AIM:To evaluate the role of thyroid blood flow assessment by color-flow Doppler ultrasonography in the differential diagnosis of thyrotoxicosis and compare it to technetium pertechnetate thyroid scanning. METHODS:Twen...AIM:To evaluate the role of thyroid blood flow assessment by color-flow Doppler ultrasonography in the differential diagnosis of thyrotoxicosis and compare it to technetium pertechnetate thyroid scanning. METHODS:Twenty-six patients with thyrotoxicosis were included in the study. Clinical history was taken and physical examination and thyroid function tests were performed for all patients. Thyroid autoantibodies were measured. The thyroid glands of all patients were evaluated by gray scale ultrasonography for size, shape and echotexture. Color-flow Doppler ultrasonography of the thyroid tissue was performed and spectral flow analysis of both inferior thyroid arteries was assessed. Technetium99 pertechnetate scanning of the thyroid gland was done for all patients. According to thyroid scintigraphy, the patients were divided into two groups:18 cases with Graves' disease and 8 cases with Hashimoto's thyroiditis. All patients had suppressed thyrotropin. The diagnosis of Graves' disease and Hashimoto's thyroiditis was supported by the clinical picture and follow up of patients. RESULTS:Peak systolic velocities of the inferior thyroid arteries were significantly higher in patients with Graves' disease than in patients with thyroiditis (P = 0.004 in the right inferior thyroid artery and P = 0.001 in left inferior thyroid artery). Color-flow Doppler ultrasonography parameters demonstrated a sensitivity of 88.9% and a specificity of 87.5% in the differential diagnosis of thyrotoxicosis. CONCLUSION:Color Doppler flow of the inferior thyroid artery can be used in the differential diagnosis of thyrotoxicosis, especially when there is a contraindication of thyroid scintigraphy by radioactive material in some patients.展开更多
BACKGROUND The literature on thyrotoxicosis caused by excessive ingestion of exogenous thyroid hormone is limited,and most cases reported have involved pediatric clinical studies.CASE SUMMARY A 21-year-old woman initi...BACKGROUND The literature on thyrotoxicosis caused by excessive ingestion of exogenous thyroid hormone is limited,and most cases reported have involved pediatric clinical studies.CASE SUMMARY A 21-year-old woman initially presented with palpitation and chest tightness after an overdose of levothyroxine(10 mg).The patient transiently lost consciousness and developed atrial fibrillation during hospitalization.We used propylthiouracil to decrease the peripheral conversion of T4 to T3 and inhibit the synthesis of endogenous thyroxine,propranolol to control heart rate,hydrocortisone to correct severe thyrotoxicosis,and hemoperfusion to increase levothyroxine clearance.The patient recovered and was discharged.CONCLUSION For patients with thyrotoxicosis after taking excess levothyroxine,it is critical to monitor vital signs and initiate effective treatment.展开更多
Diffuse sclerosing variant of papillary thyroid carcinoma (DSVPC) is a rare variant of conventional papillary thyroid carcinoma which was first reported in 1985. It appears to be more aggressive than conventional type...Diffuse sclerosing variant of papillary thyroid carcinoma (DSVPC) is a rare variant of conventional papillary thyroid carcinoma which was first reported in 1985. It appears to be more aggressive than conventional type of papillary thyroid carcinoma. We present a case in a 14-year-old girl who initially presented with thyrotoxicosis and was later diagnosed with DSVPC on subsequent ultrasound and fine need leaspiration when cervicallymph node was evident on clinical examination. Concomitant thyrotoxicosis in thyroid carcinoma is uncommon. The prevalence, clinical presentation, characteristic radiological and histological features, management and prognosis of DSVPC are discussed with literature review. We also hope to illustrate through this case that ultrasound as a non-invasive imaging modality is an invaluable tool for workup in functional thyroid problems and concomitant malignancy may not be that uncommon, so that we could provide prompt treatment to our patients.展开更多
Two healthy dogs weighing 18 kg and 13 kg each received an intravenous injection of 7 μg/kg 25-hydroxyvitamin D3 (25OHD3). Subsequently, they were blood-sampled in order to determine the plasma levels of 25(OH)D3 ove...Two healthy dogs weighing 18 kg and 13 kg each received an intravenous injection of 7 μg/kg 25-hydroxyvitamin D3 (25OHD3). Subsequently, they were blood-sampled in order to determine the plasma levels of 25(OH)D3 over 4-hourly time intervals and for a time period of 24 hours. After a period of 18 days since the last blood sampling, the animals were brought to a hyperthyroid state and the intravenous injection of 7 μg/kg 25OHD3 was repeated. Blood sampling was performed every 4 hours and over a time period of 24 hours in order to determine the levels of 25OHD3. The graphic plotting of plasma levels of 25OHD3 in the euthyroid state did not differ from that in the hyperthyroid state. This finding in dog animal experimentation is indicative that the increased levels of thyroid hormones did not affect the activity of CYP27B1 and CYP24A1 enzymes that are related to the catabolism of 25OHD3 over a minimum of 24 hours period.展开更多
BACKGROUND The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019(COVID-19). SARS-CoV-2 infections not only re...BACKGROUND The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019(COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2.CASE SUMMARY A 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room(ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction(PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test,serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography,and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient’s condition worsened, and a cesarean section was performed under general anesthesia;a healthy boy was delivered, and 12 h after delivery, the patient’s seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves’ disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures.CONCLUSION In pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.展开更多
文摘AIM:To evaluate the role of thyroid blood flow assessment by color-flow Doppler ultrasonography in the differential diagnosis of thyrotoxicosis and compare it to technetium pertechnetate thyroid scanning. METHODS:Twenty-six patients with thyrotoxicosis were included in the study. Clinical history was taken and physical examination and thyroid function tests were performed for all patients. Thyroid autoantibodies were measured. The thyroid glands of all patients were evaluated by gray scale ultrasonography for size, shape and echotexture. Color-flow Doppler ultrasonography of the thyroid tissue was performed and spectral flow analysis of both inferior thyroid arteries was assessed. Technetium99 pertechnetate scanning of the thyroid gland was done for all patients. According to thyroid scintigraphy, the patients were divided into two groups:18 cases with Graves' disease and 8 cases with Hashimoto's thyroiditis. All patients had suppressed thyrotropin. The diagnosis of Graves' disease and Hashimoto's thyroiditis was supported by the clinical picture and follow up of patients. RESULTS:Peak systolic velocities of the inferior thyroid arteries were significantly higher in patients with Graves' disease than in patients with thyroiditis (P = 0.004 in the right inferior thyroid artery and P = 0.001 in left inferior thyroid artery). Color-flow Doppler ultrasonography parameters demonstrated a sensitivity of 88.9% and a specificity of 87.5% in the differential diagnosis of thyrotoxicosis. CONCLUSION:Color Doppler flow of the inferior thyroid artery can be used in the differential diagnosis of thyrotoxicosis, especially when there is a contraindication of thyroid scintigraphy by radioactive material in some patients.
文摘BACKGROUND The literature on thyrotoxicosis caused by excessive ingestion of exogenous thyroid hormone is limited,and most cases reported have involved pediatric clinical studies.CASE SUMMARY A 21-year-old woman initially presented with palpitation and chest tightness after an overdose of levothyroxine(10 mg).The patient transiently lost consciousness and developed atrial fibrillation during hospitalization.We used propylthiouracil to decrease the peripheral conversion of T4 to T3 and inhibit the synthesis of endogenous thyroxine,propranolol to control heart rate,hydrocortisone to correct severe thyrotoxicosis,and hemoperfusion to increase levothyroxine clearance.The patient recovered and was discharged.CONCLUSION For patients with thyrotoxicosis after taking excess levothyroxine,it is critical to monitor vital signs and initiate effective treatment.
文摘Diffuse sclerosing variant of papillary thyroid carcinoma (DSVPC) is a rare variant of conventional papillary thyroid carcinoma which was first reported in 1985. It appears to be more aggressive than conventional type of papillary thyroid carcinoma. We present a case in a 14-year-old girl who initially presented with thyrotoxicosis and was later diagnosed with DSVPC on subsequent ultrasound and fine need leaspiration when cervicallymph node was evident on clinical examination. Concomitant thyrotoxicosis in thyroid carcinoma is uncommon. The prevalence, clinical presentation, characteristic radiological and histological features, management and prognosis of DSVPC are discussed with literature review. We also hope to illustrate through this case that ultrasound as a non-invasive imaging modality is an invaluable tool for workup in functional thyroid problems and concomitant malignancy may not be that uncommon, so that we could provide prompt treatment to our patients.
文摘Two healthy dogs weighing 18 kg and 13 kg each received an intravenous injection of 7 μg/kg 25-hydroxyvitamin D3 (25OHD3). Subsequently, they were blood-sampled in order to determine the plasma levels of 25(OH)D3 over 4-hourly time intervals and for a time period of 24 hours. After a period of 18 days since the last blood sampling, the animals were brought to a hyperthyroid state and the intravenous injection of 7 μg/kg 25OHD3 was repeated. Blood sampling was performed every 4 hours and over a time period of 24 hours in order to determine the levels of 25OHD3. The graphic plotting of plasma levels of 25OHD3 in the euthyroid state did not differ from that in the hyperthyroid state. This finding in dog animal experimentation is indicative that the increased levels of thyroid hormones did not affect the activity of CYP27B1 and CYP24A1 enzymes that are related to the catabolism of 25OHD3 over a minimum of 24 hours period.
文摘BACKGROUND The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019(COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2.CASE SUMMARY A 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room(ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction(PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test,serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography,and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient’s condition worsened, and a cesarean section was performed under general anesthesia;a healthy boy was delivered, and 12 h after delivery, the patient’s seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves’ disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures.CONCLUSION In pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.
