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

Symptoms consistent with hypothyroidism or adrenal insufficiency, such as lethargy, anorexia, cold intolerance, weakness, hypotension or paraesthesia, are frequently reported in the literature in patients with Human African Trypanosomiasis (HAT), but an endocrine origin for these symptoms has not yet been demonstrated. Thyroid and adrenocortical function were assessed in 60 patients with late-stage HAT and compared to those in 60 age- and gender-matched healthy controls. Clinical assessment and endocrine laboratory examinations were performed on admission, within 2 days after the end of treatment and at follow-up 3 months later. Signs and symptoms of hypothyroidism, such as fatigue, cold sensation, constipation, paraesthesia, peripheral oedema and dry skin, were significantly more frequent in HAT patients than in the controls. However, these signs and symptoms could not be attributed to hypothyroidism due to the lack of supporting laboratory data, and thus empirical replacement therapy for the clinically suspected hypothyroidism was not warranted. Signs and symptoms consistent with adrenal insufficiency, such as weakness, anorexia, weight loss or hypotension, were significantly more frequent in HAT patients than in controls, but they could not be associated with an insufficiency of the adrenocortical axis. Higher basal levels of cortisol were found in HAT patients than in controls, which can be viewed as a stress response to the infection. However, a transitory adrenal insufficiency was suspected in 8% of HAT patients at admission and in 9% at discharge. All values were normal at follow-up 3 months later.
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PMID:Sleeping glands? - The role of endocrine disorders in sleeping sickness (T.b. gambiense Human African Trypanosomiasis). 1776 11

The thyroid gland produces hormones critical to the maintenance of the cellular metabolic rate. The actions of these hormones are far-reaching, affecting thermoregulation and calorigenesis; the metabolism of carbohydrates, fats, and proteins; and oxygen utilization. Thyroid hormones also appear to act synergistically with epinephrine and enhance tissue sensitivity to catecholamines. Signs and symptoms of hypothyroidism include listlessness, fatigue, cold intolerance, dry skin, hair loss, constipation, weight gain, muscle soreness, and slow heart rate. Signs and symptoms of hyperthyroidism include irritability, heat intolerance, tremors, increased sweating, frequent bowel movements, and quickened heart rate. The effect of inadequately treated or undiagnosed hyperthyroidism on the heart carries perioperative risks. To provide competent dental care to patients with thyroid dysfunction, clinicians must understand the disease, its treatment, and the impact the disease and its treatment may have on the patient's ability to undergo and respond to dental care.
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PMID:Risk stratification and dental management of the patient with thyroid dysfunction. 1856 Jun 52

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

A 27-year-old male, who had developed diabetes mellitus type 1 (DMT1) since the age of eighteen and alopecia areata universalis nine months later, attended the outpatient clinics complaining of general fatigue and shortness of breath. A Schilling test was indicative of pernicious anemia. Antigastric parietal cell (AGPA) and anti-intrinsic factor antibodies were positive, confirming diagnosis of pernicious anemia. Thyroid and Addison's disease were excluded. Gastroscopy revealed atrophic gastritis without any evidence of carcinoid tumors. The aim of this case, which, to our knowledge, is the first one to describe a correlation between diabetes mellitus Type 1 (DMT1), pernicious anaemia, and alopecia areata universalis, is to remind the clinician of the increased risk of pernicious anaemia and gastric carcinoids in DMT1 patients. Screening for AGPA followed by serum gastrin and vitamin B(12) levels constitute the most evidence-based diagnostic approach.
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PMID:Pernicious anemia in a patient with Type 1 diabetes mellitus and alopecia areata universalis. 1861 80

Several conditions and drugs induce subclinical hypothyroidism. We report the first case of subclinical hypothyroidism in a 65-year-old woman with breast cancer receiving therapy with the third-generation aromatase inhibitor exemestane 25 mg/day for 2 months. The patient presented with complaints of increasing fatigue and weakness since being commenced on exemestane and was taking no other drugs. There was no past history or family history of thyroid disease. Thyroid function tests prior to breast cancer surgery were normal. Detailed clinical examination and laboratory tests to determine the cause of the patient's increasing fatigue and weakness revealed only subclinical hypothyroidism, that is, an elevated level of thyroid-stimulating hormone (thyrotropin, TSH) only. Ultrasonography revealed a normal thyroid gland. Based on a diagnosis of symptomatic subclinical hypothyroidism, the patient was commenced on levothyroxine sodium 50 microg/day and exemestane was withdrawn. Thyroid dysfunction was restored 4 months after her admission with a significant improvement in symptoms. Levothyroxine sodium was withdrawn 6 months later and no recurrence of thyroid dysfunction occurred during a 1-year follow-up. We believe that the increasing fatigue and weakness in our patient might have been associated either with subclinical hypothyroidism or with administration of exemestane (a known adverse effect of the drug) or both. Further studies are required to investigate how exemestane influences thyroid function.
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PMID:Exemestane-induced subclinical hypothyroidism : a case report. 1878 5

We sought to assess the developing of thyroid disorders in forty eight patients with chronic stable heart failure and without thyroid abnormalities during six months follow-up. Thyroid function disorders were observed in 27.1% of the subjects: sick euthyroid syndrome (12.5%), subclinical hypothyroidism (10.4%) and overt hypothyroidism (6.2%). Subjects with higher thyroid stimulating hormone (TSH) levels at the end of the study had more hospitalizations. The developing of altered thyroid profile was related to lower hemoglobin levels, smaller phase angle with bioelectrical impedance method and more fatigue perception by the patients. This abnormal thyroid function behavior on stable chronic heart failure and was observed as part of the disease progress and was associated to worse prognosis factors as lower phase angle and anemia.
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PMID:Developing thyroid disorders is associated with poor prognosis factors in patient with stable chronic heart failure. 1920 98

Sunitinib is a novel, oral, multi-targeted tyrosine kinase inhibitor with antiproliferative effects against cancer cells and antiangiogenic properties. Sunitinib was recently approved for the first-line treatment of patients with advanced renal cell carcinoma (RCC) and for the treatment of patients with gastrointestinal stromal tumours (GIST) after disease progression or intolerance to imatinib therapy. The main purpose of this benefit-risk assessment is to review data on sunitinib efficacy along with its toxicity in patients with GIST and RCC. Sunitinib demonstrates a high level of efficacy with acceptable tolerability using either the 50 mg daily oral dosing for 4 weeks every 6 weeks or a continuous daily administration schedule at a lower dose. Hypertension and asthenia appear to be the most common adverse effects with sunitinib. Diarrhoea, anorexia, disgeusia, stomatitis and skin toxicity are other clinically relevant toxicities. Fatigue may, at least in part, be related to the development of hypothyroidism during sunitinib therapy. Skin toxicity consists of bullous lesion in the soles and palms that may require treatment discontinuation for a few days and/or dose reduction. Thyroid hormone levels should be monitored during treatment with sunitinib, with the occurrence of clinical signs of hypothyroidism needing treatment with levothyroxine sodium. Hypertension usually requires standard antihypertensive therapy and treatment discontinuation is less frequently necessary. Mild neutropenia and thrombocytopenia usually require no intervention. A decrease in left ventricular ejection fraction is a rare but potentially life-threatening complication. Although usually well tolerated, sunitinib needs to be administered cautiously with medical follow-up in patients with cancer to prevent, avoid and treat adverse effects in order to improve patient compliance. Its established antitumor activity requires attempting to maintain the highest tolerable dose in individual patients. Current oral formulations allow physicians to modulate dosages (between 25 and 50 mg/day) and/or schedules (4 weeks on, 2 weeks off or continuous administration) to optimize the benefit-risk profile of sunitinib in individual patients.
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PMID:Benefit-risk assessment of sunitinib in gastrointestinal stromal tumours and renal cancer. 1967 Sep 13

A 14-year-old boy presented with fatigue and abdominal pain. Laboratory tests revealed a primary hypothyroidism with circulating auto-antibodies against thyroid peroxidase (TPO), anaemia and an elevated level of creatine kinase (CK). A diagnosis of auto-immune hypothyroidism with associated anaemia and myopathy was made. Thyroid hormone replacement therapy was started. However, six months later, he still complained of fatigue. He had unexpectedly varying thyroid function tests and the anaemia and the elevated level of CK persisted. Analysis of the other hormonal axes demonstrated a secondary adrenal insufficiency which was treated with hydrocortisone suppletion therapy. If a patient suffering from hypothyroidism does not respond appropriately to therapy or even deteriorates, adrenal insufficiency should always be considered. Patients with one type of auto-immune endocrinopathy have a greater risk at developing other types of auto-immune endocrinopathies.
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PMID:[Clinical reasoning and decision making in clinical practice: a boy with fatigue and abdominal pain]. 1978 3

Thyroid diseases are common, and most can be safely and effectively managed in primary care. Two of the most common reasons for thyroid function testing are fatigue and obesity, but the vast majority of affected patients do not have hypothyroidism. There is no plausible basis for the assertion that hypothyroidism commonly occurs despite normal thyroid function tests. In primary hypothyroidism all patients, except the elderly and those with ischaemic heart disease, can safely be started on a full replacement dose of thyroxine; the aim is to restore thyroid stimulating hormone (TSH) to normal. Triiodothyronine (T3) has no role in the treatment of primary hypothyroidism. Subclinical thyroid disease should not be treated except in certain well defined situations. Its main importance lies in the increased risk of progression to overt thyroid disease. The development of hyperthyroidism is easily overlooked, and it is important to maintain a high index of suspicion, especially in the elderly. The most common causes are Graves' disease and thyroiditis (especially postpartum), and in the elderly toxic nodular goitre and amiodarone. Patients taking amiodarone should have their thyroid function checked every 6 months. Patients with overt hyperthyroidism should be referred for specialist management; beta-blockers and sometimes anti-thyroid drugs may be initiated in primary care. Most thyroid nodules, especially those detected incidentally on ultrasound scanning, are benign. Indications for referral include newly occurring nodules >1cm in diameter, painful nodules, and nodules that are increasing in size.
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PMID:Management of thyroid disorders in primary care: challenges and controversies. 2007 3

Fever of unknown origin (FUO) refers to prolonged fevers of > or = 101 degrees F and that persists for > 3 weeks that remain undiagnosed after an intensive in-hospital/outpatient workup. The most common FUO categories of are infectious, neoplastic, rheumatic/inflammatory, and miscellaneous causes. Malignancies have supplanted infectious diseases as the most common cause of FUOs in the adult population. Rheumatic/inflammatory causes of FUO are relatively less common than previously because of the introduction over the years of sophisticated diagnostic tests for most rheumatic diseases. The rheumatic/inflammatory disorders that remain important causes of FUO today are those that cannot be readily diagnosed by readily available/noninvasive tests, for example, adult Still's disease and temporal arteritis (TA). In older patients with FUO, TA can be a difficult diagnosis when the characteristic findings (ie, scalp tenderness, jaw claudication) are not present. Patients with TA presenting as FUO often have only headaches that may be accompanied by bilateral jaw discomfort. Endocrine causes of FUOs are rare. The most common endocrine disorder rarely presenting as an FUO is de Quervain's subacute thyroiditis. As in TA, subacute thyroiditis may present with headache and pain at the angle of the jaw. Both TA and subacute thyroiditis may be accompanied by fatigue, weight loss, and night sweats. We present a case of 55-year-old woman who presented with an FUO with clinical and laboratory findings suggesting TA. However, the absence of thrombocytosis and a normal alkaline phosphatase argued against the diagnosis of TA. Also against the diagnosis of TA was weight loss without loss of appetite and a slightly increased pulse. After nonspecific laboratory test results suggested that TA was not the cause of her FUO, additional tests were ordered. Thyroid function test results suggested the possibility of de Quervain's subacute thyroiditis as the cause of her FUO. To the best of our knowledge, this is the first case of de Quervain's subacute thyroiditis presenting as an FUO with elevated ferritin levels.
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PMID:Fever of unknown origin (FUO): de Quervain's subacute thyroiditis with highly elevated ferritin levels mimicking temporal arteritis (TA). 2010 88


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