Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 30-year old woman with a history of recurrent goiter, who had undergone two partial thyroidectomies, is described. She presented with tachycardia, nervousness and a fine tremor of the fingers. Initially, she had normal serum thyroid hormone levels: thyroxine (T4 (D)) 11.6 MUG/100 ML, TRIIODOTHYRONINE (T3) 138 ng/100ml, normal levels of binding proteins and a very high serum thyrotropin (TSH), 98 muU/ml. During follow-up T4 (D) increased to 17.2 mug/100 ml, T3 increased to 277 ng/100 ml, while TSH decreased to 11 muU/ml. There was an exaggerated response of TSH to a peak value of 550 muU/ml after intravenous administration of 200 mug thyrotropin-releasing hormone (TRH). Administration of 60 mg prednisolone daily resulted in a blunting of the response to TRH. Administration of 50 mug T3 daily for 1 month resulted in a fall in serum TSH from 98 to 50 muU/ml. Later, when the serum TSH level had fallen spontaneously to 20 muU/ml, administration of 100 mug T3 daily for two weeks resulted in a fall in serum TSH to 5.3 muU/ml. Treatment with 20 mg carbimazole daily for 3 weeks resulted in a decrease in serum T4 levels with a concomitant increase of serum TSH. There was no evidence of pituitary enlargement and other pituitary hormone levels were normal. All the relatives studied (father, sister, three children) had elevated T4 levels with normal basal TSH values. It is concluded from this study that our patient presents evidence of partial resistance to thyroid hormones.
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PMID:Familial partial target organ resistance to thyroid hormones. 6 Mar 46

In hyperthyroidism we differentiate two main forms: (1) hyperthyroidism due to Basedow's (Graves') disease, always characterized by endocrine eye signs, frequently with goiter; (2) hyperthyroidism due to nodular goiter or to Plummers' disease, without endocrine exophthalmos. The clinical diagnosis includes typical complaints (e.g., weight loss, heat intolerance, sweating) and findings (e.g., tachycardia, tremor, soft-warm skin). The technical diagnosis includes in vivo (scintigraphy, RI-uptake, X-ray examination) and in vitro (T3-RIA, T4-assay, TRH response to TRH) tests.
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PMID:[Hyperthyroidism: diagnosis (author's transl)]. 10 1

Two patients had ocular myasthenia gravis coexistent with Hashimoto's thyroiditis. A 37-year-old woman presented with diplopia and displayed a head tremor and thyroid enlargement. Thyroid function tests showed an elevated thyroid stimulating hormone (TSH). A quantitative Tensilon test yeilded a "perverse" response and a needle biopsy indicated Hashimoto's disease. A 26-year-old woman presented with diplopia and subsequently developed blepharoptosis and thyroid enlargement. Examination revealed Cogan's eyelid twitch sign, a paradoxical quantitative Tensilon test, and laboratory studies revealed normal thyroid function tests. Treatment was directed at each disease entity separately. Ocular myasthenia gravis was managed with an anticholinesterase agent in combination with oral corticosteroids that provided additional control. Suppressive therapy with desiccated thyroid hormone reduced the size of the thyroid gland, diminished the signs and symptoms of hypothyroidism, and lowered the levels of TSH, possibly decreasing the risk of thyroid carcinoma. Both patients showed gratifying responses to therapy.
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PMID:Ocular myasthenia gravis and Hashimoto's thyroiditis. 117 40

A lithium long-term catamnesis of 124 patients (107 manic-depressive and 17 schizoaffective psychoses) after more than 8 years of lithium prophylaxis led to the following results: 1.) Recovering: 30.3%. Improvement - particularly mitigation of the episodes of illness -: 56%. Lack of efficiency: 13%. Mean incidence of episodes of illness before lithium 0.57 per year, during lithium 0.36. Mean incidence of hospitalisation before lithium 3.4 years, during Lithium 7.1 years. Deterioration following discontinuation of lithium: 21 of 22 cases. 2.) Side effects at the beginning: 61.2%, finally 42.7% (incidence of struma 19.5% of tremor 19%, of polydipsia/polyuria 9.1%). 3.) EEG changes (general slowing-down and dysrhythmia, to a quarter focally accentuated): 59%. 4.) Normal results of haematologic and clinical-chemical investigations (28 parameter) except serum creatinine (10%), creatinine clearance (20.5%) and leucocytosis (13%). The authors discuss the reduced incidence of recovery and the quantity of side effects based on the aspect of long-term catamnesis. Further studies are necessary with regard to the selection of lithium-treated patients, to the duration of prophylaxis without efficiency and to the shift from initial efficiency to later inefficiency.
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PMID:[Long-term catamnesis on the topic of uses and side effects of lithium prevention of phasic psychoses]. 250 26

An 11-year-old girl with diffuse goiter is presented. She had no clinical evidence of thyrotoxic symptoms or signs of palpitation, excessive sweating, tachycardia or finger tremor. Both the serum T4 (24.0 micrograms/dl) and T3 (282ng/dl) were high, and thyroid 131I uptake rate (63.2%) was significantly elevated, but T3/T4 ratio was not elevated (11.8). BMR was measured three times and remained within normal limits. Her serum TSH was 1.9 microU/ml, and a TRH stimulation test resulted in a normal rise of serum TSH (13.4 microU/ml). The TSH secretion was not suppressed by medication (p.o.) of 75 micrograms of L-triiodothyronine given for 8 days. The autoantibodies of T4, T3 and TSH were negative. No sign of pituitary tumor was observed by plain X-ray film. No defect in her sight-field was found. From these clinical figures and data, Refetoff's syndrome was suspected. She was eumetabolic without any treatment, but the goiter gradually enlarged and dysphagia developed. A large dose of L-thyroxine (450 micrograms/day) was given for a period of one year and four months. She has been eumetabolic. Her goiter disappeared and the dysphagia completely subsided. After she was given large doses of L-T4, her serum TSH was reduced to 0.07 microU/ml and was slightly elevated to 0.24 microU/ml at 30 min after i.v. infusion of 500 micrograms TRH. Thyroid 123I uptake rate was suppressed to 8.3%. According to Refetoff's papers, this case was classified as being in the group with generalized resistance to thyroid hormone.
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PMID:[A case report of Refetoff's syndrome]. 259 12

A 22-year old man with a goiter and clinical manifestations of mild thyrotoxicosis (finger tremor, palpitation, tachycardia) was diagnosed as a syndrome of inappropriate secretion of TSH. Serum concentrations of T4, free T4, T3 and TSH were 24.1 micrograms/100 ml, 4.07 ng/100 ml, 261 ng/100 ml and 1.72 microU/ml, respectively. Thyroidal 131I uptake at 24 hr was 80%. The BMR was within the normal range. He had a normal TSH response to TRH (500 micrograms) with a peak level of 23.8 microU/ml. The basal level of alpha-subunit of TSH was not elevated (0.35 ng/ml). Oral 1-T3 administration (75 and 150 micrograms daily) raised serum T3 concentration, reduced basal TSH and blunted TSH response to TRH. The diurnal variation of TSH was maintained. There was no evidence of abnormalities in the secretion of other pituitary hormones. These findings were compatible with thyroid hormone resistance. However, the presence of a microadenoma in the pituitary gland was suspected with CT scan. Bilateral and simultaneous venous sampling for TSH from inferior petrosal sinus showed no gradient in TSH concentration indicating that a TSH secreting pituitary tumor was unlikely. These data suggest that inappropriate TSH secretion in the present patient is resulted from resistance to thyroid hormone. In the present study selective venous sampling is useful to differentiate the thyroid hormone resistance from a TSH secreting tumor.
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PMID:A case of refetoff syndrome: selective venous sampling for TSH is useful in differentiating thyroid hormone resistance from TSH secreting tumor. 271 78

A 57-year-old woman presented with palpitations, muscle weakness, bilateral proptosis, goiter, and tremor. The thyroxine (T4) level and the free T4 index were increased while the total triiodothyronine (T3) level was normal. Iodine 123 uptake was increased, and a scan revealed an enlarged gland with homogeneous uptake. Repeated studies again revealed an increased T4 level and free T4 index and normal total and free T3 levels. A protirelin test showed a blunted thyrotropin response. Treatment with propylthiouracil was associated with disappearance of symptoms and normal T4 levels, but after 20 months of therapy, hyperthyroidism recurred and the patient was treated with iodine 131. This was an unusual case of T4 toxicosis because the patient was not elderly and was not exposed to iodine-containing compounds or drugs that impair T4-to-T3 conversion. There was no evidence of abnormal thyroid hormone transport or antibodies.
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PMID:A case of thyroxine thyrotoxicosis. 357 39

The most frequent clinical manifestations in 100 elderly hyperthyroid patients entered in our study were: weight loss (83%), palpitations (85%), nodular goiter (71%) and tremor (74%). Association of weight loss with anorexia and constipation was found in 6% of the patients. The apathetic form of thyrotoxicosis was present in 2% of our patients. Thyrotoxic atrial fibrillation and thyrotoxic heart disease were found in 42% and 51% respectively.
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PMID:Hyperthyroidism in the elderly. I. Clinical manifestations. 383 36

We describe a 29-year-old male with thyroid hormone resistance. He was first seen because of a goiter, and was considered to have hyperthyroid Graves' disease. Despite subtotal thyroidectomy followed by radioiodine therapy, serum thyroxine levels were elevated with high serum TSH levels. Baseline thyroid function showed serum thyroxine of 16.6 micrograms/dl, free thyroxine of 4.60 ng/dl, triiodothyronine of 197 ng/dl, and TSH of 34 microU/ml. Triiodothyronine administration by gradually increased doses of 75, 150, 225, 300, and 375 micrograms/d over a 25-day period resulted in gradual reduction of serum TSH and T4 levels, but serum TSH still responded to TRH even during this period. The basal metabolic rate was--14% and showed a minimal rise even with large doses of triiodothyronine. The results led to the diagnosis of generalized thyroid hormone resistance including the pituitary gland. Increased pulse rate, finger tremor and emotional lability in the patient suggest that the severity of peripheral refractoriness to the hormone may vary from tissue to tissue. In addition, a reduced thyroidal responsiveness to TSH as a consequence of inappropriate radioiodine therapy was observed in this patient.
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PMID:Resistance of peripheral tissues and pituitary to thyroid hormone. 644 Jul 79

The clinical value of the determination of 123I concentration in serum 48 hrs after tracer administration (123I)48 is investigated with special regard to thyroidal autonomy. Serum radioiodine concentration, thyroid radioiodide uptake at 4 and at 48 hrs were measured in 74 healthy subjects and patients with simple goiter, in 36 patients with thyroidal autonomy (diagnosis by thyroid suppression test), and in 20 hyperthyroid patients. 83% of the patients with elevated radioiodine concentration belonged to the group of thyroidal autonomy. The product of radioiodine concentration and thyroid radioiodide uptake is a much better parameter. 95% of the patients in which this product was elevated, belonged to the autonomy group (5% diagnostic error). Also in the control group the diagnostic error was 5%. The combination of (123I)48 with the result of the TRH-test is very useful in excluding thyroidal autonomy, if (123I)48 is normal and the TRH-test is positive (100% of the patients have regulated thyroid glands). 94% of the patients having elevated (123I)48 and a negative TRH-test belonged to the group of thyroidal autonomy. A very useful combination for the diagnosis of borderline hyperthyroidism is the determination of the product of (123I)48 and the uptake48 together with the pulse rate or fine tremor of the fingers (or TRH-test). The results suggest that the determination of (123I)48 is a very good parameter of thyroidal autonomy beside the thyroid suppression test. It may be used alone for the diagnosis of thyroidal autonomy if the suppression test is contraindicated. In the diagnosis of borderline hyperthyroidism its determination makes the suppression test unnecessary in many instances.
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PMID:Clinical significance of endogenously labelled thyroid hormones in the diagnosis of thyroidal autonomy. 663 20


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