ABSTRACT
Although the mortality has been reduced with aggressive approach, thyrotoxic storm or crisis is still a life-threatening condition and usually triggered by preeclampsia, placenta previa, congestive heart failure, infections and induction of labor during pregnancy. We report here a 28-year-old pregnant woman suspicious of placenta previa without a previous history of hyperthyroidism was admitted to the hospital with vaginal spotting and labor. After receiving a Cesarean section, thyrotoxic manifestations were developed and she became stable with antithyroid therapy. The second attack of thyrotoxic storm was presented after a thyroid ultrasonographic study. It appears that the vigorous examination of thyroid gland carries a significant risk of thyrotoxic crisis in poorly controlled hyperthyroidism.
Subject(s)
Adult , Female , Humans , Pregnancy , Cesarean Section , Heart Failure , Hyperthyroidism , Metrorrhagia , Mortality , Palpation , Placenta Previa , Pre-Eclampsia , Pregnant Women , Thyroid Crisis , Thyroid GlandABSTRACT
OBJECTIVE: We evaluated the clinical characteristics of tuberculous arthritis in peripheral joints and their relationship with rheumatologic disorders or other chronic illnesses. METHODS: One hundred and sixty seven patients who had suffered from skeletal tuberculosis were treated at Hanyang university medical center from January 1993 to December 2000. We retrospectively analyzed 39 patients who were diagnosed as tuberculous arthritis in peripheral joints. RESULTS: Thirty-nine (21 males, 18 females) patients with tuberculous arthritis in peripheral joints, aged 38.13+/-15.28, were found. All except one had a mono-articular feature. Affected joints were knee in 22 (56.4%), hip in 7 (17.9%), and wrist in 3 (7.7%). Extra-articular tuberculosis was noticed in 18 (46.2%) patients: lung involvement in 13 (33.3%), spine involvement in 4 (10.3%) and epididymis involvement in 1 (2.6%). One or more predisposing factors were found in 13 (33.3%) patients: 10 patients had a previous trauma history and 3 patients with previous intra-articular injections. Predisposing systemic conditions were present in 12 (30.8%) patients: 4 rheumatoid arthritis, 2 systemic lupus erythematosus, 1 juvenile rheumatoid arthritis, 4 liver cirrhosis, 2 breast cancer and 1 diabetes mellitus. CONCLUSION: Tuberculous arthritis in peripheral joints were evident in weight bearing joints, such as knee and hip, and were frequently associated with predisposing local or systemic factors. It is most important for the physician to make an early diagnosis and perform adequate treatments to prevent further complications.