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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The paper examines the basic pathophysiologic mechanisms playing a role in the development of cardiovascular changes on thyroid hyper- and hypofunction. The haemodynamic changes typically associated with increased and decreased secretion of thyroid hormones are described and compared. Using echocardiography, the haemodynamics changes are documented in 12 patients with hyperthyroidism and 19 patients with myxoedema prior to thyrostatic and substitution therapy. Characteristic findings in florid hyperthyroidism include a significant rise in left ventricular end-diastolic volume as well as increases in stroke volume (SV) and cardiac index (CI). Mean velocity of circumferential fibre shortening (mVCF) is also significantly increased. Left ventricular myocardial weight shows a tendency towards an increase. Hypothyreosis is primarily associated with decreases in SV and CI; mVCF also declines. The paper underlines the importance of causative therapy as the above haemodynamics changes are fully reversible on attaining normal thyroid function.
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PMID:Heart in thyroid diseases. 130 51

On the basis of a case history, the clinical and paraclinical manifestations of hypothyroidism are reviewed. Exertion dyspnoea without signs of cardiac insufficiency occurs frequently. The minute and stroke volume and heart rate are reduced. The blood pressure may rise (reversible) and hypertension may occur. The function of the left ventricle is reversibly reduced. A tendency to formation of exudates has been observed. X-ray of the thorax may revial massive relatively asymptomatic pleural exudates and cardiomegaly. Pericardial exudate occurs frequently and is demonstrated best by echocardiography. Inter- and intracellular deposits, infiltrations and fibroses have been demonstrated in the myocardium and these probably contribute to some of the non-specific, reversible ECG changes (low voltage, flattening/inversion of T waves, sinus bradycardia). The plasma concentrations of several different enzymes (including creatine kinase (CK), CK-MB and LDH) may be raised in myxoedema. The reason for this is perhaps compromized membrane function in the skeletal muscle cells. The diagnosis of myocardial infarction in myoedema requires that CK-MB constitutes at least 6% of the total CK and that the increase is transient. In patients with coronary sclerosis, substitution treatment should be initiated carefully because the risk of ischaemic symptoms is otherwise considerably increased. It is not elucidated whether the hypothyroidism per se can increase atheroma formation.
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PMID:[Cardiovascular manifestations of hypothyroidism]. 186 65

Some of the immediate cardiovascular changes and alterations in oxygenation occurring in a patient in myxoedema coma following the oral administration of a single dose of triiodothyronine (T3) (2.5 micrograms) are described. These included increases in oxygen consumption, oxygen delivery, cardiac output, heart rate and ventricular stroke work. Low dose oral T3 can be effective in myxoedema coma and these patients may benefit from the continuous, comprehensive monitoring which can be provided in an intensive care unit. Our observations suggest that over-vigorous attempts to reverse the hypothyroid state could precipitate tissue hypoxia and/or myocardial ischaemia.
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PMID:Effects of low dose oral triiodothyronine in myxoedema coma. 406 63

Accidental hypothermia, a core temperature below 34 degrees C., is frequently fatal, particularly in the ill and elderly. Traditional treatment methods result in reported mortalities of between 45 and 100 per cent. Despite these terrible statistics, advocates of slow rewarming persist. They cite the shock and vascular collapse which can occur with peripheral dilation as reasons to avoid rapid external rewarming. Isolated successes using internal core rewarming, such as hemodialysis or cardiopulmonary bypass, are spectacular but not practical in the usual clinical situation. By combining methods used for the resuscitation of burn injury with the treatment principles for frostbite, a highly effective treatment protocol results. Agressive fluid resuscitation, rapid immersion rewarming and careful systematic monitoring have been used to treat ten consecutive patients without a single death. Concomitant problems of alcoholism, stroke, myxedema, tuberculosis and paraplegia were also treated. Rapid external rewarming by immersion can result in a low mortality in patients with severe hypothermia.
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PMID:Accidental hypothermia treated without mortality. 740 8

Two clinical cases of endocrinologic emergency are presented: myxedema coma and thyrotoxic crisis. These are very severe situations with a high mortality rate. In myxedema coma it reaches 50% and in thyrotoxic crisis the range is between 25 and 30%. These entities are not the always present in mind because of their rarity. Consequently, they may well be undiagnosed. In our cases, the myxedema coma was initially diagnosed as brainstem stroke, and the hyperthyroidism was taken for concealed malignant tumor. The management of both situations is briefly commented.
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PMID:[Hypothyroid coma and thyrotoxic crisis]. 958 Mar 59

A variety of age-related physiologic factors and disease states predispose older patients to hypothermia. These include a decreased ability to produce heat, malnutrition, medications, infections, and social factors such as isolation and poverty. The subtle clinical signs and symptoms of mild hypothermia may mimic cognitive decline, cerebral vascular accident, hypothyroidism, or myxedema coma. The challenge for the physician is to clinically recognize hypothermia and provide prompt diagnosis and treatment. Medical management of the older patient with moderate to severe hypothermia requires in-hospital intensive care, as life-threatening conditions may arise during stabilization and resuscitation.
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PMID:Hypothermia: an easy-to-miss, dangerous disorder in winter weather. 1002 73

Immortalized in surgical history for the introduction of "antiseptic wax," Sir Victor Horsley played a pivotal role in shaping the face of standard neurosurgical practice. His contributions include the first laminectomy for spinal neoplasm, the first carotid ligation for cerebral aneurysm, the curved skin flap, the transcranial approach to the pituitary gland, intradural division of the trigeminal nerve root for trigeminal neuralgia, and surface marking of the cerebral cortex. A tireless scientist, he was a significant player in discovering the cure for myxedema, the eradication of rabies from England, and the invention of the Horsley-Clarke stereotactic frame. As a pathologist, Horsley performed research on bacteria and edema and founded the Journal of Pathology. Horsley's kindness, humility, and generous spirit endeared him to patients, colleagues, and students. Born to privilege, he was nonetheless dedicated to improving the lot of the common man and directed his efforts toward the suffrage of women, medical reform, and free health care for the working class. Knighted in 1902 for his many contributions to medicine, Sir Victor met an untimely death during World War I from heat stroke at the age of 59. An iconoclast of keen intellect, unlimited energy, and consummate skill, his life and work justify his epitaph as a "pioneer of neurological surgery."
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PMID:Sir Victor Horsley (1857-1916): pioneer of neurological surgery. 1184 30

Endocrine emergencies are commonly encountered in the ICU. This article focuses on several important endocrine emergencies, including diabetic hyperglycemic states, adrenal insufficiency, myxedema coma, thyroid storm, and pituitary apoplexy. Other endocrine issues that are related to intensive care, such as intensive insulin therapy, relative adrenal insufficiency, and thyroid function test abnormalities are also covered in detail.
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PMID:Critical issues in endocrinology. 1471 Jun 92

Diagnosis and management of endocrine crises in adulthood. The homeostasis of the body is regulated by concerted action of the endocrine, nervous and immune systems. An imbalance in this equilibrium, as a consequence of disease or endocrine failure, may lead to crisis, characterized by sudden onset and severe symptoms. The classical endocrine emergencies are rare but life-threatening conditions. Prompt and aggressive treatment significantly reduces mortality. Immediate therapy might be necessitated in cases of suspected endocrine emergencies, even prior to laboratory confirmation. These patients generally require admittance to an intensive care unit. In the present review only the most severe forms of life-threatening endocrine emergencies, including acute adrenal insufficiency, pituitary apoplexy, pheochromocytoma crisis, thyroid storm and myxedema coma will be discussed.
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PMID:[Diagnosis and management of endocrine crises in adulthood]. 1720

Endocrine emergencies constitute only a small percentage of the emergency workload of general doctors, comprising about 1.5% of all hospital admission in England in 2004-5. Most of these are diabetes related with the remaining conditions totalling a few hundred cases at most. Hence any individual doctor might not have sufficient exposure to be confident in their management. This review discusses the management of diabetic ketoacidosis, hyperosmolar hyperglycaemic state, hypoglycaemia, hypercalcaemia, thyroid storm, myxoedema coma, acute adrenal insufficiency, phaeochromocytoma hypertensive crisis and pituitary apoplexy in the adult population.
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PMID:Diabetic and endocrine emergencies. 1730 9


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