The effect of thyrotoxicosis on adrenocortical reserve

Tsatsoulis, Agathocles; Johnson, Eric J.; Kalogera, CH; Seferiadis, K.; Tsolas, O.

doi:10.1530/eje.0.1420231

Cited by 67 publications

(66 citation statements)

References 20 publications

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“…Glucocorticoid administration prevents adrenal crisis, as there is a potentially limited adrenal reserve in this acute setting. It also decreases the T4 to T3 conversion and in patients with Grave's disease may have an effect on the underlying autoimmune disease process (18). In patients who fail medical therapy, therapeutic plasma exchange is an option (19).…”

Section: Discussionmentioning

confidence: 99%

Post Coronary Artery Bypass Graft (CABG) Surgery Thyroid Storm: A Near Miss

Dhillon¹,

Manocha²,

Kahlon³

et al. 2017

Am J Hosp Med

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Altered mental status (AMS) is a challenging symptom, commonly encountered in the acute hospital setting. We present a challenging case of AMS where an early assessment could have potentially prevented a complicated hospital course. A 42-year-old male presented to emergency room with chest pain. He was tachycardic, hypotensive and electrocardiogram showed new ST depressions. He underwent emergent cardiac catheterization showing triple vessel disease with placement of intra-aortic balloon pump, followed by CABG. Post-operatively he could not be extubated and had persistent fever, tachycardia and deterioration in mental status. Initial work up for fever and AMS was unremarkable. He was treated with broad spectrum antibiotics and beta blockers but remained intubated, febrile, and altered. Thyroid function tests done around second week of hospitalization revealed TSH < 0.03uU/ml, fT4 > 4.5 ng/dl, T3 411.9 ng/dl, thyroid stimulating immunoglobulin 269%. A thyroid sonogram revealed diffusely enlarged, heterogeneous and hypervascular thyroid lobes. He was started on stress doses of steroids, propylthiouracil and continued on beta blocker. Within the next 72 hours his heart rate, fever and mental status improved and he was extubated. Thyroid storm, also referred to as thyrotoxic crisis, is an acute life threatening hypermetabolic state induced by excessive release of thyroid hormones in a patient with thyrotoxicosis. It is often precipitated by an acute event such as surgery, trauma, infection or iodine load. The Burch and Wartofsky scoring system is helpful in distinguishing this from severe thyrotoxicosis. It should always be kept in the differential diagnosis of AMS, fever, tachycardia of unknown cause.

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Section: Discussionmentioning

confidence: 99%

Post Coronary Artery Bypass Graft (CABG) Surgery Thyroid Storm: A Near Miss

Dhillon¹,

Manocha²,

Kahlon³

et al. 2017

Am J Hosp Med

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“…Tsatsoulis et al [12] have recently demonstrated a subtle impairment in the cortisol response to ACTH stimulation in patients with thyreotoxicosis, indicating a diminished adrenocortical reserve. The increase in cortisol following treatment with thiamazole may therefore reflect a normalization of the adrenocortical function following normalization of the thyroid status.…”

Section: Discussionmentioning

confidence: 99%

Ovarian Ultrasound and Ovarian and Adrenal Hormones before and after Treatment for Hyperthyroidism

Sparre¹,

Kollind

Carlström³

2002

Gynecol Obstet Invest

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Objective: To relate thyroid, steroid and pituitary hormones to ovarian ultrasonographic findings in hyperthyroid patients before and during treatment. Study Design: Ultrasonography of the ovaries and serum hormone determination by immunoassay were performed before and during thiamazole therapy in 18 women of fertile age treated for hyperthyroidism at the Danderyd Hospital from 1996 to 1998. Results: When hyperthyreotic, the patients had elevated serum levels of sex hormone-binding globulin (SHBG) and subnormal values of cortisol, free testosterone (fT) and dehydroepiandrosterone (DHEA). In the euthyreotic state following treatment, endocrine variables were normalized. Patients with a short duration of the disease had higher pretreatment levels of free thyroxine (fT4), SHBG and testosterone and lower corticosteroid binding globulin (CBG) and cortisol levels compared to patients with a long duration of the disease. The pretreatment ultrasonographic picture was abnormal in 16 of 18 patients. Of the 8 patients who were examined by ultrasonography after 3 months of treatment, all but 1 showed a normal picture. Samples from patients showing an abnormal ultrasonographic picture had significantly higher fT4 and lower free testosterone (fT) values than samples from patients with a normal ultrasonographic picture. Conclusion: Ultrasonographic findings showing a multicystic/multifollicular picture, resembling polycystic ovaries (PCO), in hyperthyroidism may be related to direct effects of thyroid hormones on the ovaries and/or altered intraovarian androgen environment due to elevated SHBG levels. It is highly recommended to assess the thyroid status in patients with multicystic/multifollicular ovaries/PCO.

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“…Recent data in rat models suggest that experimentally induced thyrotoxicosis is associated with altered HPA axis regulation: basal and ACTH-stimulated plasma corticosterone levels are increased in short-term experimental thyrotoxicosis, whereas in long-term thyroid hormone excess an attenuated corticosterone response to ACTH was observed [51][52][53][54] .…”

Section: Thyroid Function Stress and Immune Responsementioning

confidence: 99%

Stress and Autoimmune Thyroid Diseases

Bagnasco¹,

Bossert²,

Pesce³

2006

Neuroimmunomodulation

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Autoimmune thyroid diseases (AITD) are the far most common autoimmune disorders, their prevalence in Western countries exceeding 5% of the general population. In the large majority of individual cases the clinical impact of AITD is not severe, however, their widespread diffusion renders them a significant health problem. AITD are heterogeneous in their clinical presentation: the two main forms are autoimmune thyroiditis (AT) and Graves’ disease (GD). Although they probably share, at least in part, a common genetic background and may occur in the same family as well as in the same individual, they are definitely two distinct diseases both in their clinical presentation and their pathophysiology. In fact, AT causes structural thyroid damage (mainly via cell-mediated immune destruction of thyroid follicular cells) which results, as a rule, in functional impairment (hypothyroidism); however, depending on clinical variants, evolution towards hypothyroidism may be very low, or thyroid function impairment occurs after an initial phase of mild thyrotoxicosis due to relatively rapid gland destruction. GD patients have hyperthyroidism, often severe, due to autoantibody-mediated thyrotropin receptor stimulation, with thyroid cell hyperplasia and hyperfunction. Such a functional heterogeneity is a key feature for the clinical management: as a matter of fact, therapy of AITD is mainly therapy of thyroid dysfunction. Moreover, since hyperthyroidism is quite early perceived by the patient as a cause of discomfort, the timing of the natural history of GD is relatively well defined; on the other hand, AT may be asymptomatic for a long time and defining its natural history in a single patient may be difficult. In some AITD patients (mainly, but not exclusively, with GD), clinical features not directly related to thyroid dysfunction, such as orbitopathy, are present. Graves’ orbitopathy is probably related, at least in part, to autoantibodies directed to thyrotropin receptor; it may be, in a minority of patients, severe and sight-threatening, and represents an independent clinical problem.

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The effect of thyrotoxicosis on adrenocortical reserve

Cited by 67 publications

References 20 publications

Post Coronary Artery Bypass Graft (CABG) Surgery Thyroid Storm: A Near Miss

Post Coronary Artery Bypass Graft (CABG) Surgery Thyroid Storm: A Near Miss

Ovarian Ultrasound and Ovarian and Adrenal Hormones before and after Treatment for Hyperthyroidism

Stress and Autoimmune Thyroid Diseases

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