A patient with Graves' disease who survived despite developing thyroid storm and lactic acidosis

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

A 56-year-old woman with Graves' disease presented with the complaints of diarrhea and palpitations. Physical examination and laboratory data revealed hypothermia and signs of mild hyperthyroidism, heart failure, hepatic dysfunction with jaundice, hypoglycemia, and lactic acidosis. The patient was diagnosed as having developed the complication of thyroid storm in the absence of marked elevation of the thyroid hormone levels, because of the potential hepatic and cardiac dysfunctions caused by heavy alcohol drinking. A year later, after successful treatment, the patient remains well without any clinical evidence of heart failure or hepatic dysfunction. Thyroid storm associated with lactic acidosis and hypothermia is a serious condition and has rarely been reported. Prompt treatment is essential even if the serum thyroid hormone levels are not markedly elevated. We present a report about this patient, as her life could eventually be saved.

Related collections

Most cited references 14

Record: found
Abstract: found
Article: not found

Life-threatening thyrotoxicosis. Thyroid storm.

Henry Burch, Leonard Wartofsky (1993)

Although important strides in recognition and therapy have significantly reduced the mortality in this disorder from the nearly 100% fatality rate noted by Lahey, survival is by no means guaranteed. More recent series have yielded fatality rates between 20% and 50%. Although some authors have attributed this improvement, in part, to a relaxation of the diagnostic criteria for thyroid storm, it more likely represents improvements in early recognition and the beneficial effects of the serial addition of antithyroid, corticosteroid, and antiadrenergic therapies to the treatment of this disorder. Thyroid storm is a dreaded, fortunately rare complication of a very common disorder. Most cases of thyroid storm occur following a precipitating event or intercurrent illness. Effective management is predicated on a prompt recognition of impending thyroid storm which is, in turn, dependent on a thorough knowledge of both the typical and atypical presentations of this disorder. An unwavering commitment to an aggressive, multifaceted therapeutic intervention as outlined herein is critical to the obtainment of a satisfactory outcome.

0 comments Cited 172 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Mitochondrial uncoupling as a target for drug development for the treatment of obesity.

Toni M Brand, Michelle J. Harper, Ian K. Dickinson (2001)

Mitochondrial proton cycling is responsible for a significant proportion of basal or standard metabolic rate, so further uncoupling of mitochondria may be a good way to increase energy expenditure and represents a good pharmacological target for the treatment of obesity. Uncoupling by 2,4-dinitrophenol has been used in this way in the past with notable success, and some of the effects of thyroid hormone treatment to induce weight loss may also be due to uncoupling. Diet can alter the pattern of phospholipid fatty acyl groups in the mitochondrial membrane, and this may be a route to uncoupling in vivo. Energy expenditure can be increased by stimulating the activity of uncoupling protein 1 (UCP1) in brown adipocytes either directly or through beta 3-adrenoceptor agonists. UCP2 in a number of tissues, UCP3 in skeletal muscle and the adenine nucleotide translocase have also been proposed as possible drug targets. Specific uncoupling of muscle or brown adipocyte mitochondria remains an attractive target for the development of antiobesity drugs.

0 comments Cited 50 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Systematic review of associations between the presence of acute ischemic lesions on diffusion-weighted imaging and clinical predictors of early stroke risk after transient ischemic attack.

Dennis Briley, Jessica N E Redgrave, Ursula Schulz … (2007)

Early risk of stroke after a transient ischemic attack can be reliably predicted with risk scores based on clinical features of the patient and of the ischemic event, but it is unclear how these features correlate with findings on brain imaging. We performed a systematic review of the literature and identified all previous studies which reported patient characteristics and the nature of transient ischemic attack symptoms in relation to appearances on diffusion-weighted imaging (DWI). We then performed a meta-analysis of the associations between the components of the risk scores and positive DWI. Authors were contacted for additional unpublished data. Nineteen studies were identified by the systematic review, and additional unpublished data were obtained from 11 of these studies. On meta-analysis, several components of the risk scores were associated with positive DWI, including symptom duration > or =60 minutes (13 studies, odds ratio [OR], 1.50; 95% CI, 1.16 to 1.96; P=0.004), dysphasia (9 studies, OR, 2.25; 95% CI, 1.57 to 3.22; P or =50% carotid stenosis (10 studies, OR, 1.93; 95% CI, 1.34 to 2.76; P=0.001) were associated with positive DWI. Presence of acute ischemic lesions on DWI correlates with several clinical features known to predict stroke risk after transient ischemic attack. Large studies (sample size >1000) will therefore be required to determine the independent prognostic value of DWI and its interactions with these clinical characteristics.

0 comments Cited 36 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Ups J Med Sci

Journal ID (publisher-id): UPS

Title: Upsala Journal of Medical Sciences

Publisher: Informa Healthcare

ISSN (Print): 0300-9734

ISSN (Electronic): 2000-1967

Publication date (Print): October 2010

Publication date (Electronic): 27 October 2010

Volume: 115

Issue: 4

Pages: 282-286

Affiliations

¹simpleDepartment of Internal Medicine, Nerima General Hospital, Asahigaoka, Nerima-ku, Tokyo, Japan

²simpleDivision of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Oyaguchi Kamimachi, Itabashi-ku, Tokyo, Japan

Author notes

Correspondence: Tatsuo Yanagawa, MD, Department of Medicine, Nerima General Hospital, 1-24-1, Asahigaoka, Nerima-ku, Tokyo 176-8530, Japan. +81-3-5988-2250. tyana-mj@ 123456xj9.so-net.ne.jp

Article

Publisher ID: UPS_A_486908_O

DOI: 10.3109/03009734.2010.486908

PMC ID: 2971487

PubMed ID: 20731531

SO-VID: b48d7aa1-36d1-4ead-9e5a-28a513ed5d5b

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.

A patient with Graves' disease who survived despite developing thyroid storm and lactic acidosis

Read this article at

Abstract

Related collections

International Journal of Applied Technology in Medical Sciences

Most cited references 14

Life-threatening thyrotoxicosis. Thyroid storm.

Mitochondrial uncoupling as a target for drug development for the treatment of obesity.

Systematic review of associations between the presence of acute ischemic lesions on diffusion-weighted imaging and clinical predictors of early stroke risk after transient ischemic attack.

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 740

Cited by 3

Most referenced authors 83