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

Thyroid dysfunction is extremely common in women and has unique consequences related to menstrual cyclicity and reproduction. Even minimal hypothyroidism can increase rates of miscarriage and fetal death and may also have adverse effects on later cognitive development of the offspring. Hyperthyroidism during pregnancy may also have adverse consequences. Accordingly, thyrotropin (TSH) determination is warranted for all women planning pregnancy or those already pregnant. Replacement doses should be carefully monitored throughout pregnancy because the increased renal iodine loss and estrogen-induced rise in thyroxine-binding globulin (TBG) often result in a higher dose requirement. Although thyroid abnormalities are part of the standard differential diagnosis of menstrual disorders, recent studies indicate that these are relatively infrequent causes. Nonetheless, TSH is still required as part of the laboratory evaluation of women with abnormal cycles. The incidence of postpartum thyroiditis is high--6%-8% in various studies. A TSH should be performed in all postpartum patients who are depressed, who complain of unusual fatigue or anxiety or have any of the classical symptoms of hyperthyroidism or hypothyroidism. Practitioners providing health care for women should be alert to thyroid disorders as possible etiological factors in nonspecific symptoms such as fatigue and depression. However, most women with these symptoms are euthyroid; replacement therapy for them is not indicated. The long-standing dogma of thyroidology that replacement with levothyroxine alone is satisfactory for all hypothyroid patients has recently been questioned but results of trials are inconclusive. Nonetheless, satisfactory regimens can be found for the vast majority of patients.
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PMID:Thyroid dysfunction and women's reproductive health. 1567

A 36-yr-old woman began to suffer from headache, anorexia and general fatigue at 35 weeks' gestation. About 2 or 3 months after the delivery, fever, tachycardia and generalized musculoskeletal disorder appeared. Thereafter, they worsened rapidly, accompanied by a disturbance of consciousness and hypercalcemia. Thyrotoxicosis, due to a post-partum thyroiditis, and glucocorticoid deficiency, due to a pituitary failure, probably associated with lymphocytic hypophysitis, were also observed. All the symptoms and hypercalcemia disappeared after the glucocorticoid replacement therapy and the normalization of thyroid hormone levels. Serum and urinary bone resorption markers, such as urine pyridinoline (U-Pyr), urine deoxypyridinoline (U-DPD), urine amino-terminal telopeptide of type I collagen (U-NTx) and serum carboxy-terminal telopeptide of type I collagen (ICTP), were extremely high at the hypercalcemic state. In this case, they were 10 to 20 times higher than the normal upper limits, and then markedly decreased in a normocalcemic state, thereby showing an extreme acceleration of bone resorption in a state of both thyrotoxicosis and glucocorticoid deficiency.
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PMID:Elevated bone resorption markers in a patient with hypercalcemia associated with post-partum thyrotoxicosis and hypoadrenocorticism due to pituitary failure. 1563 35

A 81-year-old woman was diagnosed as having diabetes mellitus (DM) at 58 years of age. She started insulin therapy the following year, but her blood sugar levels were poorly controlled. At the age of 75, she tested positive for the anti-GAD antibody (7.8 U/ml) and was diagnosed as having slowly progressive type 1 DM (SPIDDM), as well as vitiligo vulgaris. At 78 years of age, chronic thyroiditis was diagnosed after positive tests for anti-thyroid peroxidase antibody and anti-thyroglobulin antibody. At the age of 81, general fatigue and jaundice appeared concomitantly with severe anemia, with Hb levels at 5.2 g/dl. Low serum vitamin B12 levels and the finding of erythroblastic hyperplasia with megaloblasts in bone marrow led to the diagnosis of pernicious anemia. Anemia was alleviated by intramuscular injections of vitamin B12. The patient developed chronic thyroiditis, vitiligo vulgaris, and pernicious anemia concomitantly with SPIDDM, and was diagnosed as having polyglandular autoimmune syndrome type III. Attention should be paid to these potentially associated autoimmune diseases in daily practice during the follow-up of SPIDDM patients.
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PMID:Slowly progressive type 1 diabetes mellitus associated with vitiligo vulgaris, chronic thyroiditis, and pernicious anemia. 1564 55

Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the systemic circulation. We hereby report a patient proved to be a case of unrecognized hypothyroidism presenting with rhabdomyolytic acute renal failure precipitated by the combined use of statin and fenofibrate. A 63-year-old woman was referred to our department because of fatigue, diffuse muscle pain and oliguria. On the basis of pathogenesis, clinical and laboratory examination the diagnoses of acute renal failure secondary to the statin-fibrate-derivative combination induced rhabdomyolysis and auto-immune thyroiditis induced hypothyroidism were made. Although saline, furosemide and sodium bicarbonate infusions enabled diuresis and have led to a rapid recovery of renal function and normalization of blood pressure in five days (creatinine level decreased from 4.5 mg/dl to 1.2 mg/dl), only thyroid replacement therapy (0,1 mg thyroxine) that begun after the exclusion of adrenal insufficiency resulted in complete resolution of rhabdomyolysis. This prompted the diagnosis of background, clinically silent rhabdomyolysis aggrevated by the statin-fibrate-derivative combination. To our knowledge this case illustrates the first example of rhabdomyolytic acute renal failure induced by a statin-fibrate-derivative combination with underlying hypothyroidism which was responsible for the basal clinically unobservable rhabdomyolysis.
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PMID:A case of rhabdomyolysis induced acute renal failure secondary to statin-fibrate-derivative combination and occult hypothyroidism. 1631 69

Amifostine is a broad-spectrum cytoprotective agent approved for protection against cisplatin toxicities and radiation-induced xerostomia; strong clinical evidence exists that amifostine protects normal mucosa and lung from radiation damage. Hypotension, nausea/vomiting, fatigue and fever/rash are the main side-effects associated with amifostine administration. The present study summarizes our experience on daily amifostine administration to cancer patients with various coexisting medical conditions and diseases. The tolerance and the eventual interference of amifostine with the course of the coexisting diseases is reported, providing a core list of medical conditions met in radiotherapy practice, their compatibility with amifostine administration and recommendations on how to deal with these patients. This list comprises genetic diseases (xeroderma pigmentosum, glucose-6-phosphate dehydrogenase deficiency), autoimmune disorders (vitiligo, scleroderma, thyroiditis, perforating collagenosis), metabolic diseases (diabetes mellitus), cardiovascular diseases, neuro/psychiatric diseases and other medical conditions (hypoglycemia, hepatic cirrhosis, alcoholism). A high incidence of fever/rash was noted in patients with autoimmune diseases, while all other conditions did not alter the patterns of side-effects expected following amifostine administration.
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PMID:Amifostine administration during radiotherapy for cancer patients with genetic, autoimmune, metabolic and other diseases. 1642 30

Autoimmune fatigue syndrome (AIFS) is defined by chronic nonspecific complaints, a positive antinuclear antibody (ANA) assay, and the absence of another explanation for the complaints. Some severe cases fulfill the criteria for chronic fatigue syndrome (CFS). CFS is a syndrome characterized by disabling severe fatigue and defined by the criteria proposed by the U.S. Centers for Disease Control and Prevention. In this report, a patient with chronic fatigue syndrome and positive ANA assay was described as having developed postpartum thyroiditis 5 years after the onset. Sub-chemical hypothyroidism is characterized by clinical hypothyroidism not meeting biochemical criteria but showing evidence of thyroid autoimmunity. The relation between AIFS and sub-chemical hypothyroidism is discussed.
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PMID:A case with chronic fatigue syndrome with positive antinuclear antibody followed by postpartum thyroiditis. 1714 2

The era of interferon (IFN) administration in the treatment of patients with chronic viral hepatitis creates an essential turning point for therapy of these diseases. Incessant progress of the new, more efficient and lower side effects of interferon causes decrease in treatment withdrawal. The side effects like myalgia, nausea, fatigue and loss of appetite, usually with good reaction for symptomatic treatment and intensity of the symptoms decreases during treatment continuation. Due to strong immuno-modulatory activities and long-lasting therapy, autoimmune diseases are observed in some cases. Therefore treatment process should be carefully and trifle monitored especially in autoantibodies appearance aspect. To the most common interferon mediated autoimmune diseases belong thyroiditis, autoimmune hepatitis and thrombocytopenia. Interstitial pneumonitis, systemic lupus erythematosus, type I diabetes mellitus, asthma and sarcoidosis exacerbation as well as glomerular diseases are observed rarely. In our paper we discus an issue of autoimmune diseases induction phenomena caused by interferon therapy administrated in the treatment of chronic viral hepatitis.
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PMID:[Interferon therapy in chronic viral hepatitis; an autoimmunity dilemma]. 1794 66

A 62-year-old female patient presents with myalgia, dysphagia and daytime fatigue. Clinical examination is normal. Laboratory results show a hyperthyroidism and an increased erythrocyte sedimentation rate. Clinical presentation, an ultrasound and further examinations suggest a thyroiditis de Quervain. A treatment with NSAR is started. After eight weeks the thyroid hormones return to normal and the patient is asymptomatic.
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PMID:[Muscle pain. De Quervain throiditis]. 1796 81

An adolescent with complaints of fatigue, tachycardia, abdominal discomfort, and blood-stained diarrhea is presented. Clinical and laboratory evaluation revealed a microcytemic anemia with iron deficiency, beta thalassemia, and thyrotoxicosis with thyroid antibodies. Crohn's disease was confirmed on endoscopy. A rapid normalization of clinical and laboratory parameters was observed following the initiation of therapy and further exacerbation of her illness was prevented. Although the simultaneous occurrence of Crohn's disease, autoimmune thyroiditis, and a beta-thalassemia trait is likely to be coincidental, the combination of an autoimmune thyroid disease and Crohn's disease is rare in pediatrics. Several issues of importance in the treatment of these conditions are discussed. Rectal blood loss associated with Crohn's disease may lead to severe iron deficiency, especially in patients with preexistent beta-thalassemia trait, and those with thyroiditis are prone to developing hypothyroidism following treatment, requiring that they be monitored closely.
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PMID:Crohn's disease, autoimmune thyroiditis, and beta-thalassemia trait in an adolescent: an unusual combination of diseases. 1824 69

A 60-year-old male patient complaining of palpitations, fatigue, weakness and weight loss of 1 month's duration was hospitalized in our cardiology department for atrial fibrillation. Thyroid function test results were compatible with thyrotoxicosis. The patient had been taking amiodarone for 2.5 years for hypertrophic obstructive cardiomyopathy and non-sustained ventricular tachycardia episodes. However, amiodarone had been discontinued after follow-up examinations revealed that the patient's ventricular arrhythmias were no longer present, and he had been taking metoprolol only for the preceding 6 months. In this patient, amiodarone-induced thyroiditis had developed 6 months after cessation of treatment, demonstrating that adverse effects may occur after discontinuation of amiodarone. Detection of the condition requires assessment of thyroid function before treatment initiation, during treatment and at regular intervals after treatment cessation. The type of hyperthyroidism induced by amiodarone cannot be determined in most cases. Patients with this condition should be referred to an experienced endocrinologist. Our case of delayed amiodarone-induced thryoiditis occcurred approximately 6 months after termination of amiodarone treatment.
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PMID:Atrial fibrillation due to late amiodarone-induced thyrotoxicosis. 1859 99


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