Epidemiology
Physiology
Diagnosis
Clinical
Pulmonary Manifestations
Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]])
- The association between thyroid diseases (hypothyroidism and hyperthyroidism) and PH has been reported in a number of studies (127,128). In a recent prospective study using echocardiographic evaluation, more than 40% of patients with thyroid diseases had PH (129)
- One instance of PVOD confirmed by histology was observed in a patient with Hashimoto thyroiditis (130).
- Interestingly, a recent prospective study of 63 consecutive adult patients with PAH found a 49% prevalence of autoimmune thyroid disease, including both hypothyroidism and hyperthyroidism, suggesting that these conditions may be linked by a common immunogenetic susceptibility (131)
Acute/Chronic Hypoventilation (see Acute Hypoventilation, [[Acute Hypoventilation]] and Chronic Hypoventilation, [[Chronic Hypoventilation]])
Cardiac Manifestations
Hematologic Manifestations
- Anemia (see Anemia, [[Anemia]])
Treatment
References
- 127 Li JH, Safford RE, Aduen JF, Heckman MG, Crook JE, Burger CD. Pulmonary hypertension and thyroid disease. Chest 2007;132:793–7
- 128 Ferris A, Jacobs T, Widlitz A, Barst RJ, Morse JH. Pulmonary
arterial hypertension and thyroid disease. Chest 2001;119:1980–1
- 129 Mercé J, Ferra ́s S, Oltra C, et al. Cardiovascular abnormalities in hyperthyroidism: a prospective Doppler echocardiographic study. Am J Med 2005;118:126–31.
- 130 Kokturk N, Demir N, Demircan S, et al. Pulmonary veno-occlusive disease in a patient with a history of Hashimoto’s thyroiditis. Indian J Chest Dis Allied Sci 2005;47:289–92.
- 131 Chu JW, Kao PN, Faul JL, Doyle RL. High prevalence of autoimmune thyroid disease in pulmonary arterial hypertension. Chest 2002;122:1668 –73
Thyrotoxicosis
Epidemiology
Etiology
Inadequately-Treated Grave’s Disease
- Precipitants:
- Sepsis:
- Medical Illness:
- Iodine Load-Contrast:
- Post-Thyroidal Surgery:
- Post-Non-Thyroidal Surgery:
- Exogenous Thyroid Intake:
- Toxic Nodular Goiter:
- Thyroiditis:
- Thyroid Adenoma:
- Thyroid Cancer:
Diagnosis
- TFT’s:
- TSH: decreased
- Free and total T4: increased
- Free and total T3: increased (usually more than serum T4)
Clinical
- Neuro
- Irritability:
- Delirium:
- Coma:
- Fever:
- Hyperreflexia:
- Cardiac
- Tachycardia:
- Hypotension:
- High-Output CHF:
- GI
Treatment
Supportive Care
- Hydration:
- B-complex vitamins:
- Digoxin (for AF):
Therapy #1: Beta-Blockers
- Propanolol is the best studied, but Esmolol is also effective
- Propanolol blocks beta receptors, as well as partially inhibiting conversion of T4->T3
- Relief of symptoms usually occurs within minutes
- Useful if CHF is absent
Therapy #2: PTU (100 mg every 2 hours PO) or Methimazole
- Effect may take weeks
- Blocks T4 and T3 synthesis (within 2 hrs), as well as peripheral conversion of T4->T3
Therapy #3: Potassium Iodide (SSKI) or Lugol Solution
- Works almost immediately
- Give at least 1 hr after beta blockers + PTU to prevent iodine from being used as substrate by hyperfunctioning gland
- Blocks hormone release and peripheral conversion
Therapy #4: Dexamethasone (2 mg IV q6 hours)
- Aids decreased adrenal reserve that may be present, inhibits hormone release, and inhibits peripheral conversion from T4 to T3
Clinical Course
- With treatment with PTU, iodide, and dexamethasone, T3 usually returns to normal within 24-48 hrs