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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A young female presented with evidence of right-sided heart failure and was subsequently found to have significant pulmonary artery hypertension (PAH). Because of her normal left ventricular function and pulmonary capillary wedge pressure, the most probable site of etiology seemed to be the pulmonary vasculature. All the common possible secondary causes of PAH were ruled out, but during the investigations, she was found to have elevated thyroid function tests compatible with the diagnosis of Grave's disease. The treatment of Grave's disease, initially by medications and subsequently by radioiodine therapy, was associated with a significant reduction in the pulmonary artery systolic pressure. The purpose of this case report is to highlight one of the unusual and underdiagnosed presentations of Grave's disease.
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PMID:Secondary Pulmonary Hypertension and Right-Sided Heart Failure at Presentation in Grave's Disease. 2319 82

Graves' orbitopathy (GO) is the most common and important extrathyroidal manifestation of Flajani-Basedow-Graves' disease, with autoimmune etiology. In most cases they are mild forms, in 3-5% they are severe and progressive. For therapeutic purposes, it is classified according to the severity (mild, moderate-severe or sight threatening), to the activity (active if clinical activity score is >=3), and to the impact on quality of life. The choice of medical or surgical therapy depends on the activity of the disease. Therapy for mild GO consists of abolition of risk factors, local treatments, oral administration of selenium. Therapy for moderate-severe and active GO consists of administration of intravenous, oral, topic and local (retrobulbar, peribulbar and subconjunctival) glucocorticoids (GC). The therapy of choice, after careful selection of patients, is pulse therapy with intravenous GC, with 79% of response. Orbital radiotherapy is effective in 60% of cases; diabetes mellitus and hypertension are absolute contraindications. Contemporary administration of oral GC and orbital radiotherapy are more effective than single therapies. Marginal and not validated therapies are cyclosporine, somatostatin analogues, TNF-a inhibitors and rituximab. The treatment for dysthyroid optic neuropathy (DON) consists of combination of steroids, orbital radiotherapy and, if necessary, orbital decompression surgery. The surgical therapies are orbital decompression and rehabilitative surgery.
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PMID:[Management of patient with Gaves' orbitopathy]. 2330 63

A 38-year-old woman on medical therapy for Basedow disease and hypertension with a history of recent heart failure became pregnant. At the 13th week of gestation, her echocardiography showed pulmonary hypertension with 63 mmHg of estimated systolic pulmonary arterial pressure. At the 26th week of gestation, she was admitted to our hospital with dyspnea and uncontrolled hypertension. After medical treatments, elective caesarean section was scheduled at the 30th week of gestation. While monitoring continuously arterial blood pressure and central venous pressure, continuous infusion of prostaglandin E1 was initiated. After epidural anesthesia had been established, surgical procedure was safely performed. The patient was discharged 9 days after surgery, and her estimated systolic pulmonary arterial pressure dropped to 35 mmHg on echocardiography 2 months after the operation. We speculate that pregnancy induced her severe pulmonary hypertension.
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PMID:[Anesthetic management of a patient with pulmonary arterial hypertension undergoing caesarean section]. 2347 20

Pheochromocytoma is an uncommon cause of high blood pressure touching adults. The combination of severe hypertension in the triad of headache, sweating, and tachycardia should suggest this diagnosis; this clinical picture is similar to that of hyperthyroidism. We report the case of a 22-year-old patient with multiple pheochromocytoma associated with Graves' disease revealed by malignant hypertension and discussed the difficulties of the diagnosis and the treatment approach.
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PMID:Graves' disease allied with multiple pheochromocytoma. 2377 12

Pregnancy represents a real challenge to all body systems. Physiological changes can involve any of the body organs including the eye and visual system. The ocular effect of pregnancy involves a wide spectrum of physiologic and pathologic changes. The latter might be presenting for the first time during pregnancy such as corneal melting and corneal ectasia, or an already existing ocular pathologies that are modified by pregnancy such as diabetic retinopathy and glaucoma. In addition, pregnancy can affect vision through systemic disease that are either specific to the pregnant state itself such as the pre-eclampsia/eclampsia and Sheehan's syndrome, or systemic diseases that occur more frequently in relation to pregnancy such as Graves' disease, idiopathic intracranial hypertension, anti-phospholipid syndrome, and disseminated intravascular coagulation.
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PMID:The eye and visual system in pregnancy, what to expect? An in-depth review. 2408 65

A 57-year-old woman with diabetes mellitus, hypertension, obesity, and Graves disease presented with clinical evidence of thyroid eye disease (TED) and optic neuropathy. She was referred when a tapered dose of steroids prompted worsening of her TED. CT and MRI were consistent with TED and bilateral optic nerve meningioma. To the authors' knowledge, this is the first reported case of concurrent TED and unsuspected bilateral optic nerve meningioma. When investigating the etiology of TED-associated optic neuropathy, careful attention to orbital imaging is required because coexisting pathology may exist.
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PMID:Coincidental Optic Nerve Meningioma and Thyroid Eye Disease. 2483 45

As the highly blood flow of thyroid gland post-thyroidectomy bleeding (PTB) is a serious and life-threatening complication. Our aim was to investigate factors that influenced bleeding after thyroidectomy. Between February 2008 and September 2012, the data of 4449 consecutive patients with thyroid diseases undergoing thyroidectomy were collected and analysed from the department of surgical oncology retrospectively. During the study period, 88 (2.0%) patients were identified to have clinically PTB. 6 risk factors were significantly related to PTB: gender (OR 3.243; 95% CI 2.078-5.061; P < 0.001), age (OR 1.025; 95% CI 1.006-1.043; P = 0.009), tumor size (OR 4.495; 95% CI 2.462-8.208; P < 0.001), postoperative hypertension (OR 2.195; 95% CI 1.006-1.043; P = 0.035), lymph node dissection (OR 3.384; 95% CI 2.146-5.339; P < 0.001) and Graves' disease (OR 3.744; 95% CI 1.920-7.303; P < 0.001). We addressed the most common explicit source of bleeding by reexploration: infrahyoid muscles (30/88), beside the laryngeal recurrent nerve (22/88), subcutaneous tissue (10/88) and superior pole (10/88). In our study, male gender, older age, tumor size > 3 cm, postoperative hypertension (SP > 150 mmHg), lymph node dissection and Graves' disease were independent risk factors for PTB. The sources of bleeding were identified more frequently in the infrahyoid muscles and beside the laryngeal recurrent nerve. It is helpful for surgeons to decide the potential bleeding points during the reexploration of PTB.
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PMID:Risk factors target in patients with post-thyroidectomy bleeding. 2729 2

The treatment of Graves' orbitopathy (GO) remains a diagnostic and therapeutic challenge for clinicians worldwide. The elimination of risk factors, such as encouraging smoking cessation and achieving euthyroidism, are the most important and usually sufficient treatment methods in most mild cases. A course of selenium may also be beneficial. High-dose systemic corticosteroid therapy remains the first-line therapy in moderate-to-severe orbitopathy; however in some patients such treatment may be insufficient. Radiotherapy for GO has been used for decades and is considered to be effective in active GO, although less than systemic corticosteroids. Unfortunately, there are only eight randomised studies that may be analysed to assess its true effectiveness and applicability. It has been indicated that radiotherapy affects mainly eye motility and soft tissue changes, with almost no influence on exophthalmos. The combination of these two therapies has proven to be even more effective than either treatment alone, especially in subjects with resistant or recurrent GO. Orbital radiotherapy seems to be a safe procedure with few adverse effects observed long after the therapy. It should be avoided in patients with retinopathy, due to diabetes mellitus and hypertension, and in young subjects (< 35 years old). Orbital radiotherapy, as a safe and generally effective second-line therapy, is used in some countries as a supporting method during the second course of systemic corticosteroid therapy, if the response to the first course is unsatisfactory. Further randomised, double-blind studies are needed to confirm fully its clinical usefulness.
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PMID:Orbital radiotherapy in the management of Graves' orbitopathy--current state of knowledge. 2530 90

Moyamoya disease (MMD) primarily causes constriction of internal carotid artery, but it is known to extend to the middle and anterior cerebral arteries. Some of the symptoms caused by MMD include transient ischemic attack (TIA) and seizures. The etiology of MMD from Graves' disease (GD) is mostly caused by thyrotoxicosis, but our finding of leukocytosis indicates a new finding that may help physicians prepare for the pending outcome of MMD from GD with leukocytosis. A 26-year-old Hispanic woman with a significant past medical history of GD and hypertension presented to the emergency department complaining of cough and shortness of breath for the past 5 days. During the patient's stay in the hospital, the patient suddenly developed numbness of the right arm with subsequent right arm weakness 10 minutes later. The head CT showed no acute intercranial hemorrhage, but MRA showed right intracranial internal carotid artery stenosis, with marked focal stenosis along the proximal supraclinoid segment, moderate stenosis along its distal supraclinoid segment with marked stenosis along the origin of the right A1 segment. It was therefore believed to be moyamoya-like phenomena. We discuss an atypical presentation that led to moyamoya-like phenomena which we believe has not been described before. We believe that presentation of idiopathic leukocytosis may have triggered the cerebral stenosis.
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PMID:A New Early Finding of Moyamoya-Like Phenomena. 2612 13

The case report focuses on the case of heavy Graves - Basedow thyreotoxicosis in 33 years old secundipara who was transferred to our departement from regional hospital for decompensation of gestational hypertension, oligohydramnios and the suspition on intrauterine growth restriction (IUGR). In our clinical praxis the problems of thyroid gland in terms of its reduced function in pregnant women are getting more frequent. The goal of this article is to describe the less often situation, the hyperthyroidism in the third trimestr of the pregnancy. Thyretoxicosis in pregnancy is associated with higher risk of preterm labour, preeclampsia, IUGR, heart failure and stillbirth. Some of these complications confirmes our case report.
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PMID:[Hyperthyroidism in pregnancy, less common disorder of the thyroid gland complicating the pregnancy]. 2674 Nov 59


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