Hyperthyroidism Masked as Heart Disease

Levine, Samuel A.; Sturgis, Cyrus C.

doi:10.1056/nejm192402141900703

Cited by 47 publications

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“…While our patient exhibited all those signs and symptoms, she did not demonstrate goiter, exophthalmos or excessive sweating, perhaps because of her advanced age. Hyperthyroidism with atypical manifestations is referred to as "masked" thyro toxicosis (5). The relatively higher level of free T4 as compared with the level of total T4, and the presence of moderate leukocytosis in the absence of infection were highly suggestive of thyroid storm in this case (1,6).…”

Section: Introductionmentioning

confidence: 80%

Thyroid Storm Associated with Probable Subclinical Hypoadrenocorticism in an Elderly Woman.

et al. 1992

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A 73-year-old woman was admitted to the hospital for severe persistent vomiting with fever, drowsiness, and weight loss. Elevated serum levels of thyroid hormones and the presence of a consciousness disorder with fever and vomiting led to the diagnosis of thyroid storm. A low normal concentration of serum cortisol, urinary 17-hydroxycorticosteroids and an elevated plasma level of corticotropin suggest that an inadequate adrenal reserve have been involved in the pathogenesis of the thyroid storm in this patient. She responded to the administration of intravenous methimazole and oral supersaturated potassium iodide solution.

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Section: Introductionmentioning

confidence: 80%

Thyroid Storm Associated with Probable Subclinical Hypoadrenocorticism in an Elderly Woman.

et al. 1992

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“…Thyrocardiac disease refers to thyrotoxic patients with cardiac complications, such as congestive heart failure or persistent cardiac dysrhythmia 20,21. The concept of thyrotoxic heart disease or thyrocardiac disease was probably first introduced by Levine et al, based on their observations of patients in whom thyrotoxicosis was the major factor leading to cardiomegaly, atrial fibrillation,22 or congestive heart failure 23…”

Section: Discussionmentioning

confidence: 99%

Two dimensional and Doppler echocardiographic evaluation of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex Ile Ife Nigeria a prospective study of 2501 subjects

Adebayo¹,

Akinwusi²,

Balogun³

et al. 2013

IJGM

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BackgroundEchocardiography remains a key noninvasive cardiac investigative tool in the management of patients, especially in a developing economy like Nigeria. In this study, we investigated the indications for transthoracic echocardiography and spectrum of cardiac disease found in patients referred to our cardiac unit for echocardiography.MethodsA prospective two-dimensional, pulsed, continuous, and color-flow Doppler echocardiographic evaluation was done using the transthoracic approach in 2501 patients over an eight-year period. Univariate data analysis was performed for mean age, gender, clinical indications, and diagnoses.ResultsThe subject age range was less than 12 months to 97 years (mean 52.39 years). There were 1352 (54.06%) males and 1149 (45.94%) females. The most common indication for echocardiography was hypertension (52.1%) followed by congestive cardiac failure (13.9%). Others were for screening (6.1%), arrhythmias (5%), cerebrovascular disease (5%), chest pain (3.3%), chronic kidney disease (3.2%), congenital heart disease (2.6%), cardiomyopathy (1.8%), rheumatic heart disease (1.7%), diabetes mellitus (1.3%), thyrocardiac disease (1.2%), ischemic heart disease (1.2%), and pericardial disease (1.1%). The echocardiographic diagnosis was hypertensive heart disease in 59.4% of subjects and normal in 14.1%. Other echocardiographic diagnoses included rheumatic heart disease (3.1%), congenital heart disease (2.1%), cardiomyopathy (1.7%), pericardial disease (1.1%), and ischemic heart disease (0.1%).ConclusionHypertension and its cardiac complications is the most common echocardiographic indication and diagnosis at our unit.

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“…Thyroid Heart Disease The concept of thyroid heart disease was first suggested by Levine and Sturgis 12 . They described atrial dysrhythmias, congestive cardiac failure, or cardiac enlargement in hyperthyroid patients without goiter or exophthalmos.…”

Section: Discussionmentioning

confidence: 99%

Hyperthyroidism in the Elderly

Griffin

1986

J American Geriatrics Society

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It is not uncommon for thyrotoxicosis to appear in an atypical manner in older patients. The classical symptoms are often absent. The disease is frequently characterized by cardiac, gastrointestinal, neuromuscular, and neuropsychiatric symptoms. As hyperthyroidism is readily amenable to effective treatment that can improve the quality of life, the clinical suspicion of this disease is always indicated and exclusion of this diagnosis should always be pursued. Recognizing the admittedly great difficulty in making, or even suspecting, the diagnosis of hyperthyroidism in the elderly, our rule is to test for hyperthyroidism in essentially all geriatric patients presenting chronic systemic symptoms or signs. On the other hand, we do not recommend community-wide screening of persons over 60 for hyperthyroidism. Community-wide screening falls far below the break-even point in cost-benefit analysis. The most sensible detector of hyperthyroidism now widely available is the serum free T3 index (FT3I), but it may be falsely normal because of the effect of systemic illness on extrathyroidal T4-to-T3 conversion. The advent of ultrasensitive methods for TSH may change these statements considerably. It may become the single screening procedure for both hyper- and hypothyroidism.

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Hyperthyroidism Masked as Heart Disease

Cited by 47 publications

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Thyroid Storm Associated with Probable Subclinical Hypoadrenocorticism in an Elderly Woman.

Thyroid Storm Associated with Probable Subclinical Hypoadrenocorticism in an Elderly Woman.

Two dimensional and Doppler echocardiographic evaluation of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex Ile Ife Nigeria a prospective study of 2501 subjects

Hyperthyroidism in the Elderly

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Hyperthyroidism Masked as Heart Disease

Cited by 47 publications

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Thyroid Storm Associated with Probable Subclinical Hypoadrenocorticism in an Elderly Woman.

Thyroid Storm Associated with Probable Subclinical Hypoadrenocorticism in an Elderly Woman.

Two dimensional and Doppler echocardiographic evaluation of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex&nbsp;Ile Ife Nigeria a prospective study of 2501 subjects

Hyperthyroidism in the Elderly

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Two dimensional and Doppler echocardiographic evaluation of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex Ile Ife Nigeria a prospective study of 2501 subjects