scholarly journals Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

2015 ◽  
Vol 2015 ◽  
Author(s):  
V Larouche ◽  
L Snell ◽  
D V Morris
Keyword(s):  
Radioactive Iodine ◽  
Psychiatric Symptoms ◽  
Adrenal Adenoma ◽  
Primary Hyperaldosteronism ◽  
Graves Disease ◽  
List Type ◽  
Adrenal Hyperplasia ◽  
Bilateral Adrenal Hyperplasia ◽  
Acute Hypothyroidism ◽  
Radioactive Iodine Ablation

Summary Myxoedema madness was first described as a consequence of severe hypothyroidism in 1949. Most cases were secondary to long-standing untreated primary hypothyroidism. We present the first reported case of iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a second concurrent diagnosis of primary hyperaldosteronism. A 29-year-old woman presented with severe hypothyroidism, a 1-week history of psychotic behaviour and paranoid delusions 3 months after treatment with radioactive iodine ablation for Graves' disease. Her psychiatric symptoms abated with levothyroxine replacement. She was concurrently found to be hypertensive and hypokalemic. Primary hyperaldosteronism from bilateral adrenal hyperplasia was diagnosed. This case report serves as a reminder that myxoedema madness can be a complication of acute hypothyroidism following radioactive iodine ablation of Graves' disease and that primary hyperaldosteronism may be associated with autoimmune hyperthyroidism. Learning points Psychosis (myxoedema madness) can present as a neuropsychiatric manifestation of acute hypothyroidism following radioactive iodine ablation of Graves' disease. Primary hyperaldosteronism may be caused by idiopathic bilateral adrenal hyperplasia even in the presence of an adrenal adenoma seen on imaging. Adrenal vein sampling is a useful tool for differentiating between a unilateral aldosterone-producing adenoma, which is managed surgically, and an idiopathic bilateral adrenal hyperplasia, which is managed medically. The management of autoimmune hyperthyroidism, iatrogenic hypothyroidism and primary hyperaldosteronism from bilateral idiopathic adrenal hyperplasia in patients planning pregnancy includes delaying pregnancy 6 months following radioactive iodine treatment and until patient is euthyroid for 3 months, using amiloride as opposed to spironolactone, controlling blood pressure with agents safe in pregnancy such as nifedipine and avoiding β blockers. Autoimmune hyperthyroidism and primary hyperaldosteronism rarely coexist; any underlying mechanism associating the two is still unclear.

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 Bilateral adrenal hyperplasia; a common cause of drug-refractory hypertension yet amenable to medical treatment

2020 ◽  
Vol 10 (1-s) ◽  
pp. 79-82
Author(s):  
El-Reshaid Kamel ◽  
Shaikha Al-Bader
Keyword(s):  
Clinical Laboratory ◽  
Antihypertensive Drugs ◽  
Adrenal Adenoma ◽  
Adrenal Hyperplasia ◽  
Refractory Hypertension ◽  
Endocrine Disease ◽  
The Past ◽  
R Ratio ◽  
Daily Dose ◽  
Bilateral Adrenal Hyperplasia

Over the past 4 and 1/2 years, a total of 97 patients had hypertension yet lacked clinical, laboratory and radiological evidence of renal, renovascular and endocrine disease were investigated for A/R ratio.  High A/R was detected in 30 patients.  Five patients had unilateral adrenal adenoma and 1 had cancer while 24 patients (24.7%) had bilateral enlargements indicating bilateral adrenal hyperplasia (BAH).  Our study has shown that BAH is: (a) easily diagnosed with a combination of A/R ratio and CT scan of the adrenal gland, (b) responsible for 24.7% of hypertension cases, (c) associated with moderate to severe hypertension that may require 2-4 antihypertensives, (d) associated with hypokalemia in only in 54% of the cases, (e) not controlled with a single daily dose of Spironolactone (S) and ½ the cases require 50 mg/day.   Moreover, it has shown that S treatment was not associated with significant hyperkalemia yet gynecomastia and erectile dysfunction were common side effects.  Interestingly; and despite normalization of A/R ratio, most patients continue to require antihypertensive drugs though the number and dosage were less.  The latter phenomenon was more evident in those with higher initial A/R ratio and longer duration of hypertension.  Nephroangiosclerosis is the most plausible explanation for it.  In conclusion; BAH is not a rare disease and should be considered in cases of refractory hypertension.  Keywords: Aldosterone, Aldosterone/Renin ratio, hypertension, Spironolactone.

scholarly journals Predictive Value of Preoperative Tests in Discriminating Bilateral Adrenal Hyperplasia from an Aldosterone-Producing Adrenal Adenoma

2000 ◽  
Vol 85 (12) ◽  
pp. 4526-4533 ◽  
Author(s):  
John L. Phillips ◽  
McClellan M. Walther ◽  
John C. Pezzullo ◽  
Walter Rayford ◽  
Peter L. Choyke ◽  
...  
Keyword(s):  
Predictive Value ◽  
Adrenal Adenoma ◽  
Adrenal Hyperplasia ◽  
Bilateral Adrenal Hyperplasia

scholarly journals A Case of Primary Aldosteronism due to Bilateral Adrenal Hyperplasia with Hidden Undiagnosed Adrenal Adenoma for Eight Years

1996 ◽  
Vol 19 (1) ◽  
pp. 47
Author(s):  
Seock Ah Im ◽  
Eun Mi Nam ◽  
Si Hoon Park ◽  
Gil Ja Shin ◽  
Woo Hyung Lee ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Adenoma ◽  
Adrenal Hyperplasia ◽  
Bilateral Adrenal Hyperplasia

scholarly journals Coexistence of Primary Hyperaldosteronism and Graves’ Disease, a Rare Combination of Endocrine Disorders: Is It beyond a Coincidence—A Case Report and Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
S. S. C. Gunatilake ◽  
U. Bulugahapitiya
Keyword(s):  
Case Report ◽  
Adrenal Adenoma ◽  
Underlying Mechanism ◽  
Secondary Hypertension ◽  
Primary Hyperaldosteronism ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Endocrine Disorders ◽  
Sri Lankan ◽  
Underlying Mechanisms

Background. Primary hyperaldosteronism is a known cause for secondary hypertension. In addition to its effect on blood pressure, aldosterone exhibits proinflammatory actions and plays a role in immunomodulation/development of autoimmunity. Recent researches also suggest significant thyroid dysfunction among patients with hyperaldosteronism, but exact causal relationship is not established. Autoimmune hyperthyroidism (Graves’ disease) and primary hyperaldosteronism rarely coexist but underlying mechanisms associating the two are still unclear.Case Presentation. A 32-year-old Sri Lankan female was evaluated for new onset hypertension in association with hypokalemia. She also had features of hyperthyroidism together with high TSH receptor antibodies suggestive of Graves’ disease. On evaluation of persistent hypokalemia and hypertension, primary hyperaldosteronism due to right-sided adrenal adenoma was diagnosed. She was rendered euthyroid with antithyroid drugs followed by right-sided adrenalectomy. Antithyroid drugs were continued up to 12 months, after which the patient entered remission of Graves’ disease.Conclusion. Autoimmune hyperthyroidism and primary hyperaldosteronism rarely coexist and this case report adds to the limited number of cases documented in the literature. Underlying mechanism associating the two is still unclear but possibilities of autoimmune mechanisms and autoantibodies warrant further evaluation and research.

scholarly journals Change in BMI after radioactive iodine ablation for graves disease

2017 ◽  
Vol 2017 (1) ◽  
Author(s):  
Melinda Chen ◽  
Matthew Lash ◽  
Todd Nebesio ◽  
Erica Eugster
Keyword(s):  
Radioactive Iodine ◽  
Graves Disease ◽  
Radioactive Iodine Ablation

scholarly journals Hypertension and Recurrent Hypokalaemia in Young Woman - A Case Report of Primary Hyperaldosteronism (Conn’s Syndrome)

2018 ◽  
Vol 12 (2) ◽  
pp. 102-104
Author(s):  
Md Nazmul Hasan ◽  
Md Abdur Rahim ◽  
Quazi Mamtaz Uddin Ahmed ◽  
Md Syedul Islam ◽  
Md Rasul Amin ◽  
...  
Keyword(s):  
Case Report ◽  
Young Woman ◽  
Clinical Features ◽  
Resistant Hypertension ◽  
Plasma Aldosterone ◽  
Primary Hyperaldosteronism ◽  
Adrenal Hyperplasia ◽  
Conn’S Syndrome ◽  
Bilateral Adrenal Hyperplasia ◽  
Aldosterone Producing Adenoma

Primary hyperaldosteronism is caused by most commonly due to aldosterone producing adenoma(conn’s syndrome) or bilateral adrenal hyperplasia. Clinical features may be of different type which includes hypertension in young age or resistant hypertension, recurrent hypokalaemia and characterized by increased ratio of plasma aldosterone (ng/dl) to rennin (ng/ml per hour) activity. We report a case of young woman presented with hypertension and recurrent hypokalaemia.University Heart Journal Vol. 12, No. 2, July 2016; 102-104

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