Pattern and presentation of thyro-cardiac disease among patients with hyperthyroidism attending a tertiary hospital in Ethiopia: a cross sectional study

BACKGROUND:Thyro-cardiac disease describes the existence of a combination of thyroid toxicity and significant heart disease in an individual patient. The frequent manifestations of thyro-cardiac disease are hypertension, atrial flutter or fibrillation, pulmonary hypertension and dilated cardiomyopathy. The aim of the study was to determine the pattern and presentation of cardiovasculardiseases in patients with hyperthyroidism on follow-up at St. Paul's Hospital endocrine clinic. METHODS:It was a hospital based cross sectional study that evaluated hyperthyroid patients' on follow-up at St. Paul's Hospital for cardiovascular diseases from May 1st 2017 to October 31st 2017. Theyhad focused history, physical examination, electrocardiographic and echocardiographic evaluation. RESULTS: A total of 146 hyperthyroid patients on follow-up were included in the study. The mean age was 47.2 years and females accounted for 93.2% of patients. The mean duration of symptoms before presentation was 42 months. The frequent causes of hyperthyroidism were toxic multi-nodular goitre (88.4%), Graves' disease (6.8%) and toxic adenoma (2.1%). Sixteen (11%) patients had atrial fibrillation and 71 (48.6%) had hypertension. Thyrocardiac disease was detected in 46.6% of patients. The frequent abnormalities were left ventricular hypertrophy (14.4%), mild diastolic dysfunction (10.9%), moderate to severe mitral regurgitation (8.9%), pulmonary hypertension with or without right ventricular dysfunction (8.2%) and dilated cardiomyopathy (4.1%). CONCLUSION: Cardiovascular disease was frequent among patients with hyperthyroidism. The commonest abnormalities were systemic hypertension, pulmonary hypertension with or without isolated right sided heart failure, atrial fibrillation and dilated cardiomyopathy

Hyperthyroïdies à l'hôpital du Mali

Introduction : L'hyperthyroïdie est une pathologie fréquemment rencontrée dans notre pratique clinique. Elle est la conséquence d'une hyperproduction des hormones thyroïdiennes. Patients et méthodes : Il s'agissait d'une étude descriptive, rétrospective et prospective de 3 ans et 3 mois ayant inclus 523 patients présentant des signes cliniques et biologiques d'hyperthyroïdie. Les données ont été recueillies à partir des dossiers médicaux des patients.Résultats : La fréquence hospitalière de l'hyperthyroïdie était de 9,5%. L'âge moyen de nos patients était de 40,27 ± 15,77 ans. Il y avait 461 femmes (88,1%) et 62 hommes (11,9%) soit un sex-ratio de 0,13. Le goitre (36,3%) et les palpitations (13,2%) dominaient les motifs de consultations. Les signes cardiovasculaires étaient au premier plan avec les palpitations (61%) et la tachycardie (51,8%). La maladie de Basedow (56,4%) était l'étiologie la plus rencontrée et fréquemment observée avant l'âge de 40 ans. Les goitres multinodulaires toxiques et les adénomes toxiques étaient l'apanage des sujets de plus de 40 ans (p < 0,001). Les antithyroïdiens de synthèse étaient utilisés chez tous nos patients exceptés ceux présentant une thyroïdite qui ont reçu un antiinflammatoire stéroïdien ou non-stéroïdien. Seul neuf de nos patients (1,7%) ont subi une thyroïdectomie.Conclusion : L'hyperthyroïdie est une pathologie avec une symptomatologie cardiovasculaire bruyante. Les causes périphériques sont de loin les plus fréquentes. Ainsi, le dosage de la TSH (Thyroid Stimulating Hormone) seule suffit au diagnostic

Cardiac Death Risk in Diabetic Haemodialysis Patients Increased Due to Thyroid Problems

A prospective study found that diabetic haemodialysis patients' subclinical hyperthyroidism and euthyroid sick syndrome might increase the risk of sudden cardiac-related deaths. Dr Christiane Drechsler; of University Hospital Wurzburg in Wurzburg; Germany; and colleagues conducted a study that included 1 000 patients undergoing haemodialysis for diabetes. Of those patients; 78.1 had euthyroidism; 13.7 had subclinical hyperthyroidism; 1.6 had subclinical hypothyroidism and 5.4 had euthyroid sick syndrome

Thyroid Dysfunction among Young Adults in Uganda

Background: Most studies on thyroid dysfunction have been on patients refereed for treatment; little is known about the prevalence in the general populations. The importance of knowing such prevalence data lies in that fact that subclinical thyroid dysfunction is an important risk on development of heart disease; osteoporosis; hypercholesterolemia and mental illness. This study set out to determine thyroid dysfunction prevalence in a health young adult population. Methods: A cross sectional study carried out at the College of Health Sciences; Makerere University enrolled 100 Undergraduate medical students by invitations through notices and announcements. Informed consent was sought after approval from research ethics committee. Results: Of the 100 students enrolled and the samples drawn; 83 tests for TSH and 82 tests for FT4 were successfully run. Three results were abnormal making a prevalence of 3.6for thyroid dysfunction; a high TSH (5.71) with a normal fT4 (19.2); a normal TSH (1.67) with a high fT4 (22.31) and one with a low TSH (0.03). The mean age of participants was 23 years; there were slightly more males 1.3:1.Conclusion: The prevalence of thyroid dysfunction in this cohort was low but falls in the range found elsewhere. These findings could inform the criteria of screening asymptomatic otherwise young health adults

Thyroid Dysfunctions in Sudanese Patients with Vitiligo

Introduction: Vitiligo is a chronic acquired skin condition that causes loss of pigment; resulting in irregular pale patches of skin. The precise cause of vitiligo is not fully understood. The autoimmune base of the disease is supported by the frequent observation that several autoimmune disorders; particularly thyroid diseases; are associated with vitiligo. Objective: To determine the frequency of thyroid dysfunctions in Sudanese patients with vitiligo. Methods: Two groups; i.e. vitiligo patients and control; were collected with simple random collection. The control group included individuals free of vitiligo. 5 ml of venous blood was taken from every individual in both groups and the ELISA test was done for thyroid hormones; i.e. T3; T4 and TSH; using the DRG-USA kits. Results: The number of patients with vitiligo in the study was 46; while the control group was 45. Nine (19.56) patients were found to have abnormal levels of thyroid hormones. No abnormal levels in the control group. Mean T3 level in patients was 1.463ng/l; while in control group it was 1.467ng/l. Mean T4 level in patients was 102.761 nmol/l; while in control group it was 90.844 nmol/l. Mean TSH level in patients was 0.841 ?IU/l; while in control group it was 1.50 ?IU/l. The t-test was done to determine the significance of difference between means of T3; T4; and TSH between the patients and control groups. The P-values were found to be significant.Conclusion: There is a strong pathogenetic relationship between vitiligo in Sudanese patients and thyroid dysfunctions

Knowledge; Attitudes and Practices Regarding Iodine among Patients with Hyperthyroidism in the Free State; South Africa

Objectives: To gather baseline information on the knowledge; attitudes and practices regarding iodine and iodised salt among patients with hyperthyroidism in the Free State. Subjects and Setting: The study was part of a large cohort study that included the first 96 patients aged 13 years or older diagnosed withhyperthyroidism and referred to Universitas Academic Hospital in Bloemfontein; South Africa during 2005. Methods: The patients were interviewed in their language using a structured validated questionnaire. Descriptive statistics were used for data analysis. Results: The majority of the patients (86.9) did not know what iodine was. Similarly; a higher percentage of patients (76.7) were unaware of the most important or main source of iodine in the food of South Africans. Regarding knowledge of the most important harmful effect on the health of children if they did not get enough iodine; almost all of the patients (89.1) did not know what it was. Ninety-five per cent of salt was obtained from the local shops; and only 36.1of the patients read the labelling on the package during purchase. A very small proportion of patients (1.6) stored salt in closed containers and away from sunlight; while about half of them (49.2) stored salt in open containers without lids; 36.1stored it in rigid plastic containers with holes at the top; and 13.1stored it in the open plastic bags in which the salt was bought. Conclusions: Patients with hyperthyroidism lacked knowledge of iodine; as well as of the storage of iodised salt; and this could have contributed to the persisting endemic goitre reported in previous studies. An aggressive awareness programme; targeting policy makers and the public; is recommended to ensure sustainable elimination of iodine deficiency disorders in South Africa

Thyrotoxicosis - a Review

"Background: Thyrotoxicosis is the clinical and biochemical manifestations of exposure of tissues to excessive quantities of thyroid hormones; specifically free thyroxine (T4 ); tri-iodothyronine (T3) or both. The terms ""thyrotoxicosis""; ""hyperthyroidism"" and ""Graves' disease"" are used interchangeably because hyperthyroidism due to Graves' disease is the commonest cause of thyrotoxicosis. Studies in most countries reveal an increasing incidence of thyrotoxicosis. Aim: To present an update on the causes and management of thyrotoxicosis with emphasis on Graves' disease. Methods: A review of publications obtained from medline search and Google on ""thyrotoxicosis"" or ""Graves' disease"" or ""hyperthyroidism"" was done. Results: Graves' disease constitutes about 70of cases of thyrotoxicosis.The common clinical features include weight loss despite enhanced appetite; hyperactivity and heat intolerance etc. Features specific to Graves' disease include ophthalmopathy; pretibial myxoedema and thyroid acropachy. Thyrotoxicosis affects about 1of women and 0.1of men globally. It is indicated in most cases by an elevated serum concentration of total T4 and T3 and a suppressed thyroid stimulating hormone (TSH). Thyroid imaging and radiotracer uptake measurements combined with serological data enable specific aetiological diagnosis. The three treatment modalites for Graves' disease are antithyroid drugs; 131I therapy and thyroidectomy. Conclusion: The incidence of thyrotoxicosis is increasing globally. Optimal clinical and laboratory evaluation of the patient is necessary to identify the cause and institute appropriate therapy. There is need for prospective studies to identify the factors for the observed increasing incidence of thyrotoxicosis in our population"

Les goitres nodulaires toxiques

Introduction : Jusqu'ici; aucune etude dans notre pays n'avait porte specifiquement sur les goitres nodulaires toxiques. Elles n'ont ete citees que dans des etudes generales des hyperthyroidies. Methodes : Il s'agit d'une etude retrospective de 62cas de goitres nodulaires toxiques colliges entre 1979 et 1999 a la clinique medicale 2 du CHU de Dakar. Le diagnostic de nodule toxique a ete retenu sur les criteres suivants : la coexistence d'un ou plusieurs nodules thyroidiens et de signes de thyrotoxicose; l'existence d'un nodule hyperfixiant a la scintigraphie thyroidienne a l'iode 131; l'elevation des hormones thyroidiennes T3 et/ou T4. Nous nous sommes interesses aux aspects epidemiologiques; cliniques; aux complications et aux aspects therapeutiques et evolutifs. Resultats : Il s'agissait de 49 nodules uniques (79;03) et de 13 goitres multi nodulaires (20;97). Dans les cas de nodules uniques; l'age moyen etait de 40 ans; le sexe ratio de 0;04 (47 femmes; 2 hommes). Le nodule etait cliniquement decelable dans 47 cas (95;9) et extinctif dans73;5; La cardiothyreose existait dans 34;6des cas. En cas de goitre multi nodulaire; l'age moyen etait de 45ans; le sexe feminin dans tous les cas. Le goitre etait cliniquement decelable chez 12 patients (95;3). La cardiothyreose existait dans 46;15des cas. 62des patients ont ete perdus de vue en cours de traitement d'equilibration de l'hyperthyroidie. Sur les 37adresses en chirurgie; seuls deux ont ete revus apres thyroidectomie. Conclusion : Cette etude confirme la predominance du goitre nodulaire toxique chez la femme jeune; sa gravite par la frequence de la cardiothyreose et souligne les difficultes liees a la prise en charge therapeutique

Les hyperthyroides en milieu chirurgical au centre hospitalier universitaire Yalgado Ouedraogo; Burkina Faso. A propos de 95 cas

Les auteurs rapportent dans une etude retrospective; 95 cas d'hyperthyroidie; recenses au CHU Yalgado Ouedraogo de janvier 2000 a juin 2005. Ces hyperthyroidies representent 39des affections thyroidiennes; avec une predominance feminine (97); un age moyen de 32 ans. La provenance urbaine des patients (90des cas) et l'importance de l'automedication (73) ont ete notees. Les auteurs soulignent l'importance de l'echographie; permettant une classification en goitres diffus (44) et multinodulaires (56). Ils insistent sur une bonne preparation du malade avant l'intervention et sur l'interet de la thyroidectomie subtotale. Ils estiment qu'une ligature correcte des vaisseaux; la dissection des recurrents; la visualisation et la dissection des parathyroides et de leur pedicule vasculaire devraient permettre de reduire les complications post-operatoires : taux de mortalite nul et de morbidite 12;5

Reduced Thyrotropin in Euthyroid Goitrous Patients Suggesting Subclinical Hyperthyroidism

B a c k g r o u n d : Subclinical hypertyhroidism; a biochemical finding of low serum thyrotropin (TSH) with the serum levels of thyroxine (T4 ) and triiodothyronine (T3) within the reference range; could easily be ignored by clinicians; as it; usually; does not manifest with any thyroid specific symptoms. It is of two types : endogenous and exogenous. However; patients with the findings of low TSH; normal T4 and T3 develop some abnormalities in the cardiovascular system; such as atrial fibrillation; increasein left ventricular mass and diastolic dysfunction. It is believed that treatment intervention may reduce or halt the progression of the cardiac abnormalities. The main objective of the study was to determine how frequent subclinical hyperthyroidism was occurs and to serve as a reminder to the existence of the disorder. Methods : It was a hospital-based study carried out at the Jos University Teaching Hospital (JUTH). Consecutive clinically euthyroid goitre patients attending the outpatient department of JUTH; were studied for various parameters including TSH; T4 and T3. The serum concentrations of T4 and T3 were determined by enzyme-linked immunosorbent assay (ELISA) technique. The serum TSH concentration was estimated using a 2nd generation ELISA technique. Results : 98 patients participated in the study. Nine patients had non-specific symptoms not referable to the thyroid and found to have high levels of thyroid hormone concentration with depressed TSH and were excluded from further analysis; while 7 had subclinical hyperthyroidism giving a prevalence rate of 7.9among these clinical euthyroid goitre patients. The subjects with this condition were mainly above 60 years of age and mainly had long-standing goitre. Conclusion: Endogenous subclinical hyperthyroidism was present in 7.9of these clinically euthyroid goitre patients mainly 60 years and above; with long - standing goitre. This high prevalence rate calls for high index of suspicion as this condition is associated with morbidities that can raise mortality

Hyperthyroide chez les malades traites par Amiodarone a Yaounde: a propos de 6 observations.[Lettre]

6 dossiers de malades sous Amiodarone ayant une hyper-thyroide par surcharge iodee sont analyses; ils representent 10 pour cent de la population d'hyperthyroidies en 4 ans. L'Amiodarone a ete prescrite comme anti-arythmique et anti-angoroux; apres une longue amelioration; l'aggravation de l'arythmie et l'angor a permis de diagnostiquer l'hyperthyroidie par surcharge iodee. En l'absence d'investigation scintigraphique en Afrique; l'iodurie de 24 heures elevee; les hormonemies thyroidiennes elevees; la TSH basse et l'absence d'anticorps antithyroidiens permettent de poser le diagnostic. L'evolution est en general bonne; apres sevrage de l'Amiodarone et mise sous propylthiouracile et corticoide. Les auteurs concluent que le malade sous Amiodarone en Afrique noire; comme ailleurs; doit beneficier d'une surveillance attentive; notamment pour la complication majeure qu'est l'hyperthyroidie par surcharge iodee

A comparison of the clinical manifestations of thyrotoxicosis in young and elderly Nigerian patients

This prospective study compared the mode of presentation and the clinical features of thyrotoxicosis in 15 elderly patients with the same parameters in 43 young patients. Differences which were observed between the groups included a statistically significant higher frequency of multinodular goitre; congestive heart failure; atrial fibrillation; anorexia and wasting; as well as a lower frequency of dysthyroid ophthalmopathy in the older patients. Also; in contrast to the observation in the young patients; the presence of thyrotoxicosis was not initially suspected in most (73) of the old patients probably because of the prominent cardiovascular; gastrointestinal and myopathic symptoms; which they presented with. It is suggested that; in order to improve diagnosis; thyroid function tests should be a routine part of the initial evaluation of all elderly patients who present with these features