UNEXPLAINED DELIRIUM : THINK OF THYROID STORM

2021 ◽  
pp. 23-25
Author(s):  
Soni Namita ◽  
Shruti A ◽  
Soni Anand ◽  
Nikalje A ◽  
Bharadwaj M
Keyword(s):  
Ventricular Tachycardia ◽  
Thyroid Storm ◽  
Rare Entity ◽  
Thyroid Medication ◽  
Malignant Arrhythmia ◽  
Life Threatening ◽  
Systemic Condition ◽  
Very High ◽  
Serum Tsh

Background: Thyroid storm is a life-threatening Endocrine emergency with an incidence rate of 1% to 2% all over the world. It is a systemic condition leading to increased production of Thyroid Hormone and its release leading to Thermoregulatory, Adrenergic, Neuropsychiatric, Cardiovascular, and Abdominal Manifestations. Thyroid storm with Malignant Arrhythmia and delirium both together is rare entity, but the mortality rate is very high. The presentation of Malignant Arrhythmias and delirium together in the initial phase of the disease is much less common with only a few isolated cases described in the scientic literature. Objective: To present a case in which a patient had two simultaneous complication of thyroid storm i.e. delirium and ventricular tachycardia. Case Study: We report a 65 years-year-old man who came with complaints of Diarrhea, Fever, Breathlessness and psychosis. His serum tsh was <0.015 and anti tpo antibodies was 83. He was diagnosed to be in Thyroid storm and later had complications including Ventricular Tachycardia and delirium in an undiagnosed case of Hyperthyroidism. He was started on anti thyroid medication and slowly as his condition improved he was discharged. Conclusion: Patients with Thyrotoxicosis need to be closely monitored for complications since its early diagnosis and treatment may save lives.

scholarly journals Thyroid Storm Associated with Testicular Choriocarcinoma

2020 ◽  
Author(s):  
Julio César Martínez ◽  
Ernesto Alfonso Ovalle-Zavala
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Antithyroid Drugs ◽  
Rare Occurrence ◽  
Blood Tests ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Β Hcg ◽  
Very High

Thyroid storm is a rare, life-threatening condition that can be caused by various pathologies including serious conditions associated with human chorionic gonadotropin (hCG)-producing tumours. We present the case of a 17-year-old male patient with a 1-month history of dyspnoea and a 3-day history of palpitations and fever. General examination revealed a left testicular mass. Blood tests revealed β-hCG >225,000 mIU/ml, thyroid-stimulating hormone (TSH) 0.02 IU/ml, and thyroxine (T4) 19.07 µg/dl. He was admitted with thyroid storm. Treatment with antithyroid drugs and chemotherapy was started, but the patient died on the third day of admission. This case highlights a rare occurrence of thyroid storm linked to testicular choriocarcinoma, and provides a necessary reminder that, in some instances, hCG at very high levels can exert a thyrotropic effect due to its molecular structure, which is similar to that of TSH.

scholarly journals Influence of Hydrogeochemistry on Tunnel Drainage in Evaporitic Formations: El Regajal Tunnel Case Study (Aranjuez, Spain)

2021 ◽  
Vol 13 (3) ◽  
pp. 1505
Author(s):  
Ignacio Menéndez Pidal ◽  
Jose Antonio Mancebo Piqueras ◽  
Eugenio Sanz Pérez ◽  
Clemente Sáenz Sanz
Keyword(s):  
High Speed ◽  
Civil Engineering ◽  
Saturation Index ◽  
The Subject ◽  
Under Construction ◽  
Underground Flow ◽  
Very High ◽  
Over Time

Many of the large number of underground works constructed or under construction in recent years are in unfavorable terrains facing unusual situations and construction conditions. This is the case of the subject under study in this paper: a tunnel excavated in evaporitic rocks that experienced significant karstification problems very quickly over time. As a result of this situation, the causes that may underlie this rapid karstification are investigated and a novel methodology is presented in civil engineering where the use of saturation indices for the different mineral specimens present has been crucial. The drainage of the rock massif of El Regajal (Madrid-Toledo, Spain, in the Madrid-Valencia high-speed train line) was studied and permitted the in-situ study of the hydrogeochemical evolution of water flow in the Miocene evaporitic materials of the Tajo Basin as a full-scale testing laboratory, that are conforms as a whole, a single aquifer. The work provides a novel methodology based on the calculation of activities through the hydrogeochemical study of water samples in different piezometers, estimating the saturation index of different saline materials and the dissolution capacity of the brine, which is surprisingly very high despite the high electrical conductivity. The circulating brine appears unsaturated with respect to thenardite, mirabilite, epsomite, glauberite, and halite. The alteration of the underground flow and the consequent renewal of the water of the aquifer by the infiltration water of rain and irrigation is the cause of the hydrogeochemical imbalance and the modification of the characteristics of the massif. These modifications include very important loss of material by dissolution, altering the resistance of the terrain and the increase of the porosity. Simultaneously, different expansive and recrystallization processes that decrease the porosity of the massif were identified in the present work. The hydrogeochemical study allows the evolution of these phenomena to be followed over time, and this, in turn, may facilitate the implementation of preventive works in civil engineering.

scholarly journals Thyroid storm in the second stage of labour: a case report

2021 ◽  
Vol 14 (7) ◽  
pp. e243159
Author(s):  
Yudianto Budi Saroyo ◽  
Achmad Kemal Harzif ◽  
Beryliana Maya Anisa ◽  
Fistyanisa Elya Charilda
Keyword(s):  
Treatment Guidelines ◽  
Thyroid Storm ◽  
Lung Oedema ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Failure Treatment ◽  
Life Threatening ◽  
Thyroid Hormone Levels ◽  
Peripartum Period ◽  
In Pregnancy

A thyroid storm (or thyroid crisis) is an emergency in endocrinology. It is a form of complication of hyperthyroidism that can be life-threatening. Inadequate control of hyperthyroidism in pregnancy could develop into thyroid storm, especially in the peripartum period. We present a woman came in the second stage of labour, with thyroid storm, superimposed pre-eclampsia, acute lung oedema and impending respiratory failure. Treatment for thyroid storm, pre-eclampsia protocol and corticosteroid was delivered. The baby was born uneventfully, while the mother was discharged after 5 days of hospitalisation. Delivery is an important precipitant in the development of thyroid storm in uncontrolled hyperthyroidism in pregnancy. Although very rare, it can cause severe consequences. Diagnosis and treatment guidelines for thyroid storm were available and should be done aggressively and immediately. Uncontrolled hyperthyroidism should be prevented by adequate control in thyroid hormone levels, especially before the peripartum period.

scholarly journals Report of a Rare Case of Trauma-Induced Thyroid Storm

2002 ◽  
Vol 81 (8) ◽  
pp. 570-574 ◽  
Author(s):  
Neil M. Vora ◽  
Fred Fedok ◽  
Brendan C. Stack
Keyword(s):  
Nervous System ◽  
Rare Case ◽  
Hepatic Dysfunction ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Definitive Treatment ◽  
Thyroid Storm ◽  
Vehicle Accident ◽  
Hyperthyroid State ◽  
Life Threatening

Thyroid storm is a potentially life-threatening endocrinologic emergency characterized by an exacerbation of a hyperthyroid state. Several inciting factors can instigate the conversion of thyrotoxicosis to thyroid storm; trauma is one such trigger, but it is rare. Patients with thyroid storm can manifest fever, nervous system disorders, gastrointestinal or hepatic dysfunction (e.g., nausea, vomiting, diarrhea, and/or jaundice), and arrhythmia and other cardiovascular abnormalities. Treatment of thyroid storm is multimodal and is best managed by the endocrinologist and medical intensivist. Initial medical and supportive therapies are directed at stabilizing the patient, correcting the hyperthyroid state, managing the systemic decompensation, and treating the underlying cause. Once this has been achieved, definitive treatment in the form of radioactive ablation or surgery should be undertaken. We describe a case of thyroid storm in a young man that was precipitated by a motor vehicle accident.

Thyroid Disease I: Hyperthyroidism in Pregnancy

2020 ◽  
Author(s):  
Robert B. Martin ◽  
Brian Casey
Keyword(s):  
Hyperemesis Gravidarum ◽  
Beta Blockers ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Care Level ◽  
Hypermetabolic State ◽  
Life Threatening ◽  
Overt Hyperthyroidism ◽  
In Pregnancy ◽  
Stimulating Hormone

Thyroid physiologic adaptations in pregnancy may be confused with pathologic changes. Human chorionic gonadotropin rises early in pregnancy, stimulating thyrotropin secretion and suppressing thyroid stimulating hormone. These chemical changes are often seen in hyperemesis gravidarum and gestational transient thyrotoxicosis. Therefore, mild thyrotoxicosis may be difficult to differentiate from early pregnancy thyroxine stimulation.  However, overt hyperthyroidism usually includes classic symptoms seen outside of pregnancy in addition to suppressed TSH and T4 levels. Treatment includes thionamides propylthiouracil and methimazole.  Thyroid ablation is contraindicated in pregnancy. Often, in affected women, the fetus is euthyroid, but neonates can develop hyper or hypothyroidism with or without a goiter. Lastly, thyroid storm, though rare, is life threatening. Often presenting as a hypermetabolic state with cardiomyopathy and pulmonary hypertension, it generally results from decompensation from preeclampsia, anemia, sepsis, or surgery.  Treatment requires intensive care level management, with initiation of thionamides, iodine, and beta blockers.   This review contains 2 figures, 4 tables and 38 references. Keywords: Thyroid-releasing hormong, thyroid-stimulating hormone, thyromegaly, thyroid-stimulating immunoglobulins, thryotoxicosis, thionamides, thyroid storm

scholarly journals A Raster-Based Subdividing Indicator to Map Urban Heat Vulnerability: A Case Study in Sydney, Australia

2018 ◽  
Vol 15 (11) ◽  
pp. 2516 ◽  
Author(s):  
Wei Zhang ◽  
Phil McManus ◽  
Elizabeth Duncan
Keyword(s):  
High Heat ◽  
The Past ◽  
Urban Heat ◽  
Research Gap ◽  
Heat Vulnerability ◽  
Very High ◽  
Flexible Model ◽  
General Indicator ◽  
Sydney Australia

Assessing and mapping urban heat vulnerability has developed significantly over the past decade. Many studies have mapped urban heat vulnerability with a census unit-based general indicator (CGI). However, this kind of indicator has many problems, such as inaccurate assessment results and lacking comparability among different studies. This paper seeks to address this research gap and proposes a raster-based subdividing indicator to map urban heat vulnerability. We created a raster-based subdividing indicator (RSI) to map urban heat vulnerability from 3 aspects: exposure, sensitivity and adaptive capacity. We applied and compared it with a raster-based general indicator (RGI) and a census unit-based general indicator (CGI) in Sydney, Australia. Spatial statistics and analysis were used to investigate the performance among those three indicators. The results indicate that: (1) compared with the RSI framework, 67.54% of very high heat vulnerability pixels were ignored in the RGI framework; and up to 83.63% of very high heat vulnerability pixels were ignored in the CGI framework; (2) Compared with the previous CGI framework, a RSI framework has many advantages. These include more accurate results, more flexible model structure, and higher comparability among different studies. This study recommends using a RSI framework to map urban heat vulnerability in the future.

scholarly journals Thyroid Storm and Complete Heart Block after Treatment with Radioactive Iodine

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Kaitlyn Vennard ◽  
Matthew P. Gilbert
Keyword(s):  
Heart Block ◽  
Radioactive Iodine ◽  
Radioiodine Therapy ◽  
Complete Heart Block ◽  
Multiple Organ ◽  
Thyroid Storm ◽  
Metabolic Abnormalities ◽  
Organ Systems ◽  
Life Threatening ◽  
Life Threatening Complication

Thyroid storm is a rare endocrine emergency characterized by dysfunction of multiple organ systems. Thyroid storm is more common in Graves’ disease and can be precipitated by surgery, trauma, infection, metabolic abnormalities, iodine load, and parturition. We present a diagnostically challenging case of thyroid storm precipitated by radioiodine therapy and accompanied by bradycardia, a rare but life-threatening complication related to treatment for hyperthyroidism.

scholarly journals Perioperative management of a patient with primary hypoparathyroidism and severe hypocalcaemia for lumbar spine surgery

2016 ◽  
Vol 03 (01) ◽  
pp. 049-051
Author(s):  
Deepak Madankar ◽  
Sheetal Samel ◽  
Abhay Ganar ◽  
Neelesh Mathankar
Keyword(s):  
Perioperative Management ◽  
Muscle Power ◽  
Lumbar Discectomy ◽  
Medical Emergency ◽  
Lumbar Spine Surgery ◽  
Rare Entity ◽  
Ionised Calcium ◽  
Life Threatening ◽  
Severe Hypocalcaemia ◽  
Intravenous Calcium

AbstractPrimary hypoparathyroidism and consequent hypocalcaemia in the absence of iatrogenic cause are a rare entity. Serum ionised calcium concentrations < 0.50 mmol l−1 are more frequently associated with life-threatening complications and constitute a medical emergency that necessitates intravenous calcium therapy. The anaesthesiologist should carefully look for the effects of hypocalcaemia on the heart, circulation, muscle power and blood coagulation. We report perioperative management of a case of hypoparathyroidism and associated hypocalcaemia posted for lumbar discectomy in prone position and its anaesthetic implications.

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