scholarly journals Transdermal Absorption of Methimazole- a Cat’s Tale

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A969-A969
Author(s):  
Ashima Mittal ◽  
Murray B Gordon
Keyword(s):  
Total Thyroidectomy ◽  
Thyroid Function ◽  
Close Contact ◽  
Thyroid Tissue ◽  
Follicular Adenoma ◽  
Thyroid Function Tests ◽  
Transdermal Administration ◽  
Transdermal Absorption ◽  
The Past ◽  
History Of

Abstract Introduction: In modern civilization different kinds of animals live with us as pets. These pets have different diseases and are on medications. Close contact with animals can cause medication adverse reactions or may worsen pre-existing conditions in humans. Here we present an interesting case of hypothyroidism worsened by transdermal absorption of methimazole administered for feline hyperthyroidism. Case History: 66-year-old Caucasian female with past medical history of postoperative hypothyroidism s/p total thyroidectomy secondary to multinodular goiter due to Hashimoto’s thyroiditis with a 0.2 cm papillofollicular microcarcinoma and 0.7 cm follicular adenoma presented for follow up. She complained of weight gain, lethargy and dry skin for the past 4 months. She was on a stable dose of levothyroxine 112 mcg daily for the past year. She took her pill correctly and did not miss any doses. Her other medical problems were impaired fasting glucose, osteopenia and B12 deficiency. Her repeat thyroid function tests showed TSH 11.2 mc IU/ l (0.4 -4) (TSH - 0.538 mc IU/ L 6 months back), T4 - 6.8 mcg/ dl (4.5 - 12) (T4 8.9 6 months back). She had a measurable serum thyroglobulin of 0.4 ng/ml with antithyroglobulin antibody 11 IU/ml (<115) consistent with some residual thyroid tissue despite her history of a “total thyroidectomy”. Due to recent worsening of her symptoms with elevated TSH on background of previous stable levothyroxine requirement, further detailed history was taken. She reported that her cat was suffering from hyperthyroidism, treated with methimazole 10 mg daily. The patient used to cut the pill in half with bare hands and fed it to her pet. She also used to handle wet methimazole that her cat coughed up. Her levothyroxine dose was continued at 112 mcg daily. The patient was advised to use gloves before feeding and wash her hands after feeding her cat. Her symptoms resolved after she took precautions and TSH normalized to 1.170 mc IU/ l with T4 7.6 two months later. Conclusion: Absorption of methimazole by transdermal administration has been shown in cats1. A study by Kasraee et al showed safety of a 5% topical methimazole application for treatment of post inflammatory hyperpigmentation in humans with no change in thyroid function tests2. Our case contradicts this study and indicates that methimazole might be absorbed transdermally in humans. To conclude, more studies are needed to study the effect of transdermal administration of methimazole in humans. References: 1. Hill KE, Mills PC, Jones BR et.al. Percutaneous absorption of methimazole: an in vitro study of the absorption pharmacokinetics for two different vehicles. J Vet Pharmacol Ther. 2015;38(6):581-589. PMID: 25683868 2. Kasraee B et al. Safety of topical methimazole for the treatment of melasma. Transdermal absorption, the effect on thyroid function and cutaneous adverse effects. Skin Pharmacol Physiol. 2008;21(6):300-305. PMID: 18667842

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.

Multinodular goitre arising in the tracheal lumen: implantation or ectopic?

2011 ◽  
Vol 126 (1) ◽  
pp. 100-102
Author(s):  
R L Love ◽  
F Ahsan ◽  
R Allison ◽  
A Keast ◽  
N Lambie
Keyword(s):  
Thyroid Tissue ◽  
Follicular Adenoma ◽  
Subtotal Thyroidectomy ◽  
Multinodular Goitre ◽  
Tracheal Lumen ◽  
Anatomical Structures ◽  
History Of ◽  
Right Lobe ◽  
Tissue Implantation ◽  
The Right

AbstractObjectives:We report a case of multinodular goitre arising in thyroid tissue within the trachea. This tissue appears to have been implanted at the time of an earlier subtotal thyroidectomy.Case report:A 79-year-old woman presented with a 12-month history of dyspnoea. Forty years earlier, she had been treated for a follicular adenoma with subtotal thyroidectomy. Investigation revealed tumour in the region of the right lobe of the thyroid, extending into and narrowing the trachea. A biopsy was performed, and the patient underwent excision of the right thyroid lobe tumour and cricotracheal resection with anastomosis. Histopathological findings were consistent with a multinodular goitre arising in thyroid tissue within the tracheal lumen.Conclusion:Intra-operative thyroid tissue implantation in the trachea and subsequent goitre development has not previously been described. This case illustrates the need for careful resection of the thyroid in order to maintain the integrity of normal anatomical structures.

scholarly journals Overt Hypothyroidism Induced by Prolonged Therapy With Imatinib

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A945-A946
Author(s):  
Ally W Wang ◽  
Emily V Nosova
Keyword(s):  
Tyrosine Kinase ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Case Reports ◽  
Myelogenous Leukemia ◽  
Prolonged Treatment ◽  
Overt Hypothyroidism ◽  
Imatinib Treatment ◽  
Thyroid Function Tests ◽  
History Of

Abstract Background: Imatinib, a tyrosine kinase inhibitor (TKI), is commonly used to treat chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors. TKI-induced thyroid dysfunction is recognized as an adverse class effect with most cases occurring between six to twelve months after treatment initiation. Clinical Case: 76-year-old man with hypertension and CML on Imatinib that had been started twenty months prior was admitted for confusion. The patient also reported constipation, cold intolerance, and weight gain despite no change in diet, appetite, or physical activity. On evaluation, his responses to questioning were noticeably delayed, however he was not lethargic. His vital signs were normal and he was otherwise euthyroid on physical exam. He had no known history of thyroid dysfunction. Labs showed a TSH of 94.7 (0.4 - 4.2 uIU/mL), Free T4 0.4 (0.8 - 1.5 ng/dL), and Total T3 30 (87 - 178 ng/dL). Thyroglobulin antibody was 1016 (0.0 - 4.1 U/mL) and TPO antibody was >2000 (0.0 - 5.6 IU/mL). A TSH checked two months before admission was 1.1. Antibody levels had not been checked previously. Thyroid ultrasound demonstrated a hyperemic and heterogeneous thyroid, consistent with thyroiditis. Levothyroxine at a dose of 50 mcg daily was advised, due to patient’s advanced age as well as history of arrhythmia. The patient’s confusion resolved on hospital day three. Repeat thyroid function tests will be checked four to six weeks after Levothyroxine initiation. Discussion: As a class, tyrosine kinase inhibitors are known to cause thyroid dysfunction with the most common medication being Sunitinib. Data related to the effects of thyroid function during Imatinib treatment are limited. Previous cases of Imatinib-induced thyroid dysfunction report only hypothyroidism in thyroidectomized patients and no clinically significant change in thyroid function among patients who were euthyroid prior to therapy initiation. Our case reports a patient with no prior thyroidectomy who developed overt hypothyroidism while on Imatinib for nearly two years. The mechanism for TKI-induced thyroid dysfunction has not been elucidated. Due to relatively acute onset and markedly positive TPO and thyroglobulin antibodies, we suspect that TKI may alter HLA recognition on thyroid follicular cells, thereby inducing autoimmunity. Our case showcases the need to maintain awareness and continuous surveillance for thyroid dysfunction when patients are on long term TKI as overt hypothyroidism may be induced by prolonged treatment.

scholarly journals MON-501 Physician-Reported Misuse of Thyroid Ultrasound

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Debbie W Chen ◽  
David Reyes-Gastelum ◽  
Archana Radhakrishnan ◽  
Ann S Hamilton ◽  
Kevin C Ward ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Function ◽  
Categorical Variables ◽  
Thyroid Function Tests ◽  
Thyroid Antibodies ◽  
Thyroid Ultrasound ◽  
Patient Request ◽  
The Past ◽  
Function Tests ◽  
General Surgeons

Abstract BACKGROUND: Over the past four decades, there has been a substantial increase in the incidence of thyroid cancer with studies suggesting that greater use of thyroid ultrasound contributes to the rise in incidence. However, little is known about physician reported practice patterns on ultrasound use. Methods: Patients diagnosed with differentiated thyroid cancer in 2014–15 from the Surveillance, Epidemiology and End Results registries of Georgia and Los Angeles were surveyed and asked to identify the surgeon who performed their thyroid surgery, and the endocrinologist and other doctors most involved in their thyroid cancer treatment decision making. We surveyed all physicians identified by more than one patient, and a random sample of physicians identified by one surveyed patient (N=610; 65% response rate). Surveyed physicians were asked to identify the clinical scenarios in which they would schedule a thyroid or neck ultrasound. We generated descriptive statistics for all categorical variables and used multivariable logistic regression to identify factors associated with thyroid ultrasound misuse. Results: The cohort consisted of primary care physicians (PCPs; N=162), endocrinologists (N=176), otolaryngologists (N=130), and general surgeons (N=134). In addition to physicians reporting ultrasound use for accepted reasons such as palpable nodule on exam (98%), large goiter (92%), and nodule seen on other imaging test (88%), a substantial number of physicians endorsed ultrasound use for clinically unsupported reasons: patient request (33%); abnormal thyroid function tests (28%); and positive thyroid antibodies (22%). In multivariable analysis, compared to PCPs, endocrinologists, otolaryngologists, and general surgeons were significantly more likely to schedule an ultrasound in response to patient request (odds ratio (OR) 2.52, 95% confidence interval (CI) 1.27–5.11; OR 2.98, 95% CI 1.57–5.79; OR 2.14, 95% CI 1.17–3.97, respectively). Physicians in private practice were more likely to schedule an ultrasound for abnormal thyroid function tests (OR 2.44, 95% CI 1.33–4.73) and positive thyroid antibodies (OR 2.47, 95% CI 1.27–5.21) compared to those in academic medical centers. Physicians who managed ten patients or less, compared to more than 50 patients, with thyroid nodules in the past 12 months were less likely to schedule an ultrasound for positive thyroid antibodies (OR 0.43, 95% CI 0.19–0.95). Conclusion: Physicians report scheduling thyroid ultrasound for reasons not supported by clinical guidelines and in conflict with the Choosing Wisely recommendations. Understanding why physicians use thyroid ultrasound and factors that correlate with clinically unsupported reasons is essential to creating targeted educational interventions to improve physician adherence to guidelines, reduce unnecessary imaging, and curb the overdiagnosis of low-risk thyroid cancer.

scholarly journals A Review of Tuberculous Meningitis in a Canadian Pediatric Hospital

1991 ◽  
Vol 2 (4) ◽  
pp. 155-160
Author(s):  
Lissette Navas ◽  
Elaine Wang
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Close Contact ◽  
Clinical Manifestations ◽  
Mantoux Test ◽  
High Morbidity ◽  
The Past ◽  
Elevated Protein ◽  
History Of ◽  
Sick Children

Tuberculous meningitis is a disease associated with high morbidity and mortality. Experience with this disease at the Hospital for Sick Children in Toronto was reviewed to determine whether changes in prognosis have occurred in the past decade. All patients from whom the organism was recovered from the cerebrospinal fluid, or who had a positive Mantoux test in association with a compatible history, were included. Thirteen patients were identified from 1978 to 1989. The median age was six years (range 11 months to 17.5 years). Nine patients were born in Canada, but all except one were members of recently immigrant families. History of close contact with an adult with tuberculosis, or travel to an endemic area in the preceding six months, was present in seven cases. All patients had clinical manifestations and mild pleocytosis with elevated protein content in the cerebrospinal fluid. Patients were all diagnosed within 20 days after admission (median one day). Computed tomography scan of the head was abnormal in all patients within three weeks of admission. No patient died, although long term sequelae developed in five. The prognosis of tuberculous meningitis has improved in the past decade. Although a specific reason for this improvement cannot be definitively stated, earlier diagnosis and better chemotherapy may contribute.

scholarly journals Natural History of Thyroid Function Tests over 5 Years in a Large Pediatric Cohort

2009 ◽  
Vol 94 (5) ◽  
pp. 1678-1682 ◽  
Author(s):  
Liora Lazar ◽  
Rachel Ben-David Frumkin ◽  
Erez Battat ◽  
Yael Lebenthal ◽  
Moshe Phillip ◽  
...  
Keyword(s):  
Natural History ◽  
Thyroid Function ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
History Of

scholarly journals A Case of Euthyroid Graves’ Ophthalmopathy in a Patient Sero-Negative for TSH Receptor Autoantibody

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Asami Hotta ◽  
Tomohiro Tanaka ◽  
Haruka Kato ◽  
Shota Kakoi ◽  
Yuki Shimizu ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Pulse Therapy ◽  
Tsh Receptor ◽  
Thyroid Autoantibodies ◽  
Thyroid Function Tests ◽  
Normal Thyroid Function ◽  
Function Tests ◽  
Graves Ophthalmopathy ◽  
History Of ◽  
Serum Tsh

We report of a case of Graves’ ophthalmopathy presented solely with symptoms of the eyes with normal thyroid function tests and negative immunoreactive TSH receptor autoantibody. 40-year-old male was referred to our hospital due to 2-month history of ocular focusing deficit without any signs or symptoms of hyper- or hypothyroidism. Serum thyroid function tests and 99mTc uptake were both within the normal range. Anti-thyroid autoantibodies were all negative except for the cell-based assay for serum TSH receptor stimulating activity. Since orbital CT scan and MRI gave typical results compatible with Graves’ ophthalmopathy, we treated the patients with corticosteroid pulse therapy and orbital radiation therapy, leading to a partial improvement of the symptoms. This case gives insights into the potential pathophysiologic mechanism underlying Graves’ ophthalmopathy and casts light upon the difficulties of establishing the diagnosis in a euthyroid case with minimal positive results for anti-thyroid autoantibodies.

scholarly journals MON-478 Impaired Sensitivity to Thyroid Hormone - A Diagnostic and Therapeutic Challenge

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jorge Pedro ◽  
Vanessa Gorito ◽  
Cristina Ferreras ◽  
Ferreira João Silva Maria ◽  
Sofia Ferreira ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Function ◽  
Thyroid Function Tests ◽  
Pediatric Endocrinology ◽  
Free T4 ◽  
Peripheral Tissues ◽  
Free T3 ◽  
Function Tests ◽  
Trh Stimulation ◽  
History Of

Abstract Background: Impaired sensitivity to thyroid hormone refers to any process that negatively affects its action, including defects in its transport, metabolism and action on the receptor. Resistance to thyroid hormone due to beta-receptor mutations (RTH-beta) is the most common form of this entity and is characterized by reduced response of peripheral tissues to the action of thyroid hormone. The genetic variability of cofactors involved in the action of thyroid hormone explains the heterogeneity of resistance among affected individuals. Generally, patients with this disorder, have increased levels of free T4 and free T3 in association with normal or high TSH. Clinical case: 11-year-old boy, with personal history of Attention-deficit/hyperactivity disorder (ADHD). A pediatric endocrinology consultation was requested to evaluate abnormalities in his thyroid function tests. A few months earlier, his father was referred to endocrinology consultation because of thyroid function tests abnormalities: TSH - 3.01 μIU / mL (N: 0.35 - 4.94); Free T4 1.7 ng / dL (N: 0.7-1.48); Free T3 4.77 pg / mL (N: 1.71-3.71). Initially, two diagnostic hypotheses were considered: central hyperthyroidism or impaired sensitivity to thyroid hormone. The adult underwent pituitary magnetic resonance, which raised the hypothesis of a pituitary microadenoma, and TRH stimulation test, whose result was strongly suggestive of the second diagnostic possibility. A genetic study was requested and the presence of the c700 G> A variant (p. Ala 324 trh) in the THRB gene was identified, which confirmed the most likely hypothesis. At the time of the pediatric endocrinology consultation, the 11-year-old boy had the results of his lab tests: TSH - 6.67 μIU / mL (N: 0.35 - 5); T4L 2.27 ng / dL (N: 0.88-1.58); T3L 7.79 pg / mL (N: 2-4.20). Given his perfect height and weight evolution and the absence of symptoms suggestive of hypo or hyperthyroidism, it was decided not to start any medication, keeping only periodic surveillance. Conclusion: This case exemplifies unusual thyroid function tests. This discordance between serum thyroid hormone and TSH concentrations should raise the possibility of impaired sensitivity to thyroid hormone. In this condition, patients may present with symptoms of hypo or hyperthyroidism and the etiology of thyroid function tests abnormalities are not easily recognized. This can lead to misdiagnosis and consequently unnecessary treatment.

scholarly journals Management Thyroid Disease in Pregnancy: Preconception, and the postpartum complications

2017 ◽  
Vol 1 (3) ◽  
pp. 01-04
Author(s):  
R F Gross man
Keyword(s):  
Thyroid Function ◽  
Thyroid Disease ◽  
Postpartum Period ◽  
Past History ◽  
First Trimester ◽  
Thyroid Function Tests ◽  
Specialist Referral ◽  
Thyrotropin Receptor Antibodies ◽  
History Of ◽  
In Pregnancy

Pregnancy has a profound impact on the thyroid gland and thyroid function since the thyroid may encounter changes to hormones and size during pregnancy. The diagnosis and treatment of thyroid disease during pregnancy and the postpartum is complex but knowledge regarding the interaction between the thyroids and pregnancy/the postpartum period is advancing at a rapid pace. For women known to have hypothyroidism, an increase in thyroxine dose by 20–40% when pregnancy is confirmed usually ensures they remain euthyroid. Treatment of subclinical hypothyroidism is recommended if the woman has antithyroid antibodies. Treatment of hyperthyroidism, unless it is related to human chorionic gonadotrophin, involves propylthiouracil in the first trimester. Carbimazole may be used in the second trimester. Thyroid function tests are checked every month and every two weeks following a change in dose. Women with a current or a past history of Graves’ disease who have thyrotropin receptor antibodies require early specialist referral as there is a 1–5% risk of fetal hyperthyroidism. Women with thyroid disorders in pregnancy should be followed up by their GP in the postpartum period. Postpartum thyroiditis may present months after delivery.

Hypothyroidism in Down's Syndrome

1988 ◽  
Vol 153 (1) ◽  
pp. 102-104 ◽  
Author(s):  
Chinta Mani
Keyword(s):  
Clinical Features ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Down's Syndrome ◽  
Thyroid Tissue ◽  
Down’S Syndrome ◽  
Thyroid Function Tests ◽  
Function Tests

Fifty-five adult Down's syndrome subjects resident at Northgate Hospital were screened for the presence of thyroid dysfunction. Approximately 50% of the subjects had clinical features suggestive of hypothyroidism, sufficient to require thyroid-function tests. Twenty-two per cent of the total suffered from some degree of hypothyroidism, and 16% had positive antibodies to thyroid tissue.

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