Thyrotoxic myo-neuropathy.

Myopathy is an important complication of thyrotoxicosis. Neuropathy is a less commonly reported complication, and is often subclinical. Here we report a patient of throtoxic myopathy with sub-clinical entrapment neuropathy. This case is reported to emphasise the importance of NCV to look for neuropathy.

Is the measurement of inferior thyroid artery blood flow velocity by color-flow Doppler ultrasonography useful for differential diagnosis between gestational transient thyrotoxicosis and Graves' disease? A prospective study

OBJECTIVE: To determine the role of peak systolic velocity, end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy. METHODS: The right and left inferior thyroid artery-peak systolic velocity, end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis (41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease) and 25 ageand sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography. RESULTS: The right and left inferior thyroid artery-peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease. The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease. CONCLUSIONS: This study suggests that the measurement of inferior thyroid artery-blood flow velocities with colorflow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.

Growth pattern of childhood thyrotoxicosis: longitudinal follow-up to final height.

OBJECTIVE: To study the growth pattern of children affected with thyrotoxicosis. MATERIAL AND METHOD: A retrospective study of growth data of 40 patients with thyrotoxicosis diagnosed at prepuberty or at early puberty was conducted. All patients were evaluated for height and weight every 3-6 months. Height and weight were transformed to standard deviation score (SDS) to account for differences of age and sex. RESULTS: At the time of diagnosis, the patients were slightly underweight for height (weight SDS -0.27 +/- 1.24, height SDS -0.06 +/- 1.26). After 1 year of treatment, the average weight gain of the patients was 4.9 +/- 3.1 kg, resulting in becoming relatively overweight for height (weight SDS +0. 32 +/- 1.42, height SDS +0.02 +/- 1.32). At the time of reaching their final height, the patients had an appropriate weight for height (weight SDS +0.06 +/- 0.21, height SDS -0.04 +/- 1.01). The average final height SDS of the patients was -0.04 +/- 1.01. This was at the average of the general population, but was +0.57 +/- 0.48 SDS or +2.85 +/- 1.0 cm greater than their target height (p < 0.01). CONCLUSION: Growth of patients with thyrotoxicosis showed the same pattern as in the general population. The final height of thyrotoxicosis patients was averagely +0.57 SDS or +2.85 cm greater than their genetic potential. This could be from the result of secular trend in the general population rather than being the effect of thyrotoxicosis.

Bloqueo auriculo-ventricular de primer grado en tirotoxicosis aguda / First degree atrio-ventricular block in acute thyrotoxicosis

El cuadro clínico de la tirotoxicosis incluye síntomas cardiovasculares variados. La taquicardia sinusal es el trastorno electrocardiográfico más frecuente y los trastornos de conducción son extremadamente raros como modo de presentación. Comunicamos un caso de bloqueo aurículo-ventricular de primer grado en una paciente con hipertiroidismo recién diagnosticado y que comenzó días antes de la consulta con un cuadro general inespecífico. Su evaluación ulterior demostró que se trataba de una tirotoxicosis aguda autoinmune, y su tratamiento con metimazol corrigió el trastorno totalmente. Se discuten los mecanismos fisiopatológicos involucrados y las implicancias clínicas desde el punto de vista del internista.

Amiodarona e distúrbios da tireóide / Amiodarone and thyroid dysfunction

A amiodarona, droga antiarrítmica e antianginosa utilizada freqüentemente em cardiologia, contém 37 por cento de iodo e pode exercer importantes efeitos na funçäo tireoideana.sua participaçäo em receituário no mercado de antiarrítmicos no Brasil é de 71,8 por cento.O mecanismo de açäo da droga envolve a reduçäo da conversäo periférica de tiroxina (T4) para triiodotironina (T3) e induçäo de hipotireoidismo tissular por competiçäo com o T3 pela ligaçäo com seu receptor.A amiodarona pode atuar sobre a funçäo tireoideana, induzindo:(a) Efeitos nas dosagens hormonais, por elevar os níveis de T4 de T3 reverso e (transitoriamente) do hormônio tirotrófico (TSH), e reduzir os níveis de T3 sem disfunçäo tireoideana clínica.(b) Tirotoxicose, por dois mecanismos: aumento da síntese dos hormônios tireoideanos induzida pelo iodeto em glândulas previamente anormais (tipo I) ou por efeito tóxico direto nos folículos tireoideanos, mesmo em tireóides aparentemente normais (tipoII).A distinçäo entre as duas formas é importante, já que a tirotoxicose amiodarona induzida tipo I é tratada como drogas bloqueadoras de síntese tireoideana (tionamidas e perclorato) ou mesmo por meio de tireoidectomia, ao passo que o tipo II freqüentemente responde à terapia com glicocorticóides.(c) Hipotireoidismo, que incide principalmente em paciente residentes em áreas com bom fornecimento de iodo, e naqueles portadores de doença tireoideana auto-imune.A hipofunçäo tireodiana é frequentemente subclínica, e de início insidioso.Pode ser tratada pela interrupçäo do uso da amiodarona, ou pela introduçäo judiciosa de substituiçäo hormonal tireoideana, nos casos em que o uso do antiarrítmico é fundamental.Dessa forma, todo paciente em uso de amiodarona deve ter sua funçäo tireoideana cuidadosamente acompanhada tanto do ponto de vista clínico como laboratorial.

Parálisis periódica tirotóxica: Presentación de dos casos y revisión de la literatura / Thyrotoxic periodic paralysis: Presentation of two cases and review of literature

La parálisis periódica tirotóxica es una manifestación clínica poco común de la tirotoxicosis que afecta principalmente a las poblaciones de origen asiático; el reconocimiento de este trastorno puede prevenir consecuencias desastrosas en los pacientes. En México nosostros sólo encontramos cuatro casos descritos en la literatura; aquí reportamos dos casos vistos en nuestro hospital, así como los hallazgos asociados en histocompatibilidad leucocitaria, los que difieren de los descritos en otras publicaciones

Manía y tirotoxicosis: Informe de dos casos / Mania and thyrotoxicosis. Report of two cases

En este trabajo se realiza una revisión sistemática de la tirotoxicosis y su relación con trastornos afectivos, especialmente la manía. Se describen las características del cuadro clínico y se alude a las principales hipótesis neurobioquímicas que explican dicha correlación, y se reportan dos casos clínicos. Finalmente se hacen comentarios alusivos, señalando algunas líneas de investigación vinculadas con esta importante condición clínica

Colestasis grave asociada a hipertiroidismo / Severe cholestasis associated to hypertiroidism

Se informa el caso de una mujer de 29 años de edad con enfermedad de Graves-Basedow, que se relacionó con colestasis centrolobulillar no atribuida a la insuficiencia cardiaca ni a la exposición a hepatotóxicos. Las bilirrubinas séricas totales alcanzaron cifras de 52 mg/dL, 889.2 µmol/L. Con el tratamiento de hipertiroidismo se corrigió la colestasis

Myelomyopathy and thyrotoxicosis.

A thirty year female patient presented with features of thyrotoxicosis, myopathy and cervical myelopathy of one year duration. Her cervical metrizamide myelogram was normal. On antithyroid therapy muscle weakness and features of myelopathy improved over three months follow up.