1.
Thyrotoxic hypokalemic periodic paralysis: two case reports and a brief review of literature.
Shah, M, Mutneja, R, Vyas, D, Trivedi, R, Silverstein, N
Connecticut medicine. 2013;(8):487-9
Abstract
Thyrotoxic Hypokalemic Periodic Paralysis (THPP) is a rare complication of thyrotoxicosis and can sometimes be fatal. It needs early recognition for proper management and prevention of recurrences. Here we describe two cases presenting with acute onset of paresis, low potassium levels, low levels of thyroid-stimulating hormones (TSH), and elevated thyroid hormone levels.
2.
Diagnostic confusion attributable to spurious elevation of both total thyroid hormone and thyroid hormone uptake measurements in the setting of autoantibodies: case report and review of related literature.
Pietras, SM, Safer, JD
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2008;(6):738-42
Abstract
OBJECTIVE To review the effect of thyroid autoantibodies on thyroid function assays and to present a case in which thyroid autoantibodies resulted in spurious assay readings for both total thyroid hormone levels and thyroid hormone uptake measurements. METHODS We present a detailed case, including serial laboratory data, and review the relevant literature. RESULTS A 61-year-old man with a history of autoimmune disease presented for evaluation of abnormal results of thyroid function tests. The patient had been treated for hypothyroidism with levothyroxine and was noted to have an elevated total thyroxine (T4) level in the setting of a low total triiodothyronine (T3) value and a mildly elevated thyrotropin concentration. He had been referred for evaluation of a presumed deiodinase deficiency that impaired conversion of T4 to T3. During treatment with levothyroxine, these test results were confirmed, and the patient was also found to have an elevated T4 uptake. These findings were initially thought to be due to an excess of transthyretin; however, more extensive testing revealed that the patient had an autoantibody to T4 that interfered with the assays for both T4 and T4 uptake. CONCLUSION Autoantibodies to both T3 and T4 have been described. Such antibodies are not uncommon in patients with thyroid disease. On rare occasions, these antibodies may cause spurious assay readings and obscure the diagnosis. To our knowledge, this is the first report in which both the total T4 level and the T4 uptake were elevated because of the presence of autoantibodies. Thyroid hormone autoantibodies must be considered when clinicians encounter patients with unexplained abnormal results of thyroid function tests.
3.
"Thyrotoxic psychosis" associated with subacute thyroiditis.
Rizvi, AA
Southern medical journal. 2007;(8):837-40
Abstract
Severe psychiatric derangements are a rare manifestation of Graves disease or toxic goiter. An 18-year-old male college student was hospitalized with depression and psychotic behavior. He was found to have thyrotoxicosis due to subacute thyroiditis, as evidenced by a reduced radioactive iodine uptake, elevated thyroglobulin level, and spontaneous remission into a hypothyroid phase. His behavioral abnormalities resolved with progressive normalization of thyroid function. To our knowledge, this is the first reported case of the self-limited condition of subacute thyroiditis causing 'thyrotoxic psychosis' and serves to remind clinicians of this association when treating patients in clinical practice.
4.
Amiodarone-induced thyrotoxicosis type 2: a case report and review of the literature.
Benbassat, CA, Mechlis-Frish, S, Cohen, M, Blum, I
The American journal of the medical sciences. 2000;(4):288-91
Abstract
Amiodarone-induced thyrotoxicosis (AIT) is not an uncommon complication in countries with low iodine intake. Two types of AIT have been described. Type 1 is associated with an underlying disorder of the gland that becomes clinically evident because of the high intrathyroidal iodine content, which acts as a trigger for hyperthyroidism. Type 2 is characterized by an ongoing inflammatory process of the thyroid, with derangement of the parenchyma causing the release of thyroid hormones into the circulation. Yet, there are no definitive tools for the differential diagnosis of these two entities, and the therapeutic approach is still a subject of controversy. A case of AIT type 2 successfully treated with steroids is described followed by a review of the literature.