1/14. Acute psychotic state due to hyperthyroidism following excision of a mandible bone tumor: a case report.The etiology of psychotic symptoms that emerge following surgery needs to be sought to allow physicians to provide effective treatment. We present the case of a patient who developed hyperthyroidism shortly after excision of a mandible bone tumor and discuss its clinical features, course, and management. A 48-year-old female without previous thyroid disease accidentally found a tumor over her left mandible bone and underwent excision of the tumor. Soon after surgery, she suffered from anxiety, mood swings, insomnia, and even auditory hallucinations. Through careful differential diagnosis and a series of examinations, she was shown to be in a hyperthyroid state. Her condition improved after short-term use of haloperidol, lithium, and methimazole. Her thyroid function recovered and she was free from any psychiatric symptoms during the 1-year follow-up. hyperthyroidism following surgery is not uncommon and its possibility should be considered when making differential diagnoses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. propranolol-exacerbated mesenteric ischemia in a patient with hyperthyroidism.OBJECTIVE: To report a case of acute mesenteric ischemia associated with the use of oral propranolol. CASE SUMMARY: A 59-year-old white man was admitted to the hospital with chronic diarrhea and weight loss. The patient was diagnosed as having hyperthyroidism. Therapy with propylthiouracil 100 mg 3 times daily and propranolol 20 mg twice daily was initiated on an outpatient basis. The following day, the patient was readmitted to our hospital with increased abdominal pain and bloody diarrhea. angiography revealed superior mesenteric artery occlusion. Antegrade aorta-mesenteric bypass surgery was performed for revascularization, and the patient was discharged 10 days after the surgery. The patient was well both clinically and endoscopically at a follow-up visit 8 months later. DISCUSSION: Although mesenteric ischemia is a devastating illness of varied causes, drug-associated mesenteric ischemia is rarely seen. By decreasing cardiac output and selective vasodilatory receptor inhibition in the splanchnic circulation, propranolol can cause a decline in splanchnic blood flow. An objective causality assessment indicated that propranolol was the possible cause of the arterial occlusion. CONCLUSIONS: propranolol may rarely be associated with mesenteric ischemia. In cases of newly developed acute abdomen undergoing propranolol therapy, physicians should be aware of this rare and serious adverse reaction to this drug.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. Three clinical problems: weird thyroid function tests, difficult gout, and dementia.Speakers at the course were given vignettes describing one or more clinical scenarios on which to base their talks, selected because they represent common but challenging problems likely to be encountered by any physician practising in general internal medicine. Three of the subjects covered--weird thyroid function tests, difficult gout, and dementia--are presented here.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. Recurrent painful unilateral gynaecomastia-interactions between hyperthyroidism and hypogonadism.We report an unusual case of recurrent, painful, unilateral gynaecomastia (GM) in an elderly male with relapsing Graves' hyperthyroidism and co-existing primary hypogonadism. This patient presented to the breast Clinic with a 4-month history of painful, right GM. Malignancy was excluded but T3 was noted to be raised at 7.3 pmol l(-1) (normal 3.5-5.5) with a suppressed thyroid-stimulating hormone. testosterone, luteinizing hormone and follicle-stimulating hormone were consistent with primary hypogonadism. He was later referred to physicians with night sweats and painful right GM. FT3 was 7.4 and carbimazole was commenced. Within 4 months, the night sweats and right GM had resolved but he became hypothyroid. When carbimazole was stopped, right GM recurred together with hyperthyroidism. The male breast, which is sensitive to subtle changes in T/E2 ratio, is more likely to be stimulated in an elderly male with hyperthyroidism and pre-existing hypogonadism, and hence recurrence of GM with relapsing hyperthyroidism. Recognition of this association is clinically relevant to avoid unnecessary investigations and undue patient anxiety, and to facilitate appropriate early diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. iodine-induced thyrotoxicosis after ingestion of kelp-containing tea.Complementary medication is en vogue and an increasing number of patients consume herbal medicine without reporting their use to physicians. We report a case of iodine-induced hyperthyroidism due to the ingestion of a kelp-containing tea. A 39-year-old woman with multinodular goiter presented with typical signs of hyperthyroidism, which was confirmed by endocrine tests. She was not exposed to iodinated radiocontrast media and did not take medications containing iodine, such as amiodarone. However, a detailed medical history revealed that she had been treated for a period of 4 weeks by a Chinese alternative practitioner with a herbal tea containing kelp because of her enlarged thyroid. The consumption of the tea was discontinued and an antithyroid drug therapy was initiated. physicians should advise patients with underlying thyroid disease to avoid all complementary or alternative medications containing iodine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. hyperthyroidism in the geriatric population.Although the thyroid gland can become overactive at any age, the syndrome of hyperthyroidism changes considerably in elderly persons. The principal reason is comorbidity. The patient over age 65 is much more likely than a young adult of 20 or 25 to have one or more preexisting disorders when the thyroid becomes overactive. In the elderly, therefore, the classic picture of hyperthyroidism--the constellation of irritability, sweating, palpitations without heart disease, weight loss despite good appetite, goiter, and warm, fine skin, familiar to all physicians--may never develop. Well before it might have appeared, a milder degree of thyroid hyperfunction may become manifest because of worsening of an underlying disease. Accordingly, the recognition of the thyroid disorder is often delayed. The purpose of this article is not so much to review hyperthyroidism as to delineate the special features found in geriatric patients and to describe a simple but effective scheme of evaluation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. How thyroid disease presents in the elderly.Some of the symptoms and signs of hypothyroidism and hyperthyroidism in elderly patients may be mistakenly attributed to "old age." weight loss, muscle weakness, tremor, angina, congestive heart failure--all signs of hyperthyroidism--are also concomitants of aging. fatigue, sluggishness, withdrawal behavior, senile atrophic skin changes--all signs of hypothroidism--are also a part of the normal aging process. Although screening elderly people for thyroid disease is economically unsound, the physician should maintain a high index of suspicion of its presence. Laboratory tests must be interpreted with extra care. Values of 131I uptake, serum T4 and T3, thyroid-stimulating hormone, and thyrotropin-releasing hormone are all helpful in diagnosis. Thyroid disease is easily treated in elderly patients, and results often are dramatic. propranolol is effective in thyrotoxic patients when symptoms require prompt relief. The definitive treatment, however, is 131I; antithyroid drugs are difficult to manage. hypothyroidism is easily treated with T4.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/14. hypothyroidism with spontaneous progression to hyperthyroidism.Chronic lymphocytic thyroiditis (Hashimoto's disease) is usually regarded as a stable and irreversible condition. This report describes a patient with autoimmune hypothyroidism who subsequently developed hyperthyroid Graves' disease. patients with Hashimoto's thyroiditis should be followed regularly, and the development of clinical and/or biochemical hyperthyroidism should alert the physician to the possibility of another thyroid disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. Renal hypophosphatemic osteomalacia unmasked by hyperthyroidism.A case of renal hypophosphatemic osteomalacia (RHO) that was unmasked by hyperthyroidism is presented. The patient presented at age 64 with pathologic leg fractures. There was no family history of osteomalacia or rickets. Initial evaluation revealed hyperthyroidism, which was treated with radioactive iodine. Despite control of thyroid function, the patient had recurrent pathologic fractures. Further evaluation revealed histologically proven osteomalacia and the biochemical findings of RHO: elevated serum alkaline phosphatase, decreased serum phosphate and tubular resorption of phosphate, and normal serum calcium, parathyroid hormone, and vitamin d levels. Other causes of osteomalacia were excluded. Treatment with phosphate and calcitriol reversed the osteomalacia. This case demonstrates that hyperthyroidism, and possibly other illnesses that affect vitamin d or bone metabolism, may unmask metabolic bone disease and that physicians should be alert for the subtle clinical and biochemical indicators of unrecognized metabolic bone disease in adults.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. Loss of bladder control in hyperthyroidism.Urinary urgency and frequency and even enuresis may be manifestations of augmented adrenergic activity in hyperthyroidism, as are sweating, tremor, and tachycardia. Because patients rarely volunteer problems with urgency, frequency, and enuresis, it is worthwhile for the physician to inquire about such symptoms in patients with moderate to severe hyperthyroidism. Symptoms generally cease after treatment of the hyperthyroidism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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