scholarly journals Successful Management of Hyperthyroidism With Lithium and Radioiodine in a Patient With Previous Methimazole-Induced Agranulocytosis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A958-A958
Author(s):  
Esther H Fantin ◽  
Iuri Martin Goemann
Keyword(s):  
Side Effects ◽  
Neutrophil Count ◽  
Previous History ◽  
Antithyroid Drug ◽  
Laboratory Evaluation ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Increased Risk ◽  
Definitive Therapy ◽  
History Of

Abstract Introduction: Antithyroid drug (ATD) therapy is the first-line treatment of Graves’ hyperthyroidism. Agranulocytosis, although rare, is a life-threatening condition associated with ATD therapy. For patients who recovered from ATD-induced agranulocytosis, surgery or radioiodine (RAI) therapy are adequate options to restore the patient’s euthyroid state. Here we report a case of ATD-related agranulocytosis where lithium therapy was used before RAI to control thyrotoxicosis and prevent worsening of hyperthyroidism. Case Report: A 74-year-old female with a previous history of hypertension presented with a 2-month history of weight loss (12 lbs), palpitations and shortness of breath. She was afebrile with a heart rate of 110, a blood pressure of 149/80, a fine tremor and a moderate diffuse goiter. She had a normal eye exam. Laboratory evaluation demonstrated TSH <0.01 uIU/mL (0.35-5.5), FT4 3.11 ng/dL (0.51-1.65) and TSH receptor antibody (TRAb) 40 (<1,0 U/L), consistent with thyrotoxicosis due to Graves’ disease. She was started on methimazole (MMI) 15mg and metoprolol. After four weeks, symptoms resolved and thyroid function tests (TFT) improved. However, after two months of treatment, she was hospitalized for fever, diarrhea and abdominal pain. White blood cell count (WBC) was 650/μL, and neutrophil count was 90/μL. A diagnosis of gastroenteritis and agranulocytosis was made and MMI was stopped. After seven days, symptoms resolved, the neutrophil count was 2200/ul and TFT were acceptable (FT4 1.25, ng/dL TT3 1.67 ng/ml, TSH < 0.02 uIU/mL). She was discharged without ATDs and a RAI dose of 20 mCi was scheduled. However, RAI therapy had to be postponed due to COVID-19 pandemic restrictions. After 3 weeks, TFT worsened and therapy with lithium carbonate 300 mg TID was started as the patient refused thyroidectomy. Lithium was initiated 12 days before RAI therapy and was maintained 7 days after the procedure. No side effects associated with lithium treatment were reported. TFT 7 days after RAI were FT4 1.43, ng/dL TT3 2.05 ng/ml and TSH < 0.02 uIU/mL. One month later, the patient was euthyroid without need for thyroid medication and remains on follow up. Discussion: Serum thyroid hormone (TH) concentrations usually increase after RAI therapy for Graves’ disease, a worrisome fact in patients with increased risk for cardiovascular complications. Previous studies report that pre-RAI treatment with lithium prevents changes in serum TH concentrations and enhances RAI therapy’s effectiveness. Here, treatment with lithium was used to control thyrotoxicosis and prevent further increase in TH levels associated with RAI therapy. Lithium is particularly suitable for patients with ATD-related side effects before definitive therapy (radioiodine or thyroidectomy). The antithyroid effect of lithium in this setting should be further studied.

scholarly journals A Case of Antithyroid Drug-Induced Agranulocytosis Pre-Covid 19 Era

2020 ◽  
pp. 1-4
Author(s):  
MosabNouraldein Mohammed Hamad
Keyword(s):  
Side Effects ◽  
Neutrophil Count ◽  
Antithyroid Drug ◽  
Drug Effects ◽  
Medical Advice ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Drug Induced ◽  
Immunological Mechanisms ◽  
Noticeable Reduction

Agranulocytosis is an infrequent and serious side effect of antithyroid drugs characterized by a noticeable reduction in granulocyte and neutrophil count, it usually occurs within the first 2-3 months of treatment. There is a variety of mechanisms by which ATD can induce agranulocytosis, direct drug effects, and immunological mechanisms. We present 33 years old female attended Atbara teaching hospital who has developed agranulocytosis 2 weeks after starting ATD to treat relapsed Graves' disease. What was unusual about this patient is that symptoms have occurred in a period less than 15 days of starting treatment and with a dose of 45 mg /day. The physician must educate the patient about the possibility of early onset of serious side effects of ATD and to seek medical advice as soon as possible.

scholarly journals An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

2021 ◽  
Vol 11 (3) ◽  
pp. 178
Author(s):  
Noah R. Delapaz ◽  
William K. Hor ◽  
Michael Gilbert ◽  
Andrew D. La ◽  
Feiran Liang ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Previous History ◽  
Current Treatment ◽  
Careful Consideration ◽  
P Value ◽  
Post Traumatic Stress ◽  
Increased Risk ◽  
History Of ◽  
Almost All

Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.

Graves’-induced prothrombotic state and the risk of early-onset myocardial infarction

2021 ◽  
Vol 14 (6) ◽  
pp. e243446
Author(s):  
Meilyr Dixey ◽  
Alice Barnes ◽  
Fiqry Fadhlillah
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Plaque Rupture ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Prothrombotic State ◽  
Thrombotic Occlusion ◽  
Increased Risk

Hyperthyroidism represents a state of hypercoagulability and hypofibrinolysis, which predisposes an individual to the increased risk of thromboembolism. We present a case of a 25-year-old patient presenting with an acute myocardial infarction secondary to plaque rupture with thrombotic occlusion of proximal left anterior descending artery, in a patient known to have Graves’ disease. She had a sudden ventricular fibrillation arrest and a precordial thump given and cardiopulmonary resuscitation started. She successfully underwent cardiac catheterisation. Subsequent thyroid function tests showed she was in active thyrotoxicosis.

scholarly journals Carbimazole induced rhabdomyolysis

2021 ◽  
Vol 2021 ◽  
Author(s):  
Niamh O’Donnell ◽  
Aisling McCarthy ◽  
Ken Thong
Keyword(s):  
Adverse Effect ◽  
Creatine Kinase ◽  
Side Effects ◽  
Temporal Relationship ◽  
Early Recognition ◽  
Antithyroid Drug ◽  
Graves Disease ◽  
List Type ◽  
Musculoskeletal Complaints ◽  
Learning Points

Summary Carbimazole is a commonly used antithyroid drug (ATD), which is associated with several well-established side effects. However, Carbimazole-induced rhabdomyolysis is rarely reported in the literature. We report a 27-year-old male who presented with upper limb myalgia and significantly raised creatine kinase elevation, 1-month post commencement of Carbimazole for Graves’ disease. Carbimazole was ceased with subsequent clinical and biochemical improvement. Though the pathophysiology remains unclear, we hope to raise awareness regarding this rare adverse effect with a view to promote early recognition and prompt discontinuation of the offending medication caused by a commonly used medication in endocrinology. Learning points Musculoskeletal complaints can relate to unidentified and untreated hyperthyroidism. However one must be mindful that the treatment for these disorders can too induce myopathies. ATD-induced myopathy should be considered when there is a temporal relationship between introduction of ATDs and the onset of symptoms. If ATD-induced myopathy is being considered, other causes of myopathy should still be outruled. Prompt discontinuation of potentially offending medications may provide resolution of symptoms and avoid significant consequences.

scholarly journals Call for Emergency Room Guidelines to Identify Hyperthyroid Patients Prior to Contrast Imaging

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A922-A923
Author(s):  
Sandhya Bassin ◽  
Louis F Amorosa
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Room ◽  
Definitive Treatment ◽  
Graves Disease ◽  
Contrast Imaging ◽  
Iodinated Contrast ◽  
Increased Risk ◽  
History Of ◽  
The Impact ◽  
Hyperthyroid Patients

Abstract Background: Thyrotoxicosis can be mistaken for conditions such as atrial fibrillation and pulmonary embolism (PE) given the nonspecific symptoms of fatigue, palpitations, and dyspnea. Patients often undergo further imaging on presentation to the emergency room (ER), many of which use iodine for contrast. This can put patients at increased risk for iodine induced hyperthyroidism and delay definitive treatment in patients with Graves’ disease, the most common cause of hyperthyroidism. Clinical Case: A 53-year-old male with history of hyperthyroidism, atrial fibrillation, and prior PE presented with palpitations to the ER. He developed worsening dyspnea on exertion and palpitations over the last three days. He was unable to afford his medications, including methimazole, for the last nine months. In the ER he was in atrial fibrillation with rapid ventricular response. Due to concern for PE, he underwent a CTA with contrast, which was negative. His physical exam was notable for a diffusely enlarged goiter. His labs showed low TSH &lt;0.01 (norm 0.35-5.50mIU/L) and high free T4 &gt;7.77 (norm 0.9-1.8ng/dL). TSH stimulating antibodies were elevated at 1.9 (norm &lt;1.3 TSI index), consistent with Graves’ hyperthyroidism. Endocrinology was then consulted for severe thyrotoxicosis, initially treating the patient with PTU and propranolol. The patient was transitioned to methimazole and continued propranolol on discharge. Since he was given contrast, plan was for repeat thyroid uptake scan and iodine ablation in 3 months. However, patient was not compliant with medications, resulting in readmission for thyrotoxicosis 3 months later. Conclusion: This case highlights the impact of increased use of contrast in imaging in hyperthyroid patients. Hyperthyroid patients are at an increased risk for emboli. However, iodine can cause contrast-induced hyperthyroidism and delay definitive treatment of Graves’ disease. As almost half of thyrotoxic patients receive iodinated contrast prior to an endocrine consultation, endocrinologists should work with emergency physicians to develop a set of guidelines to identify at risk populations for hyperthyroidism (1). We advocate for urgent thyroid testing in patients with new onset atrial fibrillation, a history of Graves’ disease, specific symptoms of Graves’, or those taking thyrotoxic-inducing medications. This will assist in determining if patients should receive a prophylactic dose of anti-thyroid medication prior to iodinated contrast imaging. These guidelines can help prevent contrast induced hyperthyroidism and disruptions in treatment of Graves’ while still imaging patients for other diagnoses on the differential. Reference: (1) Giacomini A, et al. Urgent thyroid-stimulating hormone testing in emergency medicine: A useful tool? J Emerg Med. 2015;49(4):481-487.

Drug Prediction in Healthcare Using Big Data and Machine Learning

2019 ◽  
pp. 79-92 ◽  
Author(s):  
Mamoon Rashid ◽  
Vishal Goyal ◽  
Shabir Ahmad Parah ◽  
Harjeet Singh
Keyword(s):  
Machine Learning ◽  
Big Data ◽  
Data Analysis ◽  
Side Effects ◽  
Previous History ◽  
Distributed File System ◽  
Optimal Drug ◽  
Hadoop Distributed File System ◽  
History Of ◽  
Medicinal Drugs

The healthcare system is literally losing patients due to improper diagnosis, accidents, and infections in hospitals alone. To address these challenges, the authors are proposing the drug prediction model that will act as informative guide for patients and help them for taking right medicines for the cure of particular disease. In this chapter, the authors are proposing use of Hadoop distributed file system for the storage of medical datasets related to medicinal drugs. MLLib Library of Apache Spark is to be used for initial data analysis for drug suggestions related to symptoms gathered from particular user. The model will analyze the previous history of patients for any side effects of the drug to be recommended. This proposal will consider weather and maps API from Google as well so that the patients can easily locate the nearby stores where the medicines will be available. It is believed that this proposal of research will surely eradicate the issues by prescribing the optimal drug and its availability by giving the location of the retailer of that drug near the customer.

When thyroid labs do not add up, physicians should ask patients about biotin supplements

2020 ◽  
Vol 13 (3) ◽  
pp. e231337
Author(s):  
Michael S Lundin ◽  
Ahmad Alratroot ◽  
Fawzi Abu Rous ◽  
Saleh Aldasouqi
Keyword(s):  
Thyroid Function ◽  
Dose Adjustment ◽  
Radioactive Iodine ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Medication List ◽  
Function Tests ◽  
Extensive Evaluation ◽  
History Of ◽  
Radioactive Iodine Ablation

A 69-year-old woman with a remote history of Graves’ disease treated with radioactive iodine ablation, who was maintained on a stable dose of levothyroxine for 15 years, presented with abnormal and fluctuating thyroid function tests which were confusing. After extensive evaluation, no diagnosis could be made, and it became difficult to optimise the levothyroxine dose, until we became aware of the recently recognised biotin-induced lab interference. It was then noticed that her medication list included biotin 10 mg two times per day. After holding the biotin and repeating the thyroid function tests, the labs made more sense, and the patient was easily made euthyroid with appropriate dose adjustment. We also investigated our own laboratory, and identified the thyroid labs that are performed with biotin-containing assays and developed strategies to increase the awareness about this lab artefact in our clinics.

scholarly journals Ventricular tachycardia storm management in a COVID-19 patient: a case report

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6 ◽  
Author(s):  
Gianfranco Mitacchione ◽  
Marco Schiavone ◽  
Alessio Gasperetti ◽  
Giovanni B Forleo
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Arrhythmias ◽  
Cardiac Involvement ◽  
Previous History ◽  
Left Ventricular ◽  
Electrical Storm ◽  
Increased Risk ◽  
History Of ◽  
Myocardial Involvement ◽  
Artery Disease

Abstract Background Coronavirus disease 2019 (COVID-19) has been associated with myocardial involvement. Among cardiovascular manifestations, cardiac arrhythmias seem to be fairly common, although no specifics are reported in the literature. An increased risk of malignant ventricular arrhythmias and electrical storm (ES) has to be considered. Case summary We describe a 68-year-old patient with a previous history of coronary artery disease and severe left ventricular systolic disfunction, who presented to our emergency department describing cough, dizziness, fever, and shortness of breath. She was diagnosed with COVID-19 pneumonia, confirmed after three nasopharyngeal swabs. Ventricular tachycardia (VT) storm with multiple implantable cardioverter defibrillator (ICD) shocks was the presenting manifestation of cardiac involvement during the COVID-19 clinical course. A substrate-based VT catheter ablation procedure was successfully accomplished using a remote navigation system. The patient recovered from COVID-19 and did not experience further ICD interventions. Discussion To date, COVID-19 pneumonia associated with a VT storm as the main manifestation of cardiac involvement has never been reported. This case highlights the role of COVID-19 in precipitating ventricular arrhythmias in patients with ischaemic cardiomyopathy who were previously stable.

scholarly journals Pregnancy outcome in patient who had first trimester bleeding in previous pregnancy: a prospective study

2020 ◽  
Vol 9 (4) ◽  
pp. 1559
Author(s):  
Faswila M. ◽  
Ramya N. R.
Keyword(s):  
Pregnancy Outcome ◽  
Preterm Delivery ◽  
Spontaneous Abortion ◽  
Adverse Pregnancy Outcome ◽  
Placenta Previa ◽  
Previous History ◽  
Fetal Loss ◽  
Previous Pregnancy ◽  
Increased Risk ◽  
History Of

Background: Patient who had history of spontaneous abortion in her previous pregnancy is associated with adverse outcome in her present pregnancy.Methods: A total 63 pregnant women attending OPD and admitted in department of obstetrics and gynecology, Yenepoya Medical College, from April 2017 to September 2017, considered and outcome were studied.Results: Out of 63 patient’s majority (57.1%) of patients belong to the age group 21-29 year. Anemia was found to be very severe in 4.3%, severe in 10% and moderate in 30% patients. Maximum patients (45.7%) were with history of previous one abortion followed by previous two abortions (38.6%). The final outcomes were term livebirth 47 (74.3%), abortion 9 (14.3%), preterm delivery 5 (8.6%), and stillbirth 2 (2.8%) caesarean section (23.3%) for various indications. 19.23% had term PROM, 9.09% had PPROM, 5.76% had term IUGR, 3.84% term IUD, preterm IUD accounts for 9.09% and still birth accounted for about 1.92% which was term, pre-eclampsia accounted for 4.76%, malpresentation for 7.93%, total 3 cases of antepartum hemorrhage out of which  placenta previa accounts for about 3.1% and abruption for 1.58%, manual removal of placenta 4.7% and low birth weight 7.6%.Conclusions: Previous history of spontaneous abortion is associated with adverse pregnancy outcome. There is increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss which can be reduced by booking and giving antenatal care.

scholarly journals Pregnancy with previous caesarean section: an overview of adverse fetomaternal sequelae

2018 ◽  
Vol 7 (5) ◽  
pp. 1817 ◽  
Author(s):  
Joyita Bhowmik ◽  
Amit Kyal ◽  
Indrani Das ◽  
Vidhika Berwal ◽  
Pijush Kanti Das ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Previous History ◽  
Successful Outcome ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Medical College ◽  
Increased Risk ◽  
Fetal Complications ◽  
History Of

Background: The Caesarean section epidemic is a reason for immediate concern and deserves serious international attention. The purpose of this study was to evaluate adverse maternal and fetal complications associated with pregnancies with history of previous caesarean section.Methods: A cross-sectional, observational study carried out over a period of 1 year from 1st June 2016 to 31st July 2017 in Medical College Kolkata. 200 antenatal patients with previous history of 1 or more caesarean sections were included. In all cases thorough history, complete physical and obstetrical examination, routine and case specific investigations were carried out and patients were followed till delivery and for 7 days thereafter. All adverse maternal and fetal complications were noted.Results: Out of 200 women, 30 candidates were tried for VBAC, of them 20 (66.66%) had successful outcome. Most common antenatal complication was APH (5.5%) due to placenta praevia followed by scar dehiscence. There were 12 cases (6.66%) of PPH and 6 cases (3.33%) of scar dehiscence in the study group. 3 cases required urgent hysterectomy due to placenta accreta. 42 out of 196 babies required management in SNCU immediately or later after birth.Conclusions: Women with a prior cesarean are at increased risk for repeat cesarean section. Vigilance with respect to indication at primary cesarean delivery, proper counselling for trial of labor and proper antepartum and intrapartum monitoring of patients are key to reducing the cesarean section rates and maternal complications.

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