methimazole and Tachycardia

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Drug Therapy, Combination; Electrocardiography; Graves Disease; Humans; Hypokalemia; Male; Methimazole; Muscle Weakness; Propranolol; Tachycardia; Thyroidectomy

Although simple febrile seizures are relatively common and benign in toddlers, it is important to rule out any underlying critical disease that necessitates further intervention and treatment. Thyroid storm, the extreme manifestation of hyperthyroidism, is relatively rare and not often considered in the differential diagnosis of a febrile seizure despite its high mortality rate. Here, we report 1 of the youngest patients with thyroid storm, who initially presented with a febrile seizure. After reevaluation, the 2-year-9-month-old patient was discovered to have thyromegaly, which led to recognition that her persistent tachycardia and widened pulse pressure were likely signs of thyrotoxicosis. Laboratory results were consistent with primary hyperthyroidism due to Graves' disease. Thyroid storm was then diagnosed on the basis of clinical features including gastrointestinal and central nervous system disturbances. Treatment with methimazole, propranolol, hydrocortisone, and Lugol's iodine solution was used. This medication regimen was safe and effective with restoration of a euthyroid state after 2 months and no recurrence of seizures. Improved awareness of hyperthyroidism and thyroid storm can lead to prompt diagnosis and treatment of this endocrine emergency, thus reducing mortality and morbidity. Pediatricians should consider this diagnosis in children with febrile seizures and suggestive vital signs and physical examination findings.

Topics: Child, Preschool; Female; Graves Disease; Humans; Hydrocortisone; Hypertension; Iodides; Methimazole; Propranolol; Seizures, Febrile; Tachycardia; Thyroid Crisis

A 21-year-old young man with no history of diabetes or thyroid disease presented to the emergency department with simultaneous thyroid storm and diabetic ketoacidosis. Notable findings on admission were a ventricular rate of 235 beats/min, tachypnoea, tremors, polydipsia and a lack of fever. Due to the unusual constellation of symptoms, diagnosis was only possible after initial laboratory results came back. While the lack of fever is unusual in thyroid storm, diabetic ketoacidosis has previously been reported to suppress fever, and this case supports the occurrence of this phenomenon. This case was highly unusual because the patient had not previously been diagnosed with either type 1 diabetes or Graves' disease.

Topics: Adult; Anti-Arrhythmia Agents; Anti-Inflammatory Agents; Antithyroid Agents; Diabetic Ketoacidosis; Diagnosis, Differential; Humans; Hydrocortisone; Insulin; Male; Methimazole; Propranolol; Propylthiouracil; Tachycardia; Thyroid Crisis; Young Adult

Syncope is a common emergency department (ED) chief complaint, with many known but also unknown causes. Here we present a novel ED presentation of a young woman with new-onset hyperthyroidism that masqueraded as a syncopal event with head trauma. A 21-year-old woman arrived in the ED with head trauma as the result of seemingly unprovoked syncope, due to her history as well as the nature of her trauma. Persistent tachycardia during her ED course after an unremarkable full trauma evaluation prompted ordering of additional lab testing, which revealed evidence of thyrotoxicosis. Here we consider the possibility of thyroid dysfunction resulting in syncope.

Topics: Antithyroid Agents; Craniocerebral Trauma; Diagnosis, Differential; Electrocardiography; Female; Humans; Methimazole; Syncope; Tachycardia; Thyroid Function Tests; Thyrotoxicosis; Young Adult

Topics: Female; Humans; Hypoxia; Infant; Male; Methimazole; Obstetric Labor, Premature; Pregnancy; Tachycardia; Tachypnea

A 22-year-old woman presented to the emergency department (ED) with a 24-hour history of nausea, vomiting, diarrhea, generalized abdominal pain, and mild headache. She denied shortness of breath, chest pain, or anxiety, and didn't have a history of cardiac problems. The physical examination revealed tachycardia (heart rate, 135 beats/min) and a respiratory rate of 24 breaths per minute.

Topics: Adult; Antithyroid Agents; Atenolol; Female; Humans; Hyperthyroidism; Methimazole; Nausea; Pulmonary Edema; Tachycardia; Treatment Outcome; Vomiting; Weight Loss; Young Adult

Prenatal ultrasonography of a pregnant woman with a past history of total thyroidectomy for Graves' disease detected fetal tachycardia, fetal growth restriction and oligohydramnios at 30 weeks gestation. Because a high titer of thyroid-stimulating hormone receptor antibody was noted in maternal serum and the fetal goiter was detected on ultrasonography, fetal hyperthyroidism was strongly suspected and subsequently confirmed with cordocentesis at 31 weeks gestation. After treatment of fetal hyperthyroidism through oral maternal administration of methimazole (MMI) starting at 33 weeks gestation, fetal heart rate and amniotic fluid volume returned to normal ranges. Complete resolution of the fetal goiter was observed at 35 weeks gestation. A male infant was born at 35 weeks 6 days gestation via cesarean section in the absence of thyrotoxic findings; however, cord blood chemical analysis at birth indicated iatrogenic fetal hypothyroidism. In the present report, maternal therapy using MMI to resolve symptoms of fetal thyrotoxicosis, including fetal tachycardia and oligohydramnios, was successfully conducted.

Topics: Antithyroid Agents; Cordocentesis; Female; Fetal Diseases; Goiter; Graves Disease; Humans; Hyperthyroidism; Hypothyroidism; Male; Methimazole; Middle Aged; Neck; Oligohydramnios; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Tachycardia; Thyroidectomy; Thyroxine; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal

Thyroid hormone resistance syndromes are disorders in which there is decreased end-organ responsiveness to thyroid hormone. Patients typically present with elevated levels of thyroxine and triiodothyronine with a normal or increased serum thyroid-stimulating hormone concentration. Clinical features are variable, and there are no guidelines regarding treatment.. The patient was noted to have tachycardia at 6 months of age. He had persistently elevated free thyroxine and normal/mildly elevated thyroid-stimulating hormone for the first 2 years of life. At age 2 years, he was noted to have sinus tachycardia, a mildly enlarged thyroid, hyperactive behavior, subtle developmental delay, and poor weight gain. The patient has a previously described de novo mutation in the thyroid hormone receptor-β gene.. He was started on methimazole (0.3-0.5 mg/kg/day) at age 3 years to treat his symptoms. With medication, weight gain, sleep, behavior, and tachycardia improved. Linear growth has remained appropriate for age. Heart rate is in the upper normal range and his thyroid has become more enlarged.. Methimazole has improved thyrotoxic symptoms in a 3-year-old male with thyroid hormone resistance. The use of methimazole should be considered in certain patients.

Topics: Age Factors; Antithyroid Agents; Child, Preschool; Humans; Male; Methimazole; Tachycardia; Thyroid Hormone Resistance Syndrome; Treatment Outcome

Topics: Adrenergic beta-Antagonists; Adult; Anesthesia, Intravenous; Antithyroid Agents; Chemical and Drug Induced Liver Injury; Dexamethasone; Drug Therapy, Combination; Female; Graves Disease; Humans; Hypertension; Iopanoic Acid; Kidney Diseases; Methimazole; Preoperative Care; Propranolol; Tachycardia; Thyroidectomy

Topics: Adrenergic beta-Antagonists; Antithyroid Agents; Anxiety; Body Temperature Regulation; Diagnosis, Differential; Graves Disease; Humans; Hyperthyroidism; Male; Methimazole; Middle Aged; Muscle Weakness; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Tachycardia; Thyroid Function Tests; Tremor; Weight Loss

Topics: Adrenergic beta-Antagonists; Anorexia Nervosa; Antithyroid Agents; Body Image; Female; Humans; Hyperthyroidism; Methimazole; Sweating; Tachycardia; Weight Loss

Amiodarone, a iodine-rich drug widely used in the treatment of tachyarrhythmias, represents one of the most common sources of iodine-induced thyrotoxicosis. The data concerning 58 patients with amiodarone-iodine-induced thyrotoxicosis (AIIT) were analyzed in the present study. Prevalence of AIIT was higher in males than in females (M/F = 1.23/l). Thyrotoxicosis occurred either during treatment with or at various intervals after withdrawal of amiodarone. AIIT developed not only in patients with underlying thyroid disorders, but also in subjects with apparently normal thyroid gland. Classical symptoms of thyrotoxicosis were often lacking, the main clinical feature being a worsening of cardiac disorders. Biochemical diagnosis of AIIT was established by the finding of elevated serum total and free triiodothyronine levels, since elevated serum total and free thyroxine could be found also in euthyroid amiodarone-treated subjects. Twenty-four-hour thyroid radioiodine uptake was very low or undetectable in AIIT patients with apparently normal thyroid glands, while it was inappropriately elevated in patients with underlying thyroid disorders, despite iodine contamination. The role of autoimmune phenomena in the pathogenesis of AIIT appeared to be limited, because circulating thyroid autoantibodies were undetectable in AIIT patients without underlying thyroid disorders or with nodular goiter. Conversely, humoral features of thyroid autoimmunity were mostly found in AIIT patients with diffuse goiter. Treatment of AIIT appeared to be a difficult challenge. Among the 11 patients given no treatment, thyrotoxicosis spontaneously subsided in the 5 patients with apparently normal thyroid gland, whereas the 6 patients with nodular or diffuse goiter were still hyperthyroid 6-9 months after discontinuation of the drug. The administration of high doses (40 mg/day) of methimazole alone proved to be ineffective in most (14/16) patients given this treatment. Twenty-seven patients were treated by methimazole combined with potassium perchlorate (1 g/day). With one exception, euthyroidism was restored within 15-90 days in all cases with underlying thyroid abnormalities, and within 6-55 days in subjects with apparently normal thyroid gland. Thus, the combined treatment appears to be the most effective one, but, due to the potential toxicity of potassium perchlorate, it should be reserved to patients with severe thyrotoxicosis and should be carefully monitored.

Topics: Adult; Aged; Amiodarone; Drug Therapy, Combination; Female; Humans; Immunoglobulin G; Immunoglobulins, Thyroid-Stimulating; Iodine; Iodine Radioisotopes; Male; Methimazole; Middle Aged; Tachycardia; Thyroid Hormones; Thyrotoxicosis

Topics: Electric Countershock; Heart Atria; Heart Block; Heart Ventricles; Humans; Male; Methimazole; Middle Aged; Tachycardia

Topics: Adult; Aged; Ascorbic Acid; Body Temperature; Contrast Media; Female; First Aid; Germany, West; Humans; Iodides; Iodine; Male; Methimazole; Middle Aged; Phenobarbital; Prednisolone; Tachycardia; Thyroid Crisis; Triiodothyronine