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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical manifestations of hyperthyroidism have suggested to physicians for many years that the sympathetic nervous system may be involved in their production. Despite this, the precise interrelationship between the thyroid gland and the sympathetic nervous system has never been defined but controlled investigations have shown that hypersensitivity to catcholamines does not occur in animals or man with artificially produced thyrotoxicosis. In recent years beta-adrenoceptor blocking drugs, and in particular propranolol, have been used in patients with hyperthyroidism. Evidence exists that they control some of the peripheral manifestations of the disease, including nervousness, palpitations, tachycardia, increased cardiac output and tremor, but they do not appear to affect the underlying thyrotoxic process itself. Propranolol has been used with sucess in the treatment of acute hyperthyroid crisis, in pre-operative preparations for thyroidectomy, for the control of symptoms and signs following the administration of radioactive iodine therapy and antithyroid drugs, during the period of diagnostic thyroid investigations and occasionally as the sole therapy. The supportive role of propranolol in the management of hyperthyroidism is now established and in some instances such as radioactive iodine therapy, it has enabled improvements in the existing methods of treatment to be achieved.
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PMID:Propranolol in the treatment of thyrotoxicosis: a review. 6 85

1. In hypertension, the beta-adrenoreceptor-blocker-withdrawal syndrome comprises tachycardia, sweating, tremor and general malaise, symptoms resembling thyrotoxicosis. 2. The effect of abrupt cessation of propranolol on serum concentrations of thyroxine (T4) and triiodothyronine (T3) was therefore investigated in five patients with uncomplicated essential hypertension, treated with propranolol in doses from 160 to 480 mg/day. 3. Four of the five patients developed one or more of the above-mentioned symptoms within 2-6 days after withdrawal of propranolol. 4. A mean relative increase in serum free T3 of 51% (range 22-74%) was found in these four patients on the day of onset of symptoms. 5. The increase in free T3 in the five patients correlated positively with total serum propranolol on the last day the drug was given (r = 0.91, 2P = 0.03). 6. As an increase in T3 was found only in patients suffering the withdrawal syndrome, and was maximal the day the symptoms appeared, despite a variation in time of onset from 2 to 6 days, it is suggested that the beta-adrenoreceptor-blocker-withdrawal syndrome, at least partially, is caused by rebound increased production of T3, induced by the well-known inhibition of the monodeiodination of T4 to T3 during beta-adrenoreceptor blockade. 7. This assumption may explain the clinical symptoms and the reported transient increased beta-adrenoreceptor sensitivity with unchanged serum concentrations of catecholamines.
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PMID:The pathogenesis of propranolol-withdrawal syndrome in essential hypertension. 54 Apr 62

Thirty patients with thyrotoxicosis were randomly divided into 3 groups of ten which were treated for 8 weeks with either practolol, propranolol or placebo. The pills were administered in a double blind manner and the investigator had the option of doubling the dose at each visit. Propranolol and practolol were equally effective, and better than placebo, at relieving the patients general well-being as well as the tachycardia, subjective and objective tremor, skin warmness and moistness and the intensity of the thyroid bruit.
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PMID:The effects of propranolol, practolol, and placebo on the clinical manifestations of thyrotoxicosis. 79 3

1. The effects of thyroxine treatment on soleus and extensor digitorum longus (EDL) muscle contractions and their cyclic adenosine 3',5'-monophosphate (cyclic AMP) levels were examined in anaesthetized cats. 2. Thyroxine treatment decreased the tension of incomplete tetanic contractions of the soleus as well as the EDL muscles. The effect on tension of these muscles was not associated with an increase in the cyclic AMP level of the muscle as is the case with a beta 2-adrenoceptor agonist effect. 3. The results do not support the involvement of cyclic AMP in the tension depressant effect of thyroxine on contractions of skeletal muscle. 4. It is suggested that the muscle weakness and tremor observed in thyrotoxicosis and during administration of beta 2-adrenoceptor agonists are mediated by different mechanisms.
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PMID:The effects of thyroxine treatment on slow- and fast-contracting skeletal muscle contractions of the cat and their cyclic AMP level. 133 82

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

The effects of nadolol (or placebo) and carbimazole on thyrotoxic tremor were investigated in 18 thyrotoxic patients. Both nadolol and carbimazole produced significant reductions in tremor power although nadolol did not cause any change in serum free tri-iodothyronine and free thyroxine concentrations. The results are discussed in terms of the pathogenesis of thyrotoxic tremor and the potential usefulness of tremor in the investigation of adrenergic mechanisms in thyrotoxicosis.
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PMID:Tremor: an alternative approach for investigating adrenergic mechanisms in thyrotoxicosis? 286 58

Retrospective clinical studies of 211 thyreotoxic patients having received 131I-therapy were performed and processed by computer. The patients' mean age was 58 years, the male-female ratio 7.1 to 1. The incidence of symptoms and associated diseases was in agreement with data in the literature. Of the clinical symptoms, weight loss, weakness, fatigability, a fine tremor, decompensation and nervousness, called attention to the condition. Of the ECG changes, an absolute arrhythmia of atrial fibrillation and extrasystole may be indicative of hyperthyroidism. Clinically, there is an essential difference between juvenile and old-age thyrotoxicosis. Differences could also be noted between patients with toxic adenoma and those with non-toxic one. Toxic adenoma patients were more advanced in age and the female-male ratio was higher than in non-toxic cases. Absolute arrhythmia of atrial fibrillation, extrasystole, repolarization disorders, diabetes, hypertension and arteriocardiosclerosis occurred more often, while ophthalmopathy and immune disease were less frequent. The clinical picture may raise the suspicion of old-age thyrotoxicosis. Following laboratory diagnosis, treatment should be administered without delay.
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PMID:Experience with 131I-therapy. Hyperthyroidism in old age. 367 Oct 18

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

The speed of the ankle jerk and physiological finger tremor in patients with thyrotoxicosis and myxoedema have been compared with those in age-matched control subjects. Tremor amplitude depends on the speed of muscle contraction; the faster muscle contracts the greater is the amplitude of tremor, and vice versa. The frequency of the dominant tremor peak is not affected by the speed of contraction but its size increases as muscle contracts faster. Muscle dynamics is clearly one of many factors influencing physiological tremor but is not responsible for the dominant frequency of tremor at round 9 c/sec.
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PMID:Effect of speed of muscle contraction on physiological tremor in normal subjects and in patients with thyrotoxicosis and myxoedema. 549 77

Alpha methyltyrosine (alpha-MPT) was administered to 52 patients from 4 days to 10 months; 22 patients were cases of pheochromocytoma and 20 had essential hypertension. Inhibition of catecholamine synthesis in the range of 50-80% was achieved with divided daily drug dosage of from 1.0 to 4.0 g. Striking clinical benefit was noted in patients with pheochromocytoma in whom the drug was used in preparation for surgery and during chronic medical management. The drug appeared to have limited usefulness when used in essential hypertension, unless added to existing therapy with conventional agents. No beneficial effects were noted in thyrotoxicosis, glaucoma, and Raynaud's phenomenon. Untoward effects in order of decreasing incidence were: sedation (with insomnia on withdrawal), anxiety, tremor, diarrhea, and galactorrhea. Drug crystalluria, which has been observed in animals and is currently restrictive of clinical trials, was not observed in these studies. Evidence is presented that the minor conversion of alpha-MPT to methyldopa probably does not contribute significantly to the central and peripheral effects of the drug.
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PMID:Biochemical and pharmacologic effects of alpha-methyltyrosine in man. 563 45


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