scholarly journals Methimazole Associated Neutropenia in a Preterm Neonate Treated for Hyperthyroidism

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Dimitrios Angelis ◽  
Rita Ann Kubicky ◽  
Alan B. Zubrow
Keyword(s):  
Preterm Infant ◽  
Beta Blocker ◽  
Preterm Neonate ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Graves Disease ◽  
Transient Hypothyroidism ◽  
First Case ◽  
Clinical Signs And Symptoms

Maternal Graves’ disease is relatively uncommon with an estimated incidence of 0.4%–1% of all pregnancies, but only 1–5% of newborns delivered to mothers with Graves’ disease develop overt clinical signs and symptoms of hyperthyroidism. Here, we describe a case of a 1380-gram female neonate who was born at 30-week gestation to a mother with Graves’ disease. Our patient presented with hyperthyroidism followed by transient hypothyroidism requiring treatment with levothyroxine. While hyperthyroid, she was treated with methimazole, iodine, and a beta-blocker. 20 days after the initiation of methimazole, she developed neutropenia. The neutrophil counts started to improve immediately after the initiation of the weaning of methimazole. To the best of our knowledge, this is the first case reported in the literature of methimazole induced neutropenia in a preterm infant being treated for neonatal Graves’ disease.

scholarly journals Portland Cement Use in Dental Root Perforations: A Long Term Followup

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Álvaro Henrique Borges ◽  
Matheus Coelho Bandeca ◽  
Mateus Rodrigues Tonetto ◽  
Luis Augusto Faitaroni ◽  
Elibel Reginna de Siqueira Carvalho ◽  
...  
Keyword(s):  
Portland Cement ◽  
Calcium Hydroxide ◽  
Root Canal ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Clinical Aspects ◽  
Iatrogenic Perforation ◽  
Root Canals ◽  
First Case ◽  
Clinical Signs And Symptoms

Root canal and furcal perforations are causes of endodontic therapy failure and different materials that stimulate tissue mineralization have been proposed for perforation treatment. In the first case, a patient presented tooth 46 with unsatisfactory endodontic treatment and a periapical radiographic lesion. A radiolucent area compatible with a perforating internal resorption cavity was found in the mesial root. The granulation tissue was removed, and root canals were prepared. The intracanal medication was composed of calcium hydroxide and the perforation cavity was filled with Portland cement. The 11-year followup showed radiographic repair of the tissue adjacent to the perforation and absence of clinical signs and symptoms or periapical lesion. In the second case, a patient presented with edema on the buccal surface of tooth 46. The examination showed a radiolucent area in the furcation region compatible with an iatrogenic perforation cavity. The mesial root canals were calcified, and only the distal root canal was prepared. The cavity was filled with a calcium hydroxide-based paste and the distal root canal was obturated. In sequence, the perforation cavity was filled with Portland cement. The 9-year followup showed the tooth in masticatory function with radiographic and clinical aspects compatible with normality.

scholarly journals Carotid Intima Media Thickness in Graves Disease: Comparing Overt Hyperthyroid and Remission State

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A284-A285
Author(s):  
Intan Nurjannah ◽  
Wismandari Wisnu ◽  
Dicky L Tahapary ◽  
Ika Prasetya Wijaya
Keyword(s):  
Risk Factors ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Graves Disease ◽  
Care Hospital ◽  
Media Thickness ◽  
Clinical Signs And Symptoms ◽  
Overt Hyperthyroidism

Abstract Background/Objective: Hyperthyroid has been associated with increased cardiovascular event. Carotidintima media thickness (CIMT) is oftenly measured to evaluate the risk of cardiovascularevent. The aim of this study is to measure CIMT in Graves’ disease and to comparebetween subjects in overt hyperthyroidism and remission state. Methods: Our study was a cross-sectional study performed at the outpatient endocrinologyclinic of Dr. Cipto Mangunkusumo Hospital, a tertiary care hospital in Jakarta, Indonesia. Graves’ disease subjects were recruited, of whom then grouped into overthyperthyroidism (clinical signs and symptoms of hyperthyroidism, low THS, highthyroxine levels, treatment naïve of within 3 months of treatments) and remission state(no clinical signs and symptoms of hyperthyroidism, normal THs and thyroxine levels,without any anti thyroid drugs for at least 6 months). CIMT measurements wereperformed by trained physician on both right and left artery carotid arteries using anultrasound equipped with software that automatically measured the CIMT. We alsomeasured lipid profile, fasting blood glucose, and ECG. Results: We recruited 49 Graves’ disease subjects, of whom 32 and 17 subjects werein overt hyperthyroidism and remission state respectively. Median CIMT in overthyperthyroidism and remission state were 0,473 mm and 0,488 mm respectively, p:0,109. Among clinical and laboratory risk factors, only age which had an independentcorrelation with CIMT in Graves disease. (r: 0,371; p:<0,0001). Discussion: Our is the first study that measured CIMT among subjects with Graves’disease in remission and overt hyperthyroidism state, of which we observed nodifferences. This might be due to the fact that the atherosclerosis risk factors were notdistributed evenly on both group, of which subjects were older in the remission group. Ithas been reported that there are increasing CIMT along with aging (0,003-0,010 mm peryear). Furthermore, in remission state we need to take metabolic and physical changesinto consideration, such as increasing weight as much as 2,5% from prior weight alongwith increasing total cholesterol and LDL-cholesterol which both can affect CIMT levels. Conclusions: There are no significant differences in CIMT between overt hyperthyroid andremission state in Graves’ disease. Keywords: carotid intima media thickness, Graves’ disease, overt hyperthyroid, remission.

scholarly journals Graves Disease in Infancy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A929-A930
Author(s):  
Kara A Beliard ◽  
Srinidhi Shyamkumarb ◽  
Mabel Yau ◽  
Cassie Mintz ◽  
Robert Rapaport
Keyword(s):  
Thyroid Gland ◽  
English Literature ◽  
Receptor Gene ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Free T4 ◽  
Ocular Changes ◽  
Clinical Signs And Symptoms

Abstract Background: Graves disease (GD) is the most common cause of hyperthyroidism worldwide. The usual age of presentation is between 20-30 years, and it is more common in females. Transient hyperthyroidism does occur in infants born to mothers with GD, however, the novo GD in infants is extremely rare. We are aware of only four cases of GD in children under the age of 2 years old previously reported in the literature, with the youngest being of 18 months. Although rare, the complications can be devastating, so identifying and treating GD in infants is vital. We describe an infant who presented at 12 months of life with poor weight gain. Patient Findings: A 12-month old female patient presented with weight loss, tachycardia, diaphoresis and hypertension. She had a palpable thyroid gland without ocular changes. She was found to have an undetectable Thyroid Stimulating Hormone (TSH) with an elevated free T4 of 2.1 ng/dL (normal 0.80 - 1.50 ng/dL). She was stabilized in the intensive care unit with beta-blocker and methimazole. The diagnosis of GD was subsequently confirmed with an extremely elevated elevated Thyroid Stimulating Immunoglobulins (TSI) titer of 263 Iu/L (normal 0.00-0.55 IU/L), her TSH receptor gene was normal. At 34 months of age, her TSI titer is still elevated at 34 IU/L and she still requires methimazole to maintain a euthyroid state. She is growing and developing appropriately. Conclusion: To our knowledge, this report describes the youngest child to be diagnosed with GD in the English literature. Only four patients between the ages of 18 - 24 months have been described. Autoimmune diseases are rare in infants, the reason for which GD developed at such a young age remains unclear. Clinical signs and symptoms of hyperthyroidism in infants can be subtle and easily missed: increased growth velocity, failure to gain weight, autonomic changes, and irritability. Most patients have an enlarged thyroid gland, and some have ocular changes. The major long-term complications of undiagnosed hyperthyroidism include craniosynostosis and permanent neurocognitive damage. A high index of suspicion is needed for the recognition and prompt treatment of GD in infants, leading to better clinical outcome.

scholarly journals Heterophilic antibodies may be a cause of falsely low total IGF1 levels

2009 ◽  
Vol 161 (4) ◽  
pp. 561-565 ◽  
Author(s):  
M P Brugts ◽  
J G L M Luermans ◽  
E G W M Lentjes ◽  
N J van Trooyen-van Vrouwerff ◽  
F A L van der Horst ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Signs And Symptoms ◽  
Receptor Activation ◽  
Therapeutic Interventions ◽  
Heterophilic Antibodies ◽  
First Case ◽  
Secondary Hypothyroidism ◽  
Activation Assay ◽  
Clinical Signs And Symptoms ◽  
Low Serum

BackgroundA low serum total IGF1 is considered as a diagnostic indicator of GH deficiency (GHD) in the presence of hypopituitarism. Introduction of IRMA and chemiluminescent immunometric assay (CLIA) IGF1 immunoassays has introduced endogenous antibodies as a new source of interference. In general, this goes unnoticed and might lead to unnecessary diagnostic and therapeutic interventions.CaseA 56-year-old man was referred with a decline in physical performance, unexplained osteopenia, and weight loss of 3 kg over the past 8 months. Although clinical signs and symptoms were unremarkable, laboratory results pointed to secondary hypothyroidism and secondary hypogonadism. In addition, the serum total IGF1 level (CLIA; Siemens Medical Solutions Diagnostics) was in the low normal range. Two GH stimulation tests were performed, but these tests did not support the diagnosis GHD. Moreover, IGF1 bioactivity measured by the kinase receptor activation assay was normal. Interference of heterophilic antibodies was considered. After pretreatment with specific heterophilic blocking tubes that contain blocking reagents to eliminate heterophilic antibodies, serum-free thyroxine, testosterone, and IGF1 levels turned out to be normal.ConclusionTo the best of our knowledge, we here describe the first case in the literature of a patient with low serum total IGF1 levels due to interference from heterophilic antibodies in the used IGF1 immunoassay. When confronted with low-IGF1 levels that do not fit the clinical picture, interference of heterophilic antibodies should be considered in the differential diagnosis.

scholarly journals Management of a temporomandibular joint synovial cyst in a case complicated by severe trigeminocardiac reflex

2018 ◽  
Vol 100 (7) ◽  
pp. e174-e175 ◽  
Author(s):  
S El-Habbash ◽  
P Padaki ◽  
S Bayoumi ◽  
P Ross
Keyword(s):  
Temporomandibular Joint ◽  
Maxillofacial Surgery ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Synovial Cyst ◽  
Trigeminocardiac Reflex ◽  
Cardiac Dysrhythmias ◽  
First Case ◽  
Ectopic Beats ◽  
Clinical Signs And Symptoms

The trigeminocardiac reflex is a rare occurrence in patients undergoing maxillofacial surgery, with a reported incidence of 1–2%. Clinical signs and symptoms include bradycardia, nausea, with further stimulation potentially leading to cardiac dysrhythmias, ectopic beats, atrioventricular blocks and asystole. Most maxillofacial procedures, including temporomandibular joint procedures, are considered low risk. We report the first case of a tender temporomandibular joint synovial cyst whose management was complicated by severe trigeminocardiac reflex resulting in asystole. We suggest that in such cases communication between surgeons and the anaesthesia team is of paramount importance and informing the anaesthetist intraoperatively prior to the manipulation of the capsule or temporomandibular joint meniscus is recommended in the prevention or successful treatment of this condition.

scholarly journals Serum thyroglobulin is associated with orbitopathy in Graves’ disease

2021 ◽  
Author(s):  
S. Khamisi ◽  
M. Lundqvist ◽  
P. Emadi ◽  
K. Almby ◽  
Ö. Ljunggren ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Signs And Symptoms ◽  
Drug Regimen ◽  
Tsh Receptor ◽  
Thyroid Peroxidase ◽  
Graves Disease ◽  
Serum Thyroglobulin ◽  
Increased Risk ◽  
Eye Symptoms ◽  
Clinical Signs And Symptoms

Abstract Purpose Serum thyroglobulin levels are often elevated in Graves’ disease (GD) and in most cases decrease during treatment. Its relation to Graves’ orbitopathy (GO) has not been clarified. Previously, a risk of GO has been linked to smoking, TSH receptor stimulation, high TSH-receptor antibodies (TRAb), low thyroid peroxidase and thyroglobulin antibodies (TPOAb, TgAb). Methods We examined Tg levels in 30 consecutive patients with GD were given drug therapy (methimazole + thyroxine) for up to 24 months. GO was identified by clinical signs and symptoms. 17 patients had GO, 11 of whom had it at diagnosis while 6 developed GO during treatment. During the study, 5 subjects were referred to radioiodine treatment, 3 to surgery. The remaining 22 subjects (GO n = 12, non-GO n = 10) completed the drug regimen. Results At diagnosis, Tg levels in GO patients (n = 11) were higher (84, 30–555 µg/L, median, range) than in non-GO patients (n = 19) (38, 3.5–287 µg/L), p = 0.042. Adding the 6 subjects who developed eye symptoms during treatment to the GO group (n = 17), yielded p = 0.001 vs. non-GO (n = 13). TRAb tended to be higher, while TPOAb and TgAb tended to be lower in the GO group. For the 22 patients who completed the drug regimen, Tg levels were higher in GO (n = 12) vs. non-GO (n = 10), p = 0.004, whereas TRAb levels did not differ. Conclusion The data may suggest that evaluation of thyroglobulin levels in GD could contribute to identify patients at increased risk of developing GO. Possibly, thyroidal release of Tg in GD reflects a disturbance that also impacts retroorbital tissues.

scholarly journals First Case of Chylous Ascites after Laparoscopic Myomectomy: A Case Report with a Literature Review

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 624 ◽  
Author(s):  
Stoyan Kostov ◽  
Angel Yordanov ◽  
Stanislav Slavchev ◽  
Strahil Strashilov ◽  
Deyan Dzhenkov
Keyword(s):  
Case Report ◽  
Clinical Signs ◽  
Lymphatic Vessels ◽  
Chylous Ascites ◽  
Signs And Symptoms ◽  
Benign Diseases ◽  
Rare Form ◽  
Post Surgery ◽  
First Case ◽  
Clinical Signs And Symptoms

Introduction: Chylous ascites is a rare form of ascites characterized by milk-like peritoneal fluid, rich in triglycerides. Clinical signs and symptoms include abdominal distention, pain, nausea, and vomiting. In gynecology, the most common cause for its occurrence is lymph dissection leading to impairment of major lymphatic vessels. There are only a few reported cases of chylous ascites arising after operations for benign diseases. Case report: We report a case of a 46-year-old female patient, who underwent laparoscopy for a myomatous node with chylous ascites occurring on post-surgery Day 2. The ascites was conservatively managed. The exact cause of the chyloperitonitis could not be determined. Conclusion: Although extremely rarely, chylous ascites may also occur in operative interventions for benign diseases in gynecological surgery.

scholarly journals Dementia and Major Neurocognitive Disorders: Some Lessons Learned One Century after the first Alois Alzheimer’s Clinical Notes

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 5
Author(s):  
Donatella Rita Petretto ◽  
Gian Pietro Carrogu ◽  
Luca Gaviano ◽  
Lorenzo Pili ◽  
Roberto Pili
Keyword(s):  
Young Woman ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Neurocognitive Disorders ◽  
Lessons Learned ◽  
Alzheimer Dementia ◽  
Clinical Notes ◽  
Alois Alzheimer ◽  
Clinical Signs And Symptoms

Over 100 years ago, Alois Alzheimer presented the clinical signs and symptoms of what has been later called “Alzheimer Dementia” in a young woman whose name was Augustine Deter [...]

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