1/5. Gestational thyrotoxicosis with acute wernicke encephalopathy: a case report.A 35-year-old hyperthyroid woman who developed nausea, vomiting, tachycardia, nystagmus and mental disturbance, was referred to our hospital with a suspected diagnosis of thyroid storm. However, the thyroid gland was only slightly palpable, bruits were not audible, and exophthalmos was not present. serum levels of thyroid hormone were increased, but TSH receptor antibodies were negative. Echography and color flow doppler ultrasonography revealed a slightly enlarged thyroid gland and a slightly increased blood flow, both of which were much less milder than those expected for severe hyperthyroid Graves' disease. Under the diagnosis of hyperthyroidism due to gestational thyrotoxicosis associated with wernicke encephalopathy, vitamin B1 was administered on the first day of admission. Her consciousness became nearly normal on the second day except for slight amnesia. Her right abducent nerve palsy rapidly improved, but horizontal and vertical nystagmus, diminished deep tendon reflexes and gait ataxia improved only gradually. MRI findings of the brain were compatible with acute wernicke encephalopathy. We concluded that history taking and physical findings are important to make a differential diagnosis of gestational thyrotoxicosis with acute wernicke encephalopathy from Graves' thyroid storm, and that wernicke encephalopathy should be treated as soon as possible to improve the prognosis.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/5. Emergency department management of thyrotoxic crisis with esmolol.A previously healthy 26-year-old woman presented to the emergency department complaining of a severe, throbbing, and bifrontal headache. Initial vital signs were pulse rate, 130 beats/min; blood pressure, 128/50 mm Hg; temperature, 100.1 degrees F. Shortly thereafter the patient's pulse and temperature increased to 170 beats/min and 103 degrees F, respectively. physical examination showed a tremulous, anxious woman in moderate distress who had a diffusely and symmetrically enlarged thyroid gland. A diagnosis of thyrotoxic crisis was made, and appropriate therapy instituted, including the use of an esmolol infusion for control of hypersympathetic activity. A review of the clinical presentation, diagnosis, and management of thyrotoxic crisis is presented.- - - - - - - - - - ranking = 0.5keywords = gland (Clic here for more details about this article) |
3/5. Repetitive monomorphic ventricular tachycardia in a 4-year-old boy with toxic multinodular goiter.A case of toxic multinodular goiter associated with repetitive monomorphic ventricular tachycardia (VT) is reported. A 4-year-old boy was found to have asymptomatic VT. When treatment with antiarrhythmic agents turned out to be ineffective, thyrotoxicosis was suspected due to the rapid enlargement of the left thyroid gland and associated thyroid function studies. A diagnosis of toxic multinodular goiter was made on the basis of subsequent scintigraphy and ultrasonography. Treatment with antithyroid drugs and inorganic iodine restored the thyroid function to normal, and was accompanied by the disappearance of VT. A left thyroid lobectomy was performed, and the pathological findings were compatible with toxic multinodular goiter. After the operation, the patient was transiently hypothyroid and had no VT without medication. A review of the literature revealed no previously documented cases of VT with toxic multinodular goiter.- - - - - - - - - - ranking = 0.5keywords = gland (Clic here for more details about this article) |
4/5. life-threatening hypercalcemia in a case of thyrotoxicosis: clinical features and management. A case report.hypercalcemia of thyrotoxicosis is sometimes severe and may mask other symptoms of the disease. A case is presented in which hyperparathyroid crisis was initially suspected. thyrotoxicosis was confirmed on emergency indication by 131I-uptake test and later by hormone assays. Forced diuresis and prednisolone therapy failed to lower the serum calcium level, but a dramatic effect was obtained with calcitonin. After 10 days the patient was normocalcemic on treatment with only antithyroid drugs. At thyroid resection, five months later, four normal parathyroid glands were found.- - - - - - - - - - ranking = 0.5keywords = gland (Clic here for more details about this article) |
5/5. Management problems in coexisting parathyroid crisis and florid thyrotoxicosis.The etiologic relationship between parathyroid and thyroid disease is controversial and still not well defined. An increased incidence of parathyroid adenomas with thyroid disease has been suggested by some researchers. Other authors are unable to confirm this and maintain that the major factor contributing to the coexistence of parathyroid adenomas and thyroid disease is the prevalence of these conditions, independently, in middle-aged women. serum parathyroid hormone levels are generally lower in patients with thyrotoxicosis and higher in patients with hypothyroidism. The simultaneous occurrence of thyrotoxicosis and symptomatic hyperparathyroid crisis has been reported previously only once in the American literature. We report a case of a 32-year-old woman with documented uncontrolled Graves' disease (T4 = 20 micrograms/dl [normal = 4.5 to 11.5 micrograms/dl], total T3 = 361 ng/dl [normal = 115 to 190 ng/dl], T3RU = 53% [normal = 35% to 45%]), who developed parathyroid crisis (serum calcium = 15 mg/dl [normal = 9 to 11 mg/dl], N-terminal parathyroid hormone = 121 pg/ml [normal = 11 to 24 pg/ml], C-terminal parathyroid hormone = 9416 pg/ml [normal = 60 to 450 pg/ml]). After a turbulent 10-day period to achieve a euthyroid state with propranolol, propylthiouracil, and a saturated solution of potassium iodide, operation revealed a large parathyroid adenoma (2 by 2 by 3 cm) and a diffusely hyperplastic thyroid gland. adenoma excision and bilateral subtotal thyroidectomy were performed. This case illustrates management guidelines of a true endocrine emergency in which prompt operation for acute hyperparathyroidism could not be undertaken until a euthyroid state and reduction in serum calcium levels were achieved with aggressive medical management.- - - - - - - - - - ranking = 0.5keywords = gland (Clic here for more details about this article) |