Skip to main content

Screening the Thyroid before Initiating Treatment for Acromegaly? | Chapter 06 | Current Trends in Medicine and Medical Research Vol. 4

Aim: To present a case of acromegaly with coexisting thyrotoxicosis and to emphasize the relevance of screening the screening the thyroid before initiating treatment for thyrotoxicosis.

Presentation of the Case: A 55-year-old lady presented with palpitations, and weight loss of two months’ duration. She also noted her fingers and toes had swollen up, inability to incise properly since two years. Upon examination, she had morphological features clinically diagnostic of acromegaly. Her thyroid was enlargedwas on investigation found to have biochemical evidence of thyrotoxicosis. Fine needle  aspiration  cytology  of  the  thyroid  yielded  colloid  goiter.  Insulin  like  growth  factor-1  was elevated.  Serum  growth  hormone  after  an  oral  glucose  tolerance  test  was  elevated.  Magnetic resonant imaging (MRI) of the brain revealed a hypo enhancing focal lesion of size 11X10X12 mm at the pituitary region with delayed contrast enhancement suggestive of pituitary adenoma. Patient was started on anti-thyroid medications and referred to higher centre, and is awaiting surgery for pituitary adenoma.

Discussion: Among patients with acromegaly the incidence of thyroid diseases is around 78% and it has  the  most  common  presentation  being  nodular  thyroid  disease  as  the  initial  presentation.  It  is uncommon  to  see  patients  presenting  with  symptoms  of  thyrotoxicosis  initially,  who  had  florid morphological features of acromegaly. The prevalence of toxic nodular goiter to the tune of 14.3% in acromegaly.  Goiters  seen  in  acromegaly  were  euthyroid  or  autonomous,  are  due  to  the  elevated growth  hormone  levels  independent  of  TSH  action.  In  about  13  to  17%,  thyroidectomies  were performed before acromegaly was diagnosed. When patients with acromegaly presents with a weight loss should arouse the possibilities of thyroid cancer or hyperthyroidism.

Conclusion: Screening the thyroid  is  important,  as  inadvertent  thyroidectomies  were  performed before acromegaly was diagnosed. When acromegaly co-exists with thyroid dysfunction, the burden of cardiovascular abnormality should be addressed especially, to reduce the morbidity and mortality rate.

Author(s) Details

Dr. C. Rajasekharan
Department of Medicine, Medical College Hospital, Thiruvananthapuram, Kerala, 695011, India.

Read full article: http://bp.bookpi.org/index.php/bpi/catalog/view/43/185/333-1
View Volume: https://doi.org/10.9734/bpi/ctmmr/v4

Labels:

Comments

Post a Comment

Popular posts from this blog

A Prospective Study about Safety and Efficacy of Perioperative Lidocaine Infusion | Chapter 09 | New Horizons in Medicine and Medical Research Vol. 8

 Opioids cause clinically significant side effects such as respiratory depression, immunosuppression, muscle rigidity, negative inotropism, nausea, vomiting, hyperalgesia, urine retention, postoperative ileus, and drowsiness. Perioperative opioids are a major contributor to the United States' and other countries' opioid epidemics. Non-opioid analgesics, particularly lidocaine, are becoming more common for perioperative use as a result of this. A total of 185 adult patients were randomly assigned to one of two groups: control group I (105 patients) [fentanyl group] or group ii (80 patients) [opioid-free anaesthesia group]. Lidocaine 1.5 mg/kg bolus followed by 1.5 mg/kg/h infusion intraoperatively, and 1.5-2 mg/kg/h infusion for 2-8 hours postoperatively were given to patients in both groups at anaesthetic induction. Intraoperatively, both groups received analgesic adjuvants such as diclofenac 75 mg, paracetamol 1 gm, and mgso4 30-50 mg/kg. If the mean arterial pressure (map)
Post a Comment
Read more

A Brief Study of Middleware Technologies: Programming Applications and Management Systems | Chapter 15 | Novel Research Aspects in Mathematical and Computer Science Vol. 1

  Many platforms, services, applications, hardware, and operating systems are connected through the middleware layer. Because the middleware layer abstracts much low-level complexity and makes applications and software systems portable, it allows disparate systems to interface and function together in harmony. Middleware technologies enable software engineers to swiftly construct software systems and applications, allowing developers to focus on more important tasks. This chapter examines several types of middleware systems and discusses middleware capabilities, middleware operation, middleware's function in cloud-based systems, and the best middleware platforms to use. Middleware systems are widely utilised and can be found in practically any software system or application. Middleware programmes provide as a link between many sorts of systems and protocols. They serve as a mechanism for various systems. To successfully exchange information, it runs on a variety of operating system
Post a Comment
Read more

Patients’ Perspective of Acute Post-operative Pain Management: A Multicentre Survey of Tertiary Hospitals in Maharashtra, India | Chapter 08 | New Horizons in Medicine and Medical Research Vol. 8

 When postoperative pain is adequately controlled, patients' satisfaction and patient-related outcomes (PROs) increase. Understanding the patients' perspective is crucial since it supports in the formulation of improvement strategies. Because wrong attitudes and assumptions might block pain alleviation, patients' attitudes and beliefs are critical. As a result, a multicenter study of patients' attitudes, beliefs, experiences, and satisfaction levels with acute postoperative pain management was done in Maharashtra's tertiary hospitals. In addition, the responses were examined to evaluate if the Acute Pain Service (APS) resulted in improved patient outcomes and satisfaction. A 13-item questionnaire adapted from previous studies was used to capture patients' experiences with postoperative pain treatment. The responses of 179 patients are included in the study. The findings revealed that 91.6 percent of patients experienced postoperative pain, with 75.5 percent
Post a Comment
Read more