Color-flow Doppler sonography in the differential diagnosis and management of amiodarone-induced thyrotoxicosis

2007 ◽  
Vol 48 (6) ◽  
pp. 628-634 ◽  
Author(s):  
M. Loy ◽  
E. Perra ◽  
A. Melis ◽  
M. E. Cianchetti ◽  
M. Piga ◽  
...  
Keyword(s):  
Blood Flow ◽  
Differential Diagnosis ◽  
Clinical Outcome ◽  
Doppler Sonography ◽  
Color Flow ◽  
Therapeutic Choice ◽  
Color Flow Doppler Sonography ◽  
Increased Blood Flow

Background: Amiodarone-induced thyrotoxicosis (AIT) may be caused by excessive thyroidal hormone synthesis and release (type 1) or by a destructive process (type 2). This differentiation is considered essential for therapeutic choice. Purpose: To evaluate the utility of color-flow Doppler sonography (CFDS) in the differential diagnosis and management of AIT. Material and Methods: The clinical and laboratory data, thyroid sonography (grayscale sonography [GSS], CFDS), thyroid radioiodine uptake (RAIU) and thyroid scintigraphy, treatment, and clinical outcome were retrospectively reviewed in 21 AIT patients. The CFDS pattern of thyroid nodules was separately described from that of the perinodular parenchyma, and AIT was classified as type 1 (increased blood flow) or type 2 (low/no blood flow). Type 1 AIT patients were treated with methimazole (alone or associated with potassium perchlorate), while type 2 patients were treated with prednisone or amiodarone withdrawal alone. Results: Eleven patients with increased blood flow were considered as type 1, and 10 with low/no blood flow as type 2. Ten of the 11 patients in the first group showed a hypervascular nodular pattern, while one showed a hypervascular parenchymal pattern. Clinical diagnoses were toxic nodular goiter and Graves' disease, respectively. Of the 10 patients with low/no blood flow, six had normal thyroid volume, three small diffuse goiter, and one small multinodular goiter. The clinical outcome showed that 20 of the 21 patients were treatment responsive. Conclusion: CFDS is a useful tool in the differential diagnosis of AIT. This differentiation appeared to be of clinical relevance as regards therapeutic choice. Separate evaluation of parenchymal blood flow from that of nodules may prove beneficial in the diagnosis of underlying thyroid diseases in patients with type 1 AIT.

scholarly journals Free thyroid hormons ration in patients with amiodaron-induced thyrotoxicosis type 1 and type 2

2018 ◽  
Vol 5 (3) ◽  
pp. 28-35
Author(s):  
E. O. Ulupova ◽  
G. A. Bogdanova ◽  
T. L. Karonova ◽  
E. N. Grineva
Keyword(s):  
Doppler Sonography ◽  
Graves Disease ◽  
Additional Test ◽  
Diagnostic Challenge ◽  
Color Flow ◽  
Serum T4 ◽  
Color Flow Doppler Sonography ◽  
Effect Of Treatment

Differentiation between amiodarone-induced thyrotoxicosis type 1 (AmIT1) and type 2 (AmIT2) is a diagnostic challenge. The current diagnostic tests are often unable to differentiate these two types of thyrotoxic syndrome. Several studies had shown that the serum T4 level and T3/T4 ratio are significantly different in patients with destructive thyroiditis, and those with Graves` disease. These studies showed that the serum T4 concentration is significantly higher, and the T3/T4 ratio is significantly lower in patients with destructive forms of thyroiditis compared to their values  in Graves’ disease. Since AmIT1 is known to develop in patients with latent Graves` disease, and AmIT2 is a destructive thyroiditis, the purpose of our study was to evaluate the serum FТ4 level and FT4/FT3 ratio in AmIT1 and AmIT2 as an additional diagnostic test for differentiating these types of thyrotoxicosis. 45 patients with thyrotoxicosis (33 with AmIT1 and 12 AmIT2) were included in the study. The diagnosis of thyrotoxicosis type (AmIT1 or AmIT2) was established on the basis of clinical data, color flow Doppler sonography (CFDS), the presence of TSH receptor autoantibody in patients with AmIT1, as well as the effect of treatment. There was no difference in FT3 levels in patients with AmIT1 and AmIT2, while the FT4 values were significantly higher in patients with AmIT2 (36,2±19,1 mmol/L) than in those with AmIT1 (17,8±3,7 mmol/L, p= 0,002). Also, a difference in the FT4/FT3 ratio was found between AmIT1 (2,7±0,8) and AmIT2 (6,1±5,7, p=0,048). Moreover, 75% of patients with AmIT1 had FT4/FT3ratio < 3,10, while 75% of patients with AmIT2 had FT4/FT3 ratio > 3,65. The FT4/FT3 ratio can be used as an additional test in the differential diagnosis AmIT1 and AmIT2.

scholarly journals Hepatorenal Syndrome

2021 ◽  
Author(s):  
Arshpal Gill ◽  
Ra’ed Nassar ◽  
Ruby Sangha ◽  
Mohammed Abureesh ◽  
Dhineshreddy Gurala ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Blood Flow ◽  
Mortality Rate ◽  
Kidney Injury ◽  
Type I ◽  
Tubular Necrosis ◽  
Cirrhotic Patients

Hepatorenal Syndrome (HRS) is an important condition for clinicians to be aware of in the presence of cirrhosis. In simple terms, HRS is defined as a relative rise in creatinine and relative drop in serum glomerular filtration rate (GFR) alongside renal plasma flow (RPF) in the absence of other competing etiologies of acute kidney injury (AKI) in patients with hepatic cirrhosis. It represents the end stage complication of decompensated cirrhosis in the presence of severe portal hypertension, in the absence of prerenal azotemia, acute tubular necrosis or others. It is a diagnosis of exclusion. The recognition of HRS is of paramount importance for clinicians as it carries a high mortality rate and is an indication for transplantation. Recent advances in understanding the pathophysiology of the disease improved treatment approaches, but the overall prognosis remains poor, with Type I HRS having an average survival under 2 weeks. Generally speaking, AKI and renal failure in cirrhotic patients carry a very high mortality rate, with up to 60% mortality rate for patients with renal failure and cirrhosis and 86.6% of overall mortality rates of patients admitted to the intensive care unit. Of the various etiologies of renal failure in cirrhosis, HRS carries a poor prognosis among cirrhotic patients with acute kidney injury. HRS continues to pose a diagnostic challenge. AKI can be either pre-renal, intrarenal or postrenal. Prerenal causes include hypovolemia, infection, use of vasodilators and functional due to decreased blood flow to the kidney, intra-renal such as glomerulopathy, acute tubular necrosis and post-renal such as obstruction. Patients with cirrhosis are susceptible to developing renal impairment. HRS may be classified as Type 1 or rapidly progressive disease, and Type 2 or slowly progressive disease. There are other types of HRS, but this chapter will focus on Type 1 HRS and Type 2 HRS. HRS is considered a functional etiology of acute kidney injury as there is an apparent lack of nephrological parenchymal damage. It is one several possibilities for acute kidney injury in patients with both acute and chronic liver disease. Acute kidney injury (AKI) is one of the most severe complications that could occur with cirrhosis. Up to 50% of hospitalized patients with cirrhosis can suffer from acute kidney injury, and as mentioned earlier an AKI in the presence of cirrhosis in a hospitalized patient has been associated with nearly a 3.5-fold increase in mortality. The definition of HRS will be discussed in this chapter, but it is characterized specifically as a form of acute kidney injury that occurs in patients with advanced liver cirrhosis which results in a reduction in renal blood flow, unresponsive to fluids this occurs in the setting of portal hypertension and splanchnic vasodilation. This chapter will discuss the incidence of HRS, recognizing HRS, focusing mainly on HRS Type I and Type II, recognizing competing etiologies of renal impairment in cirrhotic patients, and the management HRS.

scholarly journals The structural and functional features of the microcirculatory bed in patients with arterial hypertension and type 2 diabetes mellitus

2005 ◽  
Vol 11 (3) ◽  
pp. 177-180 ◽  
Author(s):  
L. A. Lohankova ◽  
Yu. V. Kotovskaya ◽  
A. S. Milto ◽  
Zh. D. Kobalava
Keyword(s):  
Diabetes Mellitus ◽  
Blood Flow ◽  
Arterial Hypertension ◽  
Control Group ◽  
Microcirculatory Bed ◽  
Type 2 Dm ◽  
Group A ◽  
Functional Features

The structural and functional features of the microcirculatory heel (MCB) were studied in patients with arterial hypertension (AH) in relation to the presence or absence of type 1 diabetes mellitus (DM). Two hundred and twelve patients were examined. These included 110 patients with grades 1 and 2 arterial hypertension (AH) and type 2 DM, 82 patients with AH without type 2 DM, and 20 apparently healthy individuals. Laser Doppler flowmetry (LDF) was used to estimate basal blood flow, the loading test parameters characterizing the structural and functional status of MCB, and the incidence of hemodynamic types of microcirculation. Patients with AH concurrent with type 1 DM were found to have the following microcirculatory features: an increase in perfusion blood flow (microcirculation index, 8,8±1,8 perf. units versus 4,9±0,8 perf, units in patients with AH without DM and 6,7±0,9 perf. units in the control group), a drastic reduction in myogenic activity to 13,2±5,7 % versus 16,7±6,8 and 25,2±6,4 %, respectively, a decrease in vascular resistance, impairment of autoregulation, and low reserve capacities (reserve capillary blood flow was 197,8±31,6 % versus 429,9±82,01 % in the group of AH without DM and 302,8±50,1 % in the control group), a predominance of the hyperemic hemodynamic type (58,8 % in patients with AH and DM, 20,9 % in those with AH without DM, and 20,0 % in the controls). The specific features of the altered microcirculatory bed in patients with AH concurrent with type 2 DM were ascertained. These included the predominance of hyperemic microcirculation, impaired autoregulation. diminished microvascular resistance, and the low reserve capacities of the microcirculatory bed.

PROBLEM OF DIFFERENTIAL DIAGNOSIS IN INFANTS WITH LARGE HEARTS AND INCREASED BLOOD FLOW TO THE LUNGS

PEDIATRICS ◽  
1954 ◽  
Vol 13 (1) ◽  
pp. 30-40
Author(s):  
CHARLOTTE FERENCZ ◽  
ARNOLD L. JOHNSON ◽  
ALTON GOLDBLOOM
Keyword(s):  
Blood Flow ◽  
Differential Diagnosis ◽  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Pulmonary Veins ◽  
Heart Catheterization ◽  
Radiologic Findings ◽  
The Right ◽  
Increased Blood Flow ◽  
Patent Ductus

This paper deals with the differential diagnosis of the cardiac lesion in infants who have enlargement of the heart associated with increased blood flow to the lungs, and in whom cyanosis is not a prominent feature. Some patients in this group have a patent ductus arteriosus in the absence of a typical continuous murmur, and these infants may urgently require the benefits of surgical therapy. Since the diagnosis can be established by aortography or heart catheterization, some criteria are required for the better selection of infants from this group in whom these investigations should be performed. Twenty-five infants form the subject of this study. In 19 the diagnosis was confirmed at autopsy. Eight patients had a patent ductus, either as an isolated lesion or in association with other defects; 10 had ventricular septal defects with or without overriding of the aorta; 5 had anomalous pulmonary vein drainage; one had an ostium atrioventricular communis and in one there was a functional single ventricle. Clinical, electrocardiographic and radiologic findings were analyzed. Important features which appear to favour the diagnosis of patent ductus arteriosus are full or collapsing pulses and a normal ECG or one showing evidence of combined ventricular hypertrophy. Suggestive, but of lesser importance, is the finding of an apical diastolic rumble and enlargement of the left atrium. All these findings may, however, be present in patients with other malformations, especially defects involving the ventricular septum. Evidence of marked hypertrophy of the right atrium and right ventricle by electrocardiography and fluoroscopy renders the presence of patent ductus unlikely and is consistent with the diagnosis of anomalous drainage of pulmonary veins.

Color Flow Doppler Sonography in the Diagnosis of Vesicoureteric Reflux

1994 ◽  
Vol 26 (1) ◽  
pp. 93-97 ◽  
Author(s):  
Mustafa Salih ◽  
Sümer Baltaci ◽  
Sahir Kiliç ◽  
Kadri Anafarta ◽  
Yaşar Bedük
Keyword(s):  
Doppler Sonography ◽  
Vesicoureteric Reflux ◽  
Color Flow ◽  
Color Flow Doppler Sonography
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