scholarly journals Tiroiditis por trauma en cuello luego de intento de suicidio. Reporte de caso y revisión de la literatura

2017 ◽  
Vol 2 (3) ◽  
pp. 72-75
Author(s):  
Carlos Alfonso Builes Barrera ◽  
Juan David Gómez ◽  
Alejandro Román González
Keyword(s):  
Hormone Level ◽  
Clinical Manifestations ◽  
Orotracheal Intubation ◽  
Psychotic Symptoms ◽  
Thyroid Storm ◽  
Inflammatory Disorder ◽  
Neck Trauma ◽  
Free T4 ◽  
Normal Value ◽  
Commit Suicide

La tiroiditis es un fenómeno inflamatorio de la tiroides, de causas diversas, incluyendo raramente traumas de la región anterior del cuello. Se presenta el caso de un paciente con depresión mayor de curso crónico, con síntomas sicóticos y farmacodependencia, quien intenta suicidarse mediante ahorcamiento. Ingresa con un Glasgow de 3/15, por lo cual requiere intubación orotraqueal inmediata, posterior traslado a unidad de cuidados intensivos y ventilación mecánica durante diez días. Durante este periodo desarrolla taquicardia persistente, diaforesis y alteraciones del sensorio, se encontró TSH en 0,00 (0,4- 4 mUI/ml); una T3 total en 2,42, (0,8-2,0 ng/ml) y T4 libre >6 (0,93-1,70 ng/dL), la gammagrafía de tiroides con tecnecio 99 mostró bloqueo de la captación. Se sospechó tormenta tiroidea y recibió propranolol 80 mg vía oral cada 8 horas en forma continua e hidrocortisona 50 mg intravenosa cada 8 horas durante5 días. Los controles, dos semanas después, muestran TSH en 0,00 (0,4-4 uUI/ml) y una T4 libre de 1,78 (0,93-1,70 ng/dl) y cuatro días después normalización de la T4 libre (1,45 ng/dl), acompañado de mejoría clínica de los síntomas adrenérgicos.Se presenta el caso de un paciente con tiroiditis postrauma, entidad que debe ser sospechada en pacientes con trauma en el cuello que presenten síntomas de tirotoxicosis.AbstractThyroiditis is an inflammatory disorder of the thyroid, which stems from a variety of causes including in some rare cases trauma to the neck. We present the case of a male patient with chronic depression associated with psychotic symptoms and drug abuse that tried to commit suicide through hanging. The patient had a Glasgow Coma Scale 3/15 requiring orotracheal intubation, a stay in the intensive care unit and mechanical ventilation for 10 days. While in the ICU the patient developed persistent tachycardia, diaphoresis and changes in mental status. A suppressed TSH was found with a level of 0,00 (0,4-4 uUI/ml) and high thyroid hormone level (total T 2,42, (normal value 0,8-2,0 ng/ml) and free T >6 (normal value 0,93-1,70 ng/dL). A technetium-99 thyroid scintygraphy showed blocked uptake. With those findings, a thyroid storm was suspected and management was begun with propranolol 80 mg per mouth every 8 hours and IV hydrocortisone 50 mg every 8 hours for 5 days. Two weeks later, the TSH was 0,00 (0,4-4 uUI/ ml) and the free T4 was 1,78 (normal value 0,93-1,70 ng/dl). Four days later, the free T4 concentration was normal (1,45 ng/dl) with a clinical improvement of the adrenergic symptoms. Inconclusion, thyroiditis should be suspected in patients with neck trauma with compatible clinical manifestations.

scholarly journals An Adolescent with Transient Hyperthyroxinemia after Blunt Trauma to Head and Neck

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Michelle Romijn ◽  
Leo M. G. Geeraedts ◽  
Jonathan I. M. L. Verbeke ◽  
Martijn J. J. Finken
Keyword(s):  
Blunt Trauma ◽  
Reference Range ◽  
Thyroid Storm ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Neck Trauma ◽  
Free T4 ◽  
Blunt Neck Trauma ◽  
Patient Reported ◽  
Lower Neck

Background. Thyroid storm is a well-known complication of surgical procedures in the lower neck, but is rare after a blunt neck trauma. The cases described previously have mainly focussed on adults with pre-existent thyroid disease. In this case report, we describe the disease course of a previously healthy adolescent who had asymptomatic hyperthyroxinemia after a blunt trauma of the jaw and neck. Case Presentation. A 17-year-old girl presented at our emergency department after she fell on her head while roller blading. On physical examination, among other injuries, she had a swelling in the lower neck, which appeared to involve the thyroid gland. Subsequent laboratory analysis was indicative of primary hyperthyroxinemia, with a free T4 of 59 pmol/L (reference range: 12–22) and a TSH of 0.46 mU/L (reference range: 0.5–4.3), but the patient had no symptoms fitting with this. Four weeks after the initial presentation, the patient reported only complaints regarding tenderness in the jaw and neck region. She was no longer hyperthyroidic on biochemical evaluation (with a free T4 level of 15.6 pmol/L and a TSH level of 0.33 mU/L), and antibodies against thyroid peroxidase or TSH receptor were not present. Conclusions. This case might indicate that hyperthyroxinemia following a neck trauma may go unnoticed if hyperthyroid symptoms are mild or absent and thyroid function tests are not performed.

scholarly journals Hyperinflammation in Two Severe Acute Respiratory Syndrome Coronavirus 2-Infected Adolescents Successfully Treated With the Interleukin-1 Inhibitor Anakinra and Glucocorticoids

2020 ◽  
Vol 8 ◽  
Author(s):  
Francesca I. Calò Carducci ◽  
Maria Antonietta De Ioris ◽  
Chiara Agrati ◽  
Rita Carsetti ◽  
Daniela Perrotta ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Clinical Response ◽  
Standard Dose ◽  
Interleukin 1 ◽  
Clinical Manifestations ◽  
Chronically Ill ◽  
Case Definition ◽  
World Health ◽  
Inflammatory Disorder ◽  
Good Clinical Response

Background: In severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) critically ill adults, hyperinflammation plays a key role in disease progression. The clinical manifestations of SARS-CoV-2 infection among children are much less severe compared with adult patients and usually associated with a good prognosis. However, hyperinflammation in SARS-CoV-2-infected pediatric patients has been described as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 or as Kawasaki-like disease but is still little known, and optimal management has to be defined. The World Health Organization (WHO) on the 15th of May 2020 has developed a preliminary case definition for multisystem inflammatory disorder in children and adolescents with coronavirus disease 2019 (COVID-19) and stated for an urgent need to collect data on this condition. Here, we report two adolescent patients affected by COVID-19 presenting with multisystem inflammatory disorder, 3–4 weeks after the first symptoms of SARS-CoV-2 infection, treated with the interleukin-1 receptor antagonist anakinra and glucocorticoids with good clinical response.Cases: We report two patients chronically ill appearing, with high fever, severe gastrointestinal involvement, and increased biomarkers of inflammation onset 3–4 weeks after paucisymptomatic SARS-CoV-2 infection. They had no lung involvement, but abdominal ultrasound and CT scan showed thickening of the bowel wall. SARS-CoV-2 PCR was positive on ileum biopsy in both patients, whereas it was negative on other common sampled sites. They have been admitted to the pediatric intensive care unit and have been treated with a combination of anakinra 6–8 mg/kg/day i.v. and a standard dose of methylprednisolone 2 mg/kg/day in addition to lopinavir/ritonavir 400 mg q12h and low molecular weight heparin 100 UI/kg q12h with good clinical response.

Recurrent Hypothalamic Dysfunction in Seropositive Neuromyelitis Optica

2020 ◽  
pp. 10.1212/CPJ.0000000000001012
Author(s):  
Mary Clare McKenna ◽  
Nuala McNicholas ◽  
Conor Fearon ◽  
David Bradley
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Neuromyelitis Optica ◽  
Clinical Manifestations ◽  
Inflammatory Disorder ◽  
Diverse Range ◽  
Hypothalamic Dysfunction ◽  
Inappropriate Secretion ◽  
Clinical Presentations ◽  
The Central Nervous System

Background:Neuromyelitis optica (NMO) is a rare autoimmune inflammatory disorder of the central nervous system1. Pathogenic aquaporin 4 (AQP4) antibodies are present in 65-88% of cases1. The majority of cases follow a relapsing course preferentially involving the optic nerves, spinal cord, brainstem, diencephalon or cerebral regions1, 2. Within the acute diencephalic clinical presentations, symptomatic hypothalamic lesions may have a diverse range of clinical manifestations including homeostatic dysfunction of neuroendocrine systems2-4. We report a case of recurrent hypothalamic dysfunction secondary to NMO manifesting as syndrome of inappropriate secretion of antidiuretic hormone (SIADH), thermal dysregulation, dysautonomia and disorder of alertness.

scholarly journals Differential diagnosis of neuromyelitis optica spectrum disorders

2017 ◽  
Vol 10 (7) ◽  
pp. 265-289 ◽  
Author(s):  
Sung-Min Kim ◽  
Seong-Joon Kim ◽  
Haeng Jin Lee ◽  
Hiroshi Kuroda ◽  
Jacqueline Palace ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Neuromyelitis Optica ◽  
Clinical Manifestations ◽  
Inflammatory Disorder ◽  
Test Results ◽  
Early Disease ◽  
The Central Nervous System ◽  
Assay Methods ◽  
Spectrum Disorders ◽  
Disease Stages

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system (CNS) mostly manifesting as optic neuritis and/or myelitis, which are frequently recurrent/bilateral or longitudinally extensive, respectively. As the autoantibody to aquaporin-4 (AQP4-Ab) can mediate the pathogenesis of NMOSD, testing for the AQP4-Ab in serum of patients can play a crucial role in diagnosing NMOSD. Nevertheless, the differential diagnosis of NMOSD in clinical practice is often challenging despite the phenotypical and serological characteristics of the disease because: (1) diverse diseases with autoimmune, vascular, infectious, or neoplastic etiologies can mimic these phenotypes of NMOSD; (2) patients with NMOSD may only have limited clinical manifestations, especially in their early disease stages; (3) test results for AQP4-Ab can be affected by several factors such as assay methods, serologic status, disease stages, or types of treatment; (4) some patients with NMOSD do not have AQP4-Ab; and (5) test results for the AQP4-Ab may not be readily available for the acute management of patients. Despite some similarity in their phenotypes, these NMOSD and NMOSD-mimics are distinct from each other in their pathogenesis, prognosis, and most importantly treatment. Understanding the detailed clinical, serological, radiological, and prognostic differences of these diseases will improve the proper management as well as diagnosis of patients.

scholarly journals Thyroid Storm Treated With Nonconventional Therapy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A962-A962
Author(s):  
Caroline Tashdjian ◽  
Paul Shiu ◽  
Tarandeep Kaur
Keyword(s):  
Atrial Fibrillation ◽  
Critically Ill ◽  
Liver Enzymes ◽  
Normal Liver ◽  
Ventricular Rate ◽  
Thyroid Storm ◽  
Free T4 ◽  
History Of ◽  
Chest X Ray ◽  
Iodine Treatment

Abstract Background: Thyroid storm is a rare sequela of thyrotoxicosis with mortality rate of 10-30%. Management of thyroid storm is heavily dependent on thionamides. Cholestyramine and potassium iodide (SSKI) are used as adjunctive therapy and not as the sole treatment for storm. We present a case of thyroid storm treated with cholestyramine and SSKI. Clinical Case: A 45 year old male with past medical history of atrial fibrillation, congestive heart failure, hypertension, substance abuse and grave’s disease presented to the emergency department (ED) for diarrhea. During the course of ED, patient went into atrial fibrillation with rapid ventricular rate. Chest X-ray showed pulmonary edema. Labs were: TSH <0.0025 mIU/L (0.35-4.94 mIU/L) and free T4 3.52 ng/dl (0.7-1.40 ng/dl). Patient was noncompliant with methimazole. Upon admit, ACLS was initiated due to hypoxia and transferred to ICU for ventilator and pressor support. Wartofsky score was 60, suggestive of thyroid storm. Management included methimazole 20mg every 4hours, hydrocortisone 100mg every 8 hours, cholestyramine 4mg every 6 hours, and SSKI 250mg every 6 hours for thyrotoxicosis and amiodarone infusion for afib. Despite normal liver enzymes on admit, day 3 AST increased to 2740 U/L (5-34) and ALT 2684 U/L (0-55). Methimazole was stopped due to potential hepatotoxicity. Day 3 free T4 remained high at 4.16 ng/dl and patient remained critically ill. Plasmapheresis was offered as methimazole was stopped and patient was hemodynamically unstable to undergo surgery. However, family declined this intervention; SSKI and cholestyramine were continued. Free T4 was monitored over the course of treatment; by day 5 free T4 trended down to 1.93 ng/dl. SSKI was eventually stopped on day 8 of treatment as free T4 had normalized and cholestyramine reduced to 4mg twice daily. By day 15, free T4 was 0.8 ng/dl, so cholestyramine was stopped. Due to clinical improvement, patient was weaned off the ventilator and pressor support along with hydrocortisone. Liver enzymes normalized by Day 17. Patient was restarted on methimazole 5mg daily before discharge. Discussion: Thyroid storm is associated with varying degree of liver dysfunction, which can pose a challenge to treatment. In our case, acute fulminant liver failure was multifactorial in the setting of shock, thyroid storm and potential drug toxicity. Thus, thionamides were contraindicated. Radioactive iodine treatment was contraindicated due to use of amiodarone. Plasmapheresis and emergent thyroidectomy could not be done. Thus, nonconventional therapy was used and patient responded well to treatment. This case emphasizes the use of cholestyramine along with SSKI as an effective treatment in patients who are critically ill the setting of a thyroid storm, especially when thionamides are contraindicated and other avenues of treatment are limited.

Endocrine Disorders in Pediatric Critical Care

2017 ◽  
Author(s):  
Carmen L. Soto-Rivera ◽  
Michael S. D. Agus
Keyword(s):  
Hormonal Regulation ◽  
Hormone Secretion ◽  
Clinical Manifestations ◽  
Thyroid Storm ◽  
Endocrine Disorders ◽  
Secondary Adrenal Insufficiency ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Endocrine Diseases ◽  
Antidiuretic Hormone Secretion ◽  
Life Threatening

This chapter focuses in pediatric endocrine disorders that can present acutely and warrant intensive care. Because most of the symptoms associated with endocrine diseases are nonspecific, a broad index of suspicion and knowledge of the details of hormonal regulation are essential for accurate diagnosis and timely management. The chapter includes important information on the pathophysiology, clinical manifestations, evaluation, and management of potentially life-threatening endocrine disorders, including diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion, acute primary and secondary adrenal insufficiency, disorders of calcium homeostatis, thyroid storm, and diabetic ketoacidosis. For treatment of these disorders, the authors discuss the use of vasopressin (aqueous pitressin), desmopressin, hydrocortisone, calcitonin, bisphosphonates, methimazole, iodide therapy, and insulin.

scholarly journals Considerations for Thyroidectomy as Treatment for Graves Disease

2019 ◽  
Vol 12 ◽  
pp. 117955141984452 ◽  
Author(s):  
Mary Smithson ◽  
Ammar Asban ◽  
Jason Miller ◽  
Herbert Chen
Keyword(s):  
Clinical Manifestations ◽  
Endocrine System ◽  
Thyroid Stimulating Hormone ◽  
Clinical State ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Replacement Rate ◽  
Free T4 ◽  
Organ Systems ◽  
Toxic Multinodular Goiter

Hyperthyroidism is a clinical state that results from abnormally elevated thyroid hormones. Thyroid gland affects many organ systems; therefore, patients usually present with multiple clinical manifestations that involve many organ systems such as the nervous, cardiovascular, muscular, and endocrine system as well as skin manifestations. Hyperthyroidism is most commonly caused by Graves disease, which is caused by autoantibodies to the thyrotropin receptor (TRAb). Other causes of hyperthyroidism include toxic multinodular goiter, toxic single adenoma, and thyroiditis. Diagnosis of hyperthyroidism can be established by measurement of thyroid-stimulating hormone (TSH), which will be suppressed with either elevated free T4 and/or T3 (overt hyperthyroidism) or normal free T3 and T4 (subclinical hyperthyroidism). Hyperthyroidism can be treated with antithyroid drugs (ATDs), radioactive iodine (RAI), or thyroidectomy. ATDs have a higher replacement rate when compared with RAI or thyroidectomy. Recent evidence has shown that thyroidectomy is a very effective, safe treatment modality for hyperthyroidism and can be performed as an outpatient procedure. This review article provides some of the most recent evidence on diagnosing and treating patients with hyperthyroidism.

scholarly journals Thyroid Storm in Head and Neck Emergency Patients

2020 ◽  
Vol 9 (11) ◽  
pp. 3548
Author(s):  
Mohamed A. Radhi ◽  
Basaviah Natesh ◽  
Paul Stimpson ◽  
Jonathan Hughes ◽  
Francis Vaz ◽  
...  
Keyword(s):  
Head And Neck ◽  
Early Recognition ◽  
Trauma Surgery ◽  
Thyroid Storm ◽  
Neck Trauma ◽  
Retrospective Diagnosis ◽  
Post Surgery ◽  
Surgery Patient ◽  
Head And Neck Trauma ◽  
Head Neck

Background: Thyroid storm is a rare but life-threatening emergency that prompts urgent intervention to halt its potentially disastrous outcomes. There is not much literature available on thyroid storm in head neck trauma and non-thyroid/parathyroid head neck surgery. Due to rarity of thyroid storm in head and neck trauma/surgery patients, its diagnosis becomes challenging, is often misdiagnosed and causes delay in the diagnosis and management. Therefore, the aim of this work was to compile, analyze and present details to develop a consensus and augment available literature on thyroid storm in this group of patients. Materials and methods: A comprehensive literature search of the last 30 years was performed on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index for thyroid storm using MeSH words and statistical analyses were performed. Results: Seven articles describing seven cases of thyroid storm were reviewed. All patients required medical management and one patient (14.3%) required adjunctive surgical management. Burch and Wartofsky Diagnostic criteria for thyroid storm were used in diagnosis of 42% patients. Time of diagnosis varied from immediately upon presentation to formulating a retrospective diagnosis of having a full-blown thyroid storm at 4 days post presentation. It was misdiagnosed and unthought of initially in majority of these cases, (71.4%) were not diagnosed in the first day of hospital stay. Conclusion: Early recognition of thyroid storm in head and neck patients markedly reduce morbidity/mortality. Albeit unexpected, it should be ruled out in any symptomatic head and neck trauma or post-surgery patient.

Penetrating Neck Trauma

2016 ◽  
Author(s):  
Adam R. Kellogg ◽  
B. Witkind Davis
Keyword(s):  
Airway Management ◽  
Diagnostic Testing ◽  
Case Fatality ◽  
Hemodynamic Instability ◽  
Orotracheal Intubation ◽  
Neck Injuries ◽  
Neck Trauma ◽  
Penetrating Neck Trauma ◽  
Surgical Evaluation ◽  
Serious Injuries

Penetrating neck injuries are approximately 1% of all traumatic injuries in the US, yet the case fatality rate approaches 10%. All emergency physicians need to be able to expediently differentiate those requiring emergent interventions from those with less serious injuries. Initial management of penetrating neck injuries focuses on identification of patients requiring early airway management or emergent surgical evaluation. Due to bleeding, anatomic distortion, hemodynamic instability, or potential airway violation patients with penetrating neck trauma should be presumed to have difficult to manage airways. The emergency physician must be prepared to perform cricothyrotomy, and even tracheostomy, should orotracheal intubation attempts fail. Diagnosis of injury in the stable patient with evidence of violation of the platysma has moved away from the traditional zone based approach and now focuses on structured physical exam and the use of MDCTA. Further diagnostic testing may be required dependent on the results of the MDCTA and should be at the direction of a surgeon.   Keywords: Penetrating Neck Trauma, Laryngotracheal Trauma, Carotid Artery Injury, Airway Management, Cricothyrotomy, Surgical Airway, CT Angiography

Renal Osteodystrophy due to Secondary Hyperparathyroidism in a Cat

2021 ◽  
Author(s):  
Sara Elizabeth Gonzalez ◽  
Ira G. Roth ◽  
Chad W. Schmiedt ◽  
Michelle H. Patrick ◽  
Alison G. Meindl
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Hormone Level ◽  
Health Assessment ◽  
Clinical Manifestations ◽  
Parathyroid Hormone Level ◽  
Creatinine Concentration ◽  
Normal Limits

A 6 yr old neutered male mixed-breed cat presented for renal transplantation (RTx) for chronic kidney disease. Severe periodontal disease was identified, and before initiation of immunosuppressive therapy, a comprehensive oral health assessment and treatment procedure was performed to reduce the burden of existing oral infection. Dental radiography revealed diffuse, severe bone demineralization across the mandible and maxilla, with thinning of the cortices. Nasal turbinates were easily visualized owing to the decreased opacity of maxillary bone. Generalized bone resorption left teeth to appear minimally attached. A Vitamin D panel revealed a severely elevated parathyroid hormone level. Full mouth extractions were performed. Seven days following this procedure, RTx was performed. Serum creatinine concentration was within normal limits by 48 hr after surgery and remained normal until discharge 12 days after RTx. At 3.5 mo after RTx, the cat was mildly azotemic, and the parathyroid hormone level was elevated but significantly decreased from the original measurement. Secondary hyperparathyroidism is a common abnormality in cats with chronic kidney disease. However, clinical manifestations of hyperparathyroidism are rare in this species. This is a novel presentation of a cat demonstrating bone loss in the oral cavity as a result of renal secondary hyperparathyroidism.

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