MyMedR

Fulltext Congenital Hypothyroidism in Children - A Cross-Sectional Study in a Tertiary Centre in Malaysia

Anuar Zaini A, Feng Tung Y, Ahmad Bahuri NF, Yazid Jalaludin M

J ASEAN Fed Endocr Soc, 2020;35(1):62-67.

PMID: 33790495 DOI: 10.15605/jafes.035.01.11

Introduction: The causes of congenital hypothyroidism (CHT) are thyroid dysgenesis (TD), dyshormonogenesis (TDH) or transient hypothyroidism (TH).

Methodology: This is a cross-sectional study looking at data over a period of 16 years (2000-2016). Confirmed cases had thyroid scan at the age of 3-years-old and repeated TFT (after 6 weeks off medications). Relevant data was collected retrospectively.

Results: Forty (60% female) children with CHT were included in the study. Thirty (75%) children presented with high cord TSH. Nine (23%) presented after 2 weeks of life. Majority were diagnosed with TDH (42.5%) with TD and TH of 40% and 17.5% respectively. Median cord TSH of children with TD was significantly higher compared to TDH and TH (p=0.028 and p=0.001 respectively). L-thyroxine doses were not significantly different between TD, TDH and TH at diagnosis or at 3 years.

Conclusions: TDH is highly prevalent in our population. TD may present after 2 weeks of life. One in five children treated for CHT had TH. Differentiating TD, TDH and TH before initiating treatment remains a challenge in Malaysia. This study provides clinicians practical information needed to understand the possible aetiologies from a patient's clinical presentation, biochemical markers and treatment regime. Reassessing TH cases may be warranted to prevent unnecessary treatment.

Matched MeSH terms: Hyperthyroidism

Fulltext Thyrotoxic periodic paralysis: a report of 3 Malaysian cases and a review of its pathology

Sthaneshwar P, Prathibha R, Yap SF

Malays J Pathol, 2005 Jun;27(1):29-32.

PMID: 16676690

Thyrotoxic periodic paralysis (TPP) is a medical emergency characterised by sudden onset of muscle weakness with hypokalemia that resolves with the treatment of hyperthyroidism. We report three cases of thyrotoxic periodic paralysis seen at the Accident and Emergency Care Department, University of Malaya Medical Centre in a period of four months. We also review the clinical presentation, pathophysiology, biochemical features and management of TPP. All three patients were young Asian males, presenting with muscle weakness of sudden onset. The first patient presented with lower limb weakness and had symptoms of thyrotoxicosis and goitre. He had a previous similar episode which resolved spontaneously. The second patient presented with quadriplegia, respiratory acidosis and had no signs and symptoms of thyrotoxicosis. The electrocardiogram of this patient showed normal sinus rhythm with U wave in V3 and a flat T wave, which are characteristic of hypokalaemia. The third patient, who was a known case of thyrotoxicosis, was admitted thrice for hypokalemic paralysis during the study period. All cases had low serum potassium, suppressed TSH and elevated T4 confirming thyrotoxic periodic paralysis. Potassium therapy was useful during the crisis; however prophylactic potassium has not been shown to prevent attacks as seen in one of our cases.

Matched MeSH terms: Hyperthyroidism/therapy*

α-thalassemia-associated hydrops fetalis: A rare cause of thyrotoxic cardiomyopathy

Tumian NR, Wong M, Wong CL

J Obstet Gynaecol Res, 2015 Jun;41(6):967-70.

PMID: 25510540 DOI: 10.1111/jog.12648

α°-thalassemia is a well-known cause of hydrops fetalis in South-East Asia and can be detected in utero. We report a very rare case of thyrotoxic cardiomyopathy associated with hyperplacentosis secondary to α°-thalassemia-associated hydrops fetalis. A 22-year-old primigravida with microcytic anemia presented at 27 weeks' gestation with pre-eclampsia, hyperthyroidism and cardiac failure. Serum β-human chorionic gonadotrophin was markedly elevated and abdominal ultrasound revealed severe hydropic features and enlarged placenta. Serum β-human chorionic gonadotrophin, cardiac function and thyroid function tests normalized after she delivered a macerated stillbirth. Histopathology of the placenta showed hyperplacentosis. Blood DNA analysis revealed that both patient and husband have the α°-thalassemia trait. This case illustrates a very atypical presentation of α°-thalassemia-associated hydrops fetalis and the importance of early prenatal diagnosis of α-thalassemia in women of relevant ethnic origin with microcytic anemia so that appropriate genetic counseling can be provided to reduce maternal morbidity and the incidence of hydrops fetalis.

Matched MeSH terms: Hyperthyroidism

Management strategies in Graves' hyperthyroidism

Tan CE, Tan KT, Khoo D, Wang KW

Family Physician, 1991;3:42-45.

Antithyroid drugs, radioiodine and surgery are lhe three modalities of treatment for Graves' hyperthyroidism. The treatment strategy depends on a clear understanding of the relative advantages and disadvantages of each mode of treatment as well as the individual patient's preference. Recent studies favour the use of high dose antithyroid drugs with thyroxine supplementation to induce a higher rate of remission. Radioiodine is likely to be favoured as the definitive form of treatment. Surgery still has a place particularly for young female patients with large goitres. Keywords: Antithyroid drugs, radioiodine, thyroidectomy.

Matched MeSH terms: Hyperthyroidism

Fulltext Young Lady with Bilateral Yellowish Lesions on Her Eyelids

Ishak A, Mohd Yusoff SS, Wan Abdullah W

Malays Fam Physician, 2018;13(3):44-46.

PMID: 30800235 MyJurnal

A 26-year-old woman with an unknown medical illness presented with yellowish skin lesions around both eyes, visible for the past 4 years. The lesions were neither itchy nor tender and had increased gradually in size. She had neither constitutional nor hyperthyroidism symptoms. She is the youngest out of four siblings, and none of her family members have cardiovascular disease or similar problems. Upon examination, there were bilateral yellowish plaques over the periorbital region. Her body mass index (BMI) was 23.8 kg/m2. Her vital signs were all normal at every visit.

Matched MeSH terms: Hyperthyroidism

Papillary thyroid microcarcinoma diagnosed in a patient presenting with hyperthyroidism

Surenthiran Ramanathan, Tong, Chin Voon

International e-Journal of Science, Medicine & Education, 2017;11(3):30-31.

MyJurnal

Papillary thyroid microcarcinoma is not uncommon
and constitutes almost one third of all differentiated
thyroid carcinomas. It is generally regarded as low risk
and usually an incidental finding from histopathology
examination. Some areas of management of this entity
remains uncertain and requires a multidisciplinary
approach. We present a patient who initially came to
us with symptoms of hyperthyroidism, later underwent
thyroidectomy for a suspicious lesion but was found to
have micropapillary thyroid carcinoma in another part
of her thyroid gland.

Matched MeSH terms: Hyperthyroidism

Fulltext Pancytopenia in a patient with Grave's disease

Loh HH, Tan F

Med J Malaysia, 2013 Aug;68(4):372-3.

PMID: 24145274 MyJurnal

Pancytopenia can rarely complicate Grave's disease. It can be due to uncontrolled thyrotoxicosis or as a result of rare side effect of antithyroid medication. Pernicious anemia leading to Vitamin B12 deficiency is another rare associated cause. We report a case of a patient with Grave's disease and undiagnosed pernicious anemia whom was assumed to have antithyroid drug induced pancytopenia. Failure to recognize this rare association of pernicious anemia as a cause of pancytopenia had resulted in delay in treatment and neurological complication in our patient.

Matched MeSH terms: Hyperthyroidism*

Fulltext Psychoses associated with thyrotoxicosis: a retrospective study of twenty cases

Tan CK

Med J Malaysia, 1985 Sep;40(3):247-51.

PMID: 3842721

A total of 23 patients with psychoses associated with thyrotoxicosis were admitted to the psychiatric unit of a University Hospital over a 13-year period, of which 20 patients were included in this retrospective study. It was found that a parallel relationship between thyrotoxicosis and psychosis appears to exist in six patients, while in the remaining 14 patients, the course of the two disease processes were largely independent of each other. Paranoid delusions and auditory hallucinations were the most prominent psychiatric symptoms. Depression was commonly seen even in patients who were not having an affective illness. In four patients, a mixed schizo-affective psychosis was seen, suggesting that the diagnostic distinction between the affective and schizophrenic reactions are often blurred in psychosis associated with thyrotoxicosis.

Matched MeSH terms: Hyperthyroidism*

Hyperthyroidism in systemic lupus erythematosus

Cheah JS, Chia BL, Tay HH, Tan BY

Med J Aust, 1970 Nov 28;2(22):1029-30.

PMID: 5494951

Matched MeSH terms: Hyperthyroidism/complications*

Fulltext Endoscopic orbital decompression for optic neuropathy in thyroid ophthalmopathy

Tang IP, Prepageran N, Subrayan V, Tajunisah I

Med J Malaysia, 2008 Oct;63(4):337-8.

PMID: 19385499 MyJurnal

Optic neuropathy, an uncommon manifestation occurs in 5% of patients with Graves' ophthalmopathy. Its outcome is good if early and proper treatment given. We reported a 49 years old male patient of Graves' disease with bilateral optic neuropathy. He underwent bilateral transnasal endoscopic orbital decompression with marked improvement of visual acuity bilaterally. The preoperative visual acuity was 6/36 in his right eye and 6/60 in his left eye. Two days after operation, his visual acuity was 6/12 in his right eye and 6/24 in his left eye. Transnasal endoscopic orbital decompression is a choice of treatment in optic neuropathy in thyroid ophthalmopathy after trial of corticosteroids.

Matched MeSH terms: Hyperthyroidism*

Fulltext Endoscopic orbital decompression for Graves' ophthalmopathy

Tang IP, Prepageran N, Shashinder S

Med J Malaysia, 2008 Mar;63(1):67-8.

PMID: 18935740

We report a male patient of Graves' Disease with bilateral exophthalmos who had undergone bilateral transnasal endoscopic orbital decompression with subsequent improvement of 3 mm in orbital proptosis bilaterally without any complications. Transnasal endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques especially for purely cosmetic reasons.

Matched MeSH terms: Hyperthyroidism*

Hyperthyroidism in pregnancy

Zainurrashid Z, Shaker AaRH

Family Physician, 2005;13:2-4.

Thyroid diseases are common in women, including at the time of pregnancies. Many typical features of hyperthyroidism are common in normal pregnancies and this may delay or mask the diagnosis. Uncontrolled thyrotoxicosis increases the rate of miscarriage, intrauterine growth restriction (IUGR), premature labour and perinatal mortality. Multi-disciplinary efforts are required to achieve optimal control of thyrotoxicosis. Anti-thyroid drugs are safe and should be used with the lowest possible doses. Radioiodine treatment is contraindicated during pregnancy and lactation. Indications of surgery include: compression symptoms, thyroid malignancy, non-compliance to medications or when the patient develop drugs side effects. Keywords: Hyperthyroidism, pregnancy

Matched MeSH terms: Hyperthyroidism

Hyperthyroidism in pregnancy

Zainuddin Z, Shaker AAH

Family Physician, 2005;13(3):2-4.

MyJurnal

Thyroid diseases are common in women, including at the time of pregnancies. Many typical features of hyperthyroidism are common in normal pregnancies and this may delay or mask the diagnosis. Uncontrolled thyrotoxicosis increases the rate of miscarriage, intrauterine growth restriction (IUGR), premature labour and perinatal mortality. Multi-disciplinary efforts are required to achieve optimal control of thyrotoxicosis. Anti-thyroid drugs are safe and should be used with the lowest possible doses. Radioiodine treatment is contraindicated during pregnancy and lactation. Indications of surgery include: compression symptoms, thyroid malignancy, non-compliance to medications or when the patient develop drugs side effects

Matched MeSH terms: Hyperthyroidism

Fulltext Thyrotoxicosis simulating lymphoma. A case report

Ramanathan M

Med J Malaysia, 1988 Mar;43(1):59-61.

PMID: 3244322

We report a patient with unusual manifestations of hyperthyroidism which initially suggested lymphoma. The pathophysiology of these features in thyrotoxicosis is discussed. The need to consider thyrotoxicosis in an otherwise unexplained case of lymphoid hyperplasia will be stressed.

Matched MeSH terms: Hyperthyroidism*

Fulltext Euthyroid hyperthyroxinemia: a case report

Ramanathan M

Med J Malaysia, 1987 Mar;42(1):65-7.

PMID: 3431505

This report deals with the problems of a young man who was clinically euthyroid but biochemically hyperthyroid. The possibility of peripheral resistance to thyroid hormones to explain this paradoxical state is discussed. The importance of recognising this condition to avoid the erroneous diagnosis of thyrotoxicosis and inappropriate therapy is stressed.

Matched MeSH terms: Hyperthyroidism*

Fulltext Dysphagia as a primary manifestation of thyrotoxicosis: a case report

Ramanathan M

Med J Malaysia, 1989 Mar;44(1):83-6.

PMID: 2626117

This report deals with a middle aged man in whom the presenting symptom of the disorder was dysphagia. The clinical approach to the final diagnosis of thyrotoxic myopathy causing dysphagia is outlined and the pathophysiology of dysphagia then discussed. The need to include thyrotoxicosis in the differential diagnosis of an otherwise unexplained case of dysphagia is stressed.

Matched MeSH terms: Hyperthyroidism*

Thyroid enlargement in Batu Pahat district

ROE TN

Med J Malaya, 1960 Sep;15:26-32.

PMID: 13742656

Matched MeSH terms: Hyperthyroidism/epidemiology*

Hyperthyroidism and autoimmune hemolytic anemia--a case report

Chee YC, Gill DS, Poh SC

Med J Malaysia, 1978 Dec;33(2):154-5.

PMID: 755168

Matched MeSH terms: Hyperthyroidism/complications*

Thyrotoxicosis in pregnancy