methimazole and Emergencies

Topics: Agranulocytosis; Anti-Bacterial Agents; Antithyroid Agents; Drug Substitution; Emergencies; Female; Humans; Hyperthyroidism; Lung Abscess; Methimazole; Middle Aged; Propylthiouracil; Tomography, X-Ray Computed

Myopathy is a known complication of hypothyroidism, commonly characterized by an elevation in Creatine Kinase (CPK) due to increase capillary permeability proportional to the hypothyroid state. Thyroid hormone is important for the expression of fast myofibrillar proteins in the muscle. In hypothyroidism the expression of these proteins are deficient and there is an increase accumulation of slow myofibrillar proteins. A rapid or abrupt descend in thyroid hormones caused by radioiodine therapy after prolonged hyperthyroidism can lead to local hypothyroid state within the muscle tissue, resulting in CPK elevation and hypothyroid myopathy. Hormone replacement leads to resolution of symptoms and normalization of muscle enzymes serum levels.

Topics: Diagnosis, Differential; Edema; Electromyography; Emergencies; Female; Graves Disease; Hormone Replacement Therapy; Humans; Hyperthyroidism; Hypothyroidism; Iodine Radioisotopes; Magnetic Resonance Imaging; Methimazole; Muscle Cramp; Muscle Weakness; Propranolol; Reflex, Abnormal; Thyroid Hormones; Thyroxine; Young Adult

Topics: Adult; Antihypertensive Agents; Antithyroid Agents; Emergencies; Follow-Up Studies; Genetic Predisposition to Disease; Graves Disease; Humans; Hypokalemic Periodic Paralysis; Jews; Male; Methimazole; Potassium; Prevalence; Propranolol; Recurrence; Thyrotoxicosis; Time Factors; Treatment Outcome

Each of the endocrine emergencies discussed here--adrenal crisis, myxedema coma, and thyroid storm--represents decompensation of a long-standing endocrine disorder and is precipitated in most cases by some stressful event. Each necessitates immediate, aggressive therapy. Even with such therapy, the mortality rate remains 30% to 50% for myxedema coma and 30% to 40% for thyroid storm. Therapy must be instituted on the basis of strong clinical suspicion, without delay for results of specific hormone assays to confirm the diagnosis. Although some risks may be inherent in this approach, they are minimal compared with the risks of delaying therapy until laboratory confirmation can be obtained. Immediate therapy consists of specific measures to correct the hormone deficit or excess; the precipitating cause should then be sought and treated.

Topics: Addison Disease; Coma; Emergencies; Humans; Hydrocortisone; Methimazole; Myxedema; Stress, Psychological; Thyroid Crisis; Thyroid Hormones