with β-blockers to control symptoms given that most of these conditions resolve spontaneously.

Efficacy of a single fixed 131I dose of Radioactive iodine for the treatment of hyperthyroidism

A total of 135 patients were treated for hyperthyroidism with 131I 15 mCi radioiodine ablation. The therapeutic target was achieving hypothyroidism. Between January 2014 and December 2018, clinical records were reviewed and the data was collected and reviewed for 135 patients with hyperthyroidism that were referred to the Nuclear Medicine Department at Salmaniya Medical Center, for Radioactive Iodine (RAI) thyroid gland ablation procedure for definitive treatment of hyperthyroidism. About 39.7% of our patients achieved response between 4-6 months out of which 35.7% of the patients showed response in the first 3 months. 21.4% of the patients took between 7-12 months to show response and only 3.2% responded after 12 months. The most significant response was hypothyroidism comprising of 94.4%. It is also worth mentioning that 4.0% of patients achieved euthyroidism and did not require any followup medication. Using a fixed dose of RAI of 15mCi for treating various types of Hyperthyroidism, successful treatment with a single dose of RAI can be achieved in 92.7% of the patients, with first therapy failure rate in 7.3%, with few patients requiring additional doses of RAI.

Efficacy of a single fixed 131I dose of radioactive iodine for the treatment of hyperthyroidism

A total of 135 patients were treated for hyperthyroidism with 131I 15 mCi radioiodine ablation. The therapeutic target was achieving hypothyroidism. Between January 2014 and December 2018, clinical records were reviewed and date was collected and reviewed for 135 patients with hyperthyroidism that were referred to the Nuclear Medicine Department at Salmaniya Medical Center, for radioactive iodine (RAI) thyroid gland ablation procedure for definitive treatment of hyperthyroidism. About 39.7% of our patients achieved response between 4-6 months out of which 35.7% of the patients showed response in the first 3 months. 21.4% of the patients took between 7-12 months to show response and only 3.2% responded after 12 months. The most significant response was hypothyroidism comprising of 94.4%. It is also worth mentioning that 4.0% of patients achieved euthyroidism and did not require any follow-up medication. Using fixed dose of RAI of 15mCi for treating various type of Hyperthyroidism, successful treatment with a single dose of RAI can be achieved in 92.7% of the patients, with first therapy failure rate in 7.3%, with few patients requiring additional doses of RAI.

Амиодарон-индуцированный тиреотоксикоз 1 типа: особенности ведения пациентов

Амиодарон-индуцированный тиреотоксикоз 1 типа: особенности ведения пациентов

Amiodarone-induced thyrotoxicosis type 2: predictors and treatment options

Amiodarone-induced type 2 thyrotoxicosis remains a significant problem of modern endocrinology and cardiology. The unique pharmacological character and multifaceted properties of amiodarone explain its high prescription frequency and the leading position among antiarrhythmic drugs. In its turn, cytotoxicity and supra-physiological iodine content in the drug increase the risk of drug-induced destructive thyroiditis. The development of thyrotoxicosis leads to recurrence of cardiac arrhythmias, increased left ventricular dysfunction and manifestations of chronic heart failure. Correct identification of the type of thyrotoxicosis determines the subsequent patient management strategy. Glucocorticoids have been recognized as the first-line treatment among the possible therapy options. Rapid correction of thyrotoxicosis is crucial, especially in elderly patients with severe heart disease. Of interest for practical medicine is the search for specific predictors (deep understanding of the pathogenetic mechanisms) and new possibilities of therapy for amiodarone-induced thyrotoxicosis type 2.