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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Some of the symptoms and signs of hypothyroidism and hyperthyroidism in elderly patients may be mistakenly attributed to "old age." Weight loss, muscle weakness, tremor, angina, congestive heart failure--all signs of hyperthyroidism--are also concomitants of aging. Fatigue, sluggishness, withdrawal behavior, senile atrophic skin changes--all signs of hypothroidism--are also a part of the normal aging process. Although screening elderly people for thyroid disease is economically unsound, the physician should maintain a high index of suspicion of its presence. Laboratory tests must be interpreted with extra care. Values of 131I uptake, serum T4 and T3, thyroid-stimulating hormone, and thyrotropin-releasing hormone are all helpful in diagnosis. Thyroid disease is easily treated in elderly patients, and results often are dramatic. Propranolol is effective in thyrotoxic patients when symptoms require prompt relief. The definitive treatment, however, is 131I; antithyroid drugs are difficult to manage. Hypothyroidism is easily treated with T4.
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PMID:How thyroid disease presents in the elderly. 2 76

1. Quadriceps strength, relaxation rate, fibre-type composition and energy-turnover rate during a submaximal contraction have been measured in hypo- and hyper-thyroid patients and compared with findings in normal subjects. 2. Six out of eight hypothyroid patients had normal strength whereas four out of five hyperthyroid patients were weak. 3. Relaxation rate was decreased in all the hypothyroid patients but increased in only three out of five hyperthyroid patients. 4. In hypothyroidism there was a marked reduction in the percentage contributed by type II fibres to muscle cross-section, partly due to type II atrophy but also due to a decrease in the relative frequency of type II fibres. In hyperthyroidism both fibre types tended to atrophy. 5. The rate of ATP turnover during submaximal contraction held to fatigue was reduced in hypothyroidism. This was probably due to decreased ATP utilization rather than an impaired supply of energy-supplying substrates. In hyperthyroidism the rate of ATP turnover was increased. 6. Altered relaxation rate and ATP-turnover rate may be explained on the basis of changes in myosin ATPase activity with thyroid status. Changes in muscle-fibre-type composition, as determined histochemically, could not per se account for the functional abnormalities.
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PMID:Muscle relaxation rate, fibre-type composition and energy turnover in hyper- and hypo-thyroid patients. 50 76

Postpartum thyroid dysfunction (PPTD) refers to the syndromes of transient hyperthyroidism, transient hypothyroidism, or both, occurring sequentially in the first 12 months postpartum. Approximately 5 to 9% of women develop the disorder in this period. PPTD is most often subclinical but some women will experience symptoms such as lack of energy and depression in the hypothyroid phase. The thyroid gland, which normally enlarges during pregnancy, will remain enlarged or enlarge further in the postpartum period in a significant number of affected women, instead of returning to the prepregnancy size as in unaffected women. The gland is painless and histologically demonstrates lymphocytic infiltration. PPTD is strongly associated with the presence of antimicrosomal and/or antithyroglobulin antibodies, which occur in up to 76% of cases. Antibody activity tends to increase in the postpartum period and to peak at the time of onset of the disorder. TSH receptor antibodies are not seen and the gland has low radioiodine uptake, distinguishing PPTD from Graves' disease. The HLA associations are controversial, as is the role of dietary iodine. The etiology of PPTD is almost certainly immunological, reflecting the phenomenon of rebound from the relative immune tolerance of pregnancy. Detection of the disorder is important in order to reassure or treat those who are symptomatic and because PPTD may recur in subsequent pregnancies. In addition, up to one third of affected women will go on to develop permanent hypothyroidism 2 to 4 years later. The role of screening for PPTD remains to be clarified.
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PMID:Postpartum thyroid dysfunction. 152 73

A 50-year-old man is described who had a 15-year history of Raynaud's phenomenon with severe and frequent vasospastic attacks in his fingers and toes during the past years. Exacerbation of his digital symptoms, which started about 4 years ago, was accompanied by signs of thyroid deficiency, such as tiredness, memory impairment, decreased libido, constipation, dryness of skin and bradycardia. Hormonal evaluation revealed primary hypothyroidism and the patient began substitution therapy with L-thyroxine. After 2 months of treatment not only did he become euthyroid but the digital symptoms also disappeared. The patient may thus represent one of the very few cases whose thyroid replacement therapy proved to be highly effective in treating both hypothyroidism and Raynaud's phenomenon.
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PMID:Remission of Raynaud's phenomenon after L-thyroxine therapy in a patient with hypothyroidism. 156 Jan 91

We report here the long-term toleration of treatment with a highly purified human leukocyte alpha-interferon (Interferon Alfanative) in patients with midgut carcinoid tumours with liver metastases. During an 18-month period, 13 consecutive patients with this diagnosis commenced treatment with a-interferon. Five patients died during the first 2 years of treatment due to tumour progression, and in 2 patients the treatment with a-interferon had to be stopped due to severe adverse effects (mainly joint pain and tiredness). Hence, 6 patients tolerated the treatment for a long-term period (greater than 2 years), and in these patients the treatment has continued for more than 3 years; in 3 of them for more than 4 years. In these 6 patients, adverse effects of mild or moderate degree have been observed in 2 patients: itching and hair loss in one and joint pain and hair loss in another. Except for a significant reduction in the blood number of WBC and thrombocytes (although in no patient did leukocytopenia or thrombocytopenia develop) and the development of hypothyroidism in one patient, no biochemical tests have shown significant changes during the long-term treatment. In these 6 patients, objective tumour regression has been observed in 2 patients, stable disease in 3 patients and progression in 1 patient. We conclude that, of the patients initiated on treatment with a-interferon for midgut carcinoids with liver metastases, only approximately 50% are still on the treatment after 2 years. These patients, on the other hand, may continue for a longer period of time with a low degree of adverse effects.
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PMID:Tolerance to long-term treatment of malignant midgut carcinoid with a highly purified human leukocyte alpha-interferon. 162 46

The incidence of pregnant women with thyroid dysfunction has been reported to be around 0.1-0.4%. Graves' disease accounts for more than half of these disorders. The main cause of thyroid disease in pregnancy and puerperium is autoimmune dysfunction. Whether there may be goitre or exophthalmus present, clinical signs as inappropriate weight gain, high systolic pressure, palpitation (greater than or equal to 110/min), emotional lability, fatigue, acceleration of suppression of the Achilles' tendon reflex should induce changes in the biochemical thyroid function tests. Parameters for the diagnosis and management for hyperthyroidism are serum levels of free T4 and TSH, while those of T3, reverse T3, and TSH are for hypothyroidism. Serum anti-microsomal antibodies and anti-thyroglobulin antibodies which have no effect on the fetus are also good markers for severity. The transplacental transfer of maternal TSH receptor antibodies consisting of stimulatory and inhibitory immunoglobulins and maternal thyroid-binding inhibiting immunoglobulins play roles in the development of transient neonatal hyper- or hypothyroidism. Fetal control is achieved by optimal maternal management. Untreated hyperthyroidism may be associated with fetal malformations. This risk may be reduced by antithyroid drug treatment of up to 150 mg/day of propylthiouracil which has less chance of placental passage and less secretion into the mother's milk than methyl-mercapto-imidazol. Maternal thyroid function should be kept in the upper limit of normal range, taking into consideration the fetal dysfunction induced by over-administration of the drug which passes through placenta. Children of hypothyroid women taking inadequate replacement therapy manifested lower IQ values compared to the progeny of euthyroid or hypothyroid women taking adequate therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Thyroid disease]. 170 36

Many endocrine diseases can cause fatigue. Tiredness is a frequent symptom of primary and secondary hypothyroidism, hyperthyroidism, excessive glucocorticoid or mineralocorticoid production, primary and secondary adrenal insufficiency, primary and secondary hypogonadism and hyperprolactinemia in the male, acromegaly, diabetes mellitus and diabetes insipidus. A great number of medical diseases other than those mentioned in the articles on cardiological and pneumological fatigue can also cause abnormal tiredness (infectious diseases, hematological, renal, hepatic, gastrointestinal and rheumatological disturbances, vasculitis and malignant tumors). The pathogenesis of tiredness caused by endocrine or medical illnesses, i.e. how the sensation of fatigue is produced, is not clear. The fatigue of the various endocrine or other medical diseases is not disease-specific, i.e. its characteristics do not differentiate it from the fatigue of other illnesses.
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PMID:[Endocrine and other medical causes of abnormal fatigability]. 175 71

Anti-thyroid peroxidase antibodies were prospectively assayed and compared with anti-microsome and anti-thyroglobulin antibodies in 203 patients (188 women, 15 men; mean age 42 +/- 14 years). These patients consulted for hyperthyroidism (n = 42, including 18 with Graves' disease), fumary hypothyroidism (n = 50, including 20 at the diagnosis stage), euthyroid diffuse or nodular goitre (n = 81) or benign euthyroid nodule (n = 14). Sixteen patients examined for fatigue, gynecomastia, menstrual disorders or overweight had normal thyroid function. Anti-thyroid peroxidase, anti-microsome and anti-thyroglobulin antibodies were assayed by radioimmunology or indirect immunofluorescence. Anti-thyroid peroxidase antibodies were most frequently present in patients with autoimmune thyroid diseases, such as Graves' disease (72%) or primary hypothyroidism (70%), and correlated with anti-microsome antibody levels (r = 0.87; p less than 0.001). Anti-thyroid peroxidase antibodies were absent in patients with benign euthyroid nodule; they were present in 22% of patients with euthyroid goitre and in 12% of control patients; their level decreased during replacement therapy for hypothyroidism. It is concluded that radioimmunological assays of anti-thyroid peroxidase antibodies should replace anti-microsome and anti-thyroglobulin antibodies in thyroid evaluation.
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PMID:[Anti-thyroid peroxidase in non-neoplastic thyroid pathology]. 177 11

A phase I trial of Roussel-Uclaf recombinant human interleukin 2 (IL 2) was performed on 31 cancer bearing patients of the Institut Gustave-Roussy, Villejuif, and the Institut Curie, Paris. This study allowed to define a schedule for administration of IL 2 in continuous infusion over 5 day cycles. This schedule is manageable in patients without major visceral failure. It is reproducibly feasible in conventional medical oncology units, without specialized intensive care facilities. Toxicities, although numerous, are acceptable for IL 2 doses below 24,000,000 IU/m2/day. There is a close relationship between secondary effect severity and IL 2 doses received. Main toxicities were: fever with chills, fatigue and general discomfort in 23 patients, nauseas and vomiting in 12, diarrhea in 10 and cutaneous rashes with erythema and dermal vascularitis in 13. One peculiar feature of this study was the minimal occurrence of manifestation related to leaky capillary syndrome prominant in other studies. Oliguria, functional renal failure and edema were observed in only 4 patients with functionally unique kidney. Five patients had severe anemia, 2 grade III thrombocytopenia, 1 grade IV hepatic cytolysis, 4 severe confusion episodes and 2 hypothyroidism with anti-thyroid microsome auto-antibodies. All these toxicities were reversible after withdrawal of IL 2 treatment. During this phase I trial, 3 therapeutic objective responses were observed, all 3 occurring in patients with metastatic melanoma treated with IL 2 doses equal to, or above 16,000,00 IU/m2/d. Recombinant IL 2 Roussel-Uclaf thus can be administered through a simple, manageable and efficient regimen.
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PMID:[Phase I trial of a recombinant human interleukin 2. Results in patients with disseminated solid tumors]. 182 63

A depressive man was evaluated for developing chronic fatigue and cold intolerance, in whom laboratory findings showed decreased thyroid hormone levels (T4, 2.7 micrograms dl-1; T3, 0.76 ng ml-1) with normal blood levels of TSH. A single bolus injection of TRH (500 micrograms) significantly stimulated prolactin secretion, but did not cause an increase in blood TSH levels (basal level, 1.2 microU ml-1 vs. 1.3 microU ml-1 30 min after injection). By contrast, TRH-induced TSH stimulation occurred after repeated injection of TRH for 4 consecutive days (basal level, 1.5 microU ml-1 vs. 5.6 microU ml-1 30 min after injection). Blood thyroid hormone concentrations were restored to normal levels after long-term administration of TRH. Other pituitary functions remained unchanged. A diagnosis of central hypothyroidism due to isolated TRH deficiency was made in this case, and the data presented here indicate that partial resistance of pituitary thyrotrophs to TRH may be associated with depression.
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PMID:Central hypothyroidism due to isolated TRH deficiency in a depressive man. 190 Oct 77


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