7 0–35 IU/L D-dimers 3.58 0–0.44 C-reactive protein 161.2 0–10 mg/L Blood ketones 5.3 Bicarbonate 8.1 22–29mmol/L Thyroid-stimulating hormone (TSH) 1.13 0.4–4.5 µ/L CTPA excluded
S Hussain, S Keat and S V Gelding
Skand Shekhar, Sriram Gubbi, Georgios Z Papadakis, Naris Nilubol and Fady Hannah-Shmouni
-computed tomography (PET/CT) scan revealed a large right adrenal mass (7 × 6.4 cm) with a maximum standardized uptake value (SUVmax) of 12.4, extending into a large hypermetabolic metastasis in the right hepatic lobe with possible necrotic center ( Fig. 1 ). There
Wei Yang, David Pham, Aren T Vierra, Sarah Azam, Dorina Gui and John C Yoon
literature, EAS tumors were localized by CT scan in 66.2% of cases, MRI in 51.5% and FDG-PET/CT in 51.7% of cases. The gold standard for imaging detection of EAS is Ga 68 PET/CT, which has a sensitivity of 81.8% and specificity of 100% ( 12 ). On initial
T Min, S Benjamin and L Cozma
peri-arrest state, he was thrombolysed as per local hospital protocol. Subsequently, computed tomography pulmonary angiogram (CTPA) confirmed the diagnosis of pulmonary embolism, and he was moved to intensive therapy unit (ITU) for further management
Carolina Shalini Singarayar, Foo Siew Hui, Nicholas Cheong and Goay Swee En
Thyrotoxicosis is associated with cardiac dysfunction; more commonly, left ventricular dysfunction. However, in recent years, there have been more cases reported on right ventricular dysfunction, often associated with pulmonary hypertension in patients with thyrotoxicosis. Three cases of thyrotoxicosis associated with right ventricular dysfunction were presented. A total of 25 other cases of thyrotoxicosis associated with right ventricular dysfunction published from 1994 to 2017 were reviewed along with the present 3 cases. The mean age was 45 years. Most (82%) of the cases were newly diagnosed thyrotoxicosis. There was a preponderance of female gender (71%) and Graves’ disease (86%) as the underlying aetiology. Common presenting features included dyspnoea, fatigue and ankle oedema. Atrial fibrillation was reported in 50% of the cases. The echocardiography for almost all cases revealed dilated right atrial and or ventricular chambers with elevated pulmonary artery pressure. The abnormal echocardiographic parameters were resolved in most cases after rendering the patients euthyroid. Right ventricular dysfunction and pulmonary hypertension are not well-recognized complications of thyrotoxicosis. They are life-threatening conditions that can be reversed with early recognition and treatment of thyrotoxicosis. Signs and symptoms of right ventricular dysfunction should be sought in all patients with newly diagnosed thyrotoxicosis, and prompt restoration of euthyroidism is warranted in affected patients before the development of overt right heart failure.
- Thyrotoxicosis is associated with right ventricular dysfunction and pulmonary hypertension apart from left ventricular dysfunction described in typical thyrotoxic cardiomyopathy.
- Symptoms and signs of right ventricular dysfunction and pulmonary hypertension should be sought in all patients with newly diagnosed thyrotoxicosis.
- Thyrotoxicosis should be considered in all cases of right ventricular dysfunction or pulmonary hypertension not readily explained by other causes.
- Prompt restoration of euthyroidism is warranted in patients with thyrotoxicosis complicated by right ventricular dysfunction with or without pulmonary hypertension to allow timely resolution of the abnormal cardiac parameters before development of overt right heart failure.
C Kamath, J Witczak, M A Adlan and L D Premawardhana
scanning. Author, year of publication GD subjects treated Thymic regression Remarks Kamath 2017 (current report) 3 3 Jinguji 2017 ( 10 ) 40 40 6 had RAI as primary therapy; 34 had thionamides and RAI