1/12. Anaplastic thyroid cancer with transient thyrotoxicosis: case report and literature review.A 55-year-old woman with anaplastic thyroid carcinoma presented with hyperthyroidism and neck swelling, hoarseness, and cervical lymphadenopathy. On physical examination, she was found to be clinically hyperthyroid with an enlarged, nontender multinodular goitre. Her serum thyroid hormone levels confirmed hyperthyroidism and technetium-99m pertechnetate scan failed to visualize the thyroid gland. Open biopsy showed an invasion of the thyroid gland by anaplastic thyroid carcinoma. The thyrotoxic phase lasted 60 days with predominantly increased thyroxine level and triiodothyronine/thyroxine (T3/T4) ratio decreased below 15. The thyrotoxic period was followed by subclinical hyperthyroidism and hypothyroidism which continued until she died of lung metastasis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/12. 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 = 0.081126404589411keywords = physical (Clic here for more details about this article) |
3/12. Thyrotoxic periodic paralysis in caucasians. Report of 8 cases.BACKGROUND: Periodic paralysis is a well known complication of thytotoxicosis in Chinese and Japanese patients, but has been considered extremely rare in caucasians. patients AND methods: Between 1991 and 1996, we admitted 8 caucasian patients to our Hospital due to thyrotoxic periodic paralysis. We retrospectively analysed their clinical manifestations. RESULTS: All the patients were males. Their attacks started at night or early after awakening, frequently triggered by a high carbohydrate diet and physical exertion. Myalgias and flaccid weakness predominated over proximal leg muscles, sparing bulbar and respiratory musculature. Reflexes were brisk at the onset of the attack and reduced or absent during the course of the episode. Prior to diagnosis patients presented 1-5 attacks of thyrotoxic periodic paralysis each lasting 1-96 hours. hypokalemia was documented in 6 patients. The episodes of periodic paralysis led to the diagnosis of a previously unsuspected thyrotoxicosis in 6 patients. In the other 2 patients the diagnosis of the thyroid dysfunction preceded the periodic paralysis. Attacks resolved after treatment of the hyperthyroid state. CONCLUSIONS: Thyrotoxic periodic paralysis is an under-diagnosed but probably frequent complication of hyperthyroidism in caucasians. Early recognition of the attacks is essential to investigate and treat the underlying thyroid dysfucntion whose symptoms are usually mild. The episodes of periodic paralysis resolve with the correction of the hyperthyroidism.- - - - - - - - - - ranking = 0.081126404589411keywords = physical (Clic here for more details about this article) |
4/12. amiodarone-induced thyrotoxicosis presenting as hypokalemic periodic paralysis.Thyroid disorder is a well-recognized side effect of amiodarone therapy. thyrotoxicosis is less common than hypothyroidism. hypokalemic periodic paralysis is one manifestation of thyrotoxicosis, and is more often seen in Oriental and Latin American men than in other demographic groups. This phenomenon, however, has not been previously described in thyrotoxicosis due to amiodarone usage. We describe a case of amiodarone-induced thyrotoxicosis in a 34-year-old man who presented with sudden lower extremity weakness, heat intolerance, and weight loss. physical examination demonstrated fine tremors. serum potassium level was 2.2 mEq/L on admission. Gastrointestinal and renal causes of potassium loss were excluded by history and physical examination. Further biochemical testing demonstrated abnormal thyroid function. The urinary potassium and serum bicarbonate, magnesium, and calcium levels were within normal limits. lower extremity weakness resolved immediately after potassium replacement therapy. methimazole therapy was initiated, and the patient was clinically euthyroid on discharge.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/12. Fatal hypokalemic thyrotoxic periodic paralysis presenting as the sudden, unexplained death of a Cambodian refugee.For the last decade, death investigators have been aware of an unexplained syndrome of sudden death occurring among young adult Southeast Asian refugees. Presented here is a rare instance of fatal hypokalemic periodic paralysis associated with thyrotoxicosis masquerading as the sudden, unexplained death of a Cambodian refugee. The usual features of this syndrome were present, including relatively occult thyrotoxicosis, paralysis upon awakening following a high-carbohydrate meal, and hypokalemia. This case illustrates the value of thorough background death investigation and also illustrates the potential of misinterpreting traditional folk medicine coin rubbing (Cao Gio) as signs of physical abuse.- - - - - - - - - - ranking = 0.081126404589411keywords = physical (Clic here for more details about this article) |
6/12. Itch: a symptom of occult disease.BACKGROUND: pruritus, (the Latin word for itch), is defined as the 'desire to scratch'. It is a distressing, subjective symptom that may interfere significantly with the quality of a patient's life. OBJECTIVE: This article summarises the systemic causes of pruritus, describes the assessment of a patient presenting with itch without dermatological cause, and discusses the management of itch in patients with cancer. DISCUSSION: patients with pruritus that does not respond to conservative therapy should be evaluated for underlying systemic disease. Causes of systemic pruritus include cholestasis, thyroid disease, polycythaemia rubra vera, uraemia, hodgkin disease, and hiv. A thorough history and a complete physical examination are central to the evaluation of pruritus. In the absence of skin lesions, diagnostic testing is directed by the clinical evaluation and may include a complete blood count, liver function tests, serum creatinine, blood urea nitrogen levels, measurement of thyroid stimulating hormone, and chest X-ray. Removal of the causative agent and appropriate investigation and treatment of the underlying disease are essential first line measures in the treatment of pruritus.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/12. Polyneuropathy from thiamin deficiency associated with thyrotoxicosis.Polyneuropathy from thiamin deficiency can occur in persons who consume a diet consisting mainly of polished rice with low protein and thiamin content in the setting of excessive physical activity or hypermetabolic states. The authors report here a 17-year-old fisherman who presented with a 3-month history of symptoms and signs consistent with polyneuropathy. There were also clinical features of thyrotoxicosis which was confirmed by thyroid function test. His dietary intake consisted mainly of polished rice and fish both of which contain a small amount of thiamin. This could not cope with his hypermetabolic condition from thyrotoxicosis resulting in thiamin deficiency with polyneuropathy.- - - - - - - - - - ranking = 0.081126404589411keywords = physical (Clic here for more details about this article) |
8/12. Thyrotoxic periodic paralysis in a Hispanic man after the administration of prednisone.OBJECTIVE: To present a case of thyrotoxic periodic paralysis (TPP) in a Hispanic man and to discuss the potential precipitating mechanisms. methods: We review the clinical and laboratory findings relative to the occurrence of TPP in a 34-year-old Hispanic man, who had been diagnosed as having Graves' disease. RESULTS: TPP is a rare complication of thyrotoxicosis. The two known triggers of TPP are high carbohydrate intake and rest after strenuous physical activity. Other precipitating factors include ingestion of alcohol, infection, trauma, emotional stress, and exposure to cold. Nonselective beta-adrenergic blocking agents are used as prophylaxis for the paralytic attacks. glucocorticoids have been used to treat nonresponsive and recurrent episodes. Nevertheless, our patient, a 34-year-old Hispanic man, had received propranolol for 7 days and one single dose of prednisone 2 hours before the onset of the paralysis. In patients with TPP, the Na /K -adenosinetriphosphatase (ATPase) pump activity is considerably increased by excess thyroid hormones, resulting in an increased intracellular potassium shift. insulin activates the Na /K -ATPase pump as well; thus, the precipitating effect of a high carbohydrate diet is explained. glucocorticoids have been shown to increase the number of Na /K -ATPase molecules in skeletal muscle. They also increase insulin secretion in the basal state and the first-phase insulin release after a glucose load. CONCLUSION: In our patient with TPP, the onset of the attack was not prevented by the use of propranolol and was likely triggered by the administration of prednisone.- - - - - - - - - - ranking = 0.081126404589411keywords = physical (Clic here for more details about this article) |
9/12. mitral valve prolapse in juvenile thyrotoxicosis.To determine whether there is an association between mitral valve prolapse and juvenile thyrotoxicosis, we studied 13 thyrotoxic patients (3 males, 10 females, ages 8-17 years) by physical examination, chest radiograms, electrocardiograms and echocardiography. Five patients had an apical systolic murmur and two of these had echocardiographic evidence of mitral valve prolapse. The findings of mitral valve prolapse in 15% of the hyperthyroid patients and 1.7% in the control group suggests that this abnormality may be more frequent in hyperthyroid children. Echocardiograms should be performed in hyperthyroid children who present with an apical systolic murmur.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/12. Euthyroid thyrotoxic periodic paralysis.Thyrotoxic periodic paralysis (TPP) is a dramatic complication of thyrotoxicosis usually seen in young men with untreated Graves' disease. We report the case of a 29-year-old active duty man with TPP attacks atypical in that they occurred during and after resolution of the hyperthyroidism. Our literature review revealed only two previously reported cases of TPP concurrent with euthyroidism. risk factors for TPP include the postprandial state after carbohydrate-rich meals and the post-exertional state. At least a 2-week "window of vulnerability" for TPP appears to exist after initiation of antithyroid therapy. Hyperthyroid active duty males are especially at risk of TPP, and require physical profiling at the time of diagnosis and for a limited period after they become euthyroid, to minimize the occurrence of this complication.- - - - - - - - - - ranking = 0.081126404589411keywords = physical (Clic here for more details about this article) |
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