what are the differential diagnosis of thyrotoxicosis ? and what is the cause of pulmonic flow murmur ?
and is there any contraindications in any future pregnancy ?
The term thyrotoxicosis refers to the hypermetabolic clinical syndrome resulting from serum elevations in thyroid hormone levels, specifically free thyroxine (T4), triiodothyronine (T3), or both. Hyperthyroidism is a type of thyrotoxicosis in which accelerated thyroid hormone biosynthesis and secretion by the thyroid gland produce thyrotoxicosis. However, hyperthyroidism and thyrotoxicosis are not synonymous. Although many patients have thyrotoxicosis caused by hyperthyroidism, other patients may have thyrotoxicosis caused by inflammation of the thyroid gland, which causes release of stored thyroid hormone but not accelerated synthesis, or thyrotoxicosis, which is caused by ingestion of exogenous thyroid hormone. Differentiating between thyrotoxicosis caused by hyperthyroidism and thyrotoxicosis not caused by hyperthyroidism is important because disease management and therapy differ for each form. Thyroid imaging and radiotracer thyroid uptake measurements combined with serologic data enable specific diagnosis and appropriate patient treatment. The thyroid gland actively transports iodide from circulating blood into the thyroid follicular cells. Subsequently, iodide is organified into tyrosyl residues of thyroglobulin and stored within the thyroid follicles. When required, thyroglobulin undergoes proteolysis with the release of T3 and T4 as the principle active forms of thyroid hormone. In extrathyroidal tissues, some of the T4 is deiodinated to the more metabolically potent T3 hormone. The process of synthesis, storage, and release of T3 and T4 by the thyroid is normally controlled by the pituitary gland through its release of thyrotropin. This process involves a negative feedback loop wherein increasing blood levels of T3 and/or T4 inhibit release of thyrotropin-releasing hormone (TRH) from the hypothalamus and thyrotropin from the pituitary, the high blood levels of T3 and/or T4 inhibit the hypothalamic-pituitary release of thyrotropin; therefore, serum levels of thyrotropin are markedly reduced or undetectable. Therefore, the measurement of thyrotropin serum levels is the primary test in the diagnosis of thyrotoxicosis. Several of the thyroid disorders which tend to occur during pregnancy are autoimmune in nature. By this, it means that the body develops antibodies directed against thyroid cells, which then affect the way the thyroid gland functions. Antibodies which damage the thyroid cells may result in lymphocytic thyroiditis (inflammation of the thyroid), also known as Hashimoto's disease. These damaging antibodies can reduce the function of the thyroid and lead to hypothyroidism. On the other hand, your body can make antibodies against thyroid tissue which can stimulate thyroid cell function. In this case, hyperthyroidism due to over-function of the thyroid (Graves' disease) may be the result. Postpartum thyroiditis is a recently discovered problem that spans the spectrum of both hyper- and hypothyroidism. This condition, which tends to occur immediately after pregnancy, may produce antibodies which damage thyroid tissue, thereby releasing thyroid hormone passively into the bloodstream and producing hyperthyroidism. During the recovery phase, thyroid levels may fall, producing either temporary or permanent thyroid failure. Since this condition is common, occurring in 8-10 percent of all women after pregnancy, postpartum thyroid testing is advisable for all women. Thyroid nodules, goiters, and other thyroid problems are also sometimes first detected in pregnancy but are less common.
Heart murmur is the noise made by blood as it travels through the heart, similar to the noise made by water as it run from a faucet. Blood flow in normal circumstances flow silently. It is when blood starts to flow turbulently that noise is produced, which could be heard by auscultation and is termed "heart murmur".Heart murmur could be normal or abnormal.
Normal (innocent) heart murmurs: This is heard in about 50% of all normal infants. It does not reflect abnormalities of the heart.
Abnormal (pathologic) heart murmurs: This is heard in patients with heart disease in which there is an abnormal structure of the heart, making blood travel in an abnormal fashion resulting in a noise also known as heart murmur. Heart diseases causing murmur include abnormal heart valves which are too tight (stenosis) or leaky (regurgitation). Other heart diseases which produce heart murmurs include abnormal communications within the heart (holes in the heart such as atrial septal defect ASD, ventricular septal defect (VSD), or abnormal communication between blood vessels such as patent ductus arteriosus (PDA). Many symptoms of pregnancy can mimic the symptoms found in heart disease. As pregnancy advances, enlargement of the uterus forces the diaphragm upwards, thus decreasing the vital capacity and total lung volume, giving rise to breathlessness. Similarly, oedema in the extremities, seen in almost all pregnant women, results from an increase in total body sodium and water and IVC compression by the gravid uterus. The latter causes a decreased venous return to the heart and may cause lightheadedness and presyncope. Palpitations are common and usually represent sinus tachycardia, which is normal in pregnancy. However, paroxysmal nocturnal dyspnoea, syncope, haemoptysis and chest pain are not normal symptoms of pregnancy and should be evaluated. The increase in plasma volume causes the jugular veins to fill and the central venous pressure to be slightly elevated. Changes in the left ventricular size and mass with associated increased volume may cause the apical impulse to be displaced to the left. Elevation and rotation of the heart, resulting from the enlarging uterus, also contribute to this displacement. Auscultatory changes in normal pregnancy have been well documented. The first heart sound increases in intensity and the third heart sound is audible in 84% of patients. This may cause confusion, as it can be interpreted as a diastolic murmur or an opening snap.
In all cases of concern specialist medical advice should be obtained.
Hope this helps
Matador 89 (+ info
What is the name of the murmur in thyrotoxicosis?
it is an Innocent ejection systolic murmur. (+ info
why only south Asian origin women do get Gestational thyrotoxicosis,in first trimester of pregnancy .?
It associated with heperemesis.How far beta blockers are useful in this treatment ?
google it (+ info
hi i am a 24 year old male who has recently been tested for hyperthyroidism and thyrotoxicosis?
i am 6ft 2" tall and weigh 10 stone im under weight and trying to put on the extra few pounds but struggling to do so the more i eat the more i seem to lose ive been to see my GP and had all the regular tests done but he has put it down to an overactive metabolism is there any tips i can try to put on the extra couple of stone
while checking for tremors in tongue in thyrotoxicosis it should be inside or protruded?
Thyrotoxicosis also known as hyperthyroidism is caused due to excessive thyroid hormone production.
the best way to diagnose is to get a blood test done.
if looking at the tongue then it should be protruded.
there are tremors in hands also.
there is loss of weight even if there is enormous appetite and the subject does eat a lot. (+ info
what is the latest treatment and management for thyroid storm and thyrotoxicosis?
hope u will answer it ASAP......
Thyrotoxic storm results from untreated hyperthyroidism. It is usually brought on by an acute stress such as trauma or infection. Thyroid storm produces abrupt florid symptoms of hyperthyroidism with one or more of the following: fever, marked weakness and muscle wasting, extreme restlessness with wide emotional swings, confusion, psychosis, coma, nausea, vomiting, diarrhea, and hepatomegaly with mild jaundice. The patient may present with cardiovascular collapse and shock. Thyroid storm is a life-threatening emergency requiring prompt treatment.
Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones. Symptoms are many but include tachycardia, fatigue, weight loss, and tremor. Diagnosis is clinical and with thyroid function tests. Treatment depends on cause.
Several treatments for hyperthyroidism exist. The best approach for you depends on your age, physical condition and the severity of your disorder:
* Radioactive iodine. Taken by mouth, radioactive iodine is absorbed by your thyroid gland, where it causes the gland to shrink and symptoms to subside, usually within three to six months. Because this treatment causes thyroid activity to slow considerably, you may eventually need to take a medication every day to replace thyroxine.
* Anti-thyroid medications. These medications gradually reduce symptoms of hyperthyroidism by preventing your thyroid gland from producing excess amounts of hormones. They include propylthiouracil and methimazole (Tapazole). Symptoms usually begin to improve in six to 12 weeks, but treatment with anti-thyroid medications typically continues at least a year and probably longer. For some people, this clears up the problem permanently, but other people may experience a relapse.
* Beta blockers. These drugs are commonly used to treat high blood pressure. They won't reduce your thyroid levels, but they can reduce a rapid heart rate and help prevent palpitations. For that reason, your doctor may prescribe them until your thyroid levels are closer to normal.
* Surgery (thyroidectomy). If you can't tolerate anti-thyroid drugs and don't want to have radioactive iodine therapy, you may be a candidate for thyroid surgery, although this is an option in only a few cases.
In a thyroidectomy, your doctor removes most of your thyroid gland. Risks of this surgery include damage to your vocal cords and parathyroid glands — four tiny glands located on the back of your thyroid gland that help control the level of calcium in your blood. In addition, you'll need lifelong treatment with levothyroxine to supply your body with normal amounts of thyroid hormone. If your parathyroid glands also are removed, you'll need medication to keep your blood-calcium levels normal. (+ info
Thyrotoxicosis causes heart murmurs?
How does thyrotoxicosis cause heart murmurs? How common are heart murmurs with thyrotoxicosis?
Heart murmurs are most often caused by defective heart valves. A stenotic (sten-OT'ik) heart valve has a smaller-than-normal opening and can't open completely. A valve may also be unable to close completely. This leads to regurgitation, which is blood leaking backward through the valve when it should be closed.
Murmurs also can be caused by conditions such as pregnancy, fever, thyrotoxicosis (thi"ro-toks"ih-KO'sis) (a diseased condition resulting from an overactive thyroid gland) or anemia.
Most of the time if you have an overactive thryoid, heart problems are one of the symptoms you might have.
It's interesting to me that when I first started having problems with my thyroid (Hashimotos-going back and forth between hypo and hyperthyroid before a complete removal of my thyroid in January), a doctor asked me if I knew I had a heart murmur. It's the first time any doctor has ever said that to me. (+ info
Symptoms and cure for Thyrotoxicosis?
Anyone diagnosed with this ? what is the treatment ?
Some symptoms of Thyrotoxicosis include:
weight loss in spite of increased appetite
rapid heart rate
a fine tremor
increased nervousness and emotional instability
intolerance of heat, and excessive sweating
staring, bulging eyes
enlargement of the thyroid gland, which is at the front of the neck, at the level of the voice box
Treatment includes going on a thiourea drug (carbimazole, methimazole or propylthiouracil) that will reduce the output of hormone from the thyroid... if that doesn't work your may need surgery or radioactive iodine to kill your thyroid. (+ info
Two years back i was diagnosed with intermittant thyrotoxicosis,but was not placed on any medication.?
For a few months my TH levels were abnormally high,then a few months abnormally low,then stable,they fluctuate all the time.I,ve all the symptoms of an overactive thyroid so said my endocrinologist.But until the levels are continuously high or low they will not treat the symptoms.What more can i do to get it sorted because sometimes you literally feel like your having a breakdown.
I would find a better doctor to start. The key to any healthy recovery is having a doctor you like, a doctor that knows you and your history and a good insurance policy.
Coach (+ info
if there any hyperpigmentation in patient with thyrotoxicosis?
I would say no, unless they also have comorbid Addison's Disease. Hyperpigmentation is characteristic of Addison's. The two often can occur in the same patient (Graves and Addison's) as they are both autoimmune diseases.
EDIT: I found a case history for you that claims it is possible, but very rare. I would always test for Addison's as well if a patient presented with thyrotoxicosis and hyperpigmentation.
Hyperpigmentation is seen on the cheeks and eyelids of a 36-year-old woman. She became hyperthyroid at age 19 years, with accompanying exophthalmos and hyperpigmentation, following the birth of her first child. Thyroidectomy was carried out at that time, and the patient has been receiving thyroid replacement therapy ever since. The hyperpigmentation, an uncommon accompaniment of hyperthyroidism, has persisted. (+ info
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