Ruptured ectopic pregnancy concealing thyroid storm

Bagtharia, Seema; Goyal, Varun; Chakrabarti, R.; Utting, H.

doi:10.1080/01443610601157828

Cited by 3 publications

(1 citation statement)

References 2 publications

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“…Indeed, on the one hand, the altered coagulation state peculiar to pregnancy might be worsened by thyrotoxicosis (see Diagnosis section); on the other hand, immune system modulation – and “re-modulation” in the post-natal phase – may give origin to a new-onset autoimmune hyperthyroidism, or reawaken a previously present (i.e., pre-conception) one (59–62). …”

Section: Thyrotoxic Stormmentioning

confidence: 99%

Clinical Concepts on Thyroid Emergencies

2014

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Objective: Thyroid-related emergencies are caused by overt dysfunction of the gland which are so severe that require admission to intensive care units (ICU) frequently. Nonetheless, in the ICU setting, it is crucial to differentiate patients with non-thyroidal illness and alterations in thyroid function tests from those with intrinsic thyroid disease. This review presents and discusses the main etiopathogenetical and clinical aspects of hypothyroid coma (HC) and thyrotoxic storm (TS), including therapeutic strategy flow-charts. Furthermore, a special chapter is dedicated to the approach to massive goiter, which represents a surgical thyroid emergency.Data Source: We searched the electronic MEDLINE database on September 2013.Data Selection and Data Extraction: Reviews, original articles, and case reports on “myxedematous coma,” “HC,” “thyroid storm,” “TS,” “massive goiter,” “huge goiter,” “prevalence,” “etiology,” “diagnosis,” “therapy,” and “prognosis” were selected.Data Synthesis and Conclusion: Severe excess or defect of thyroid hormone is rare conditions, which jeopardize the life of patients in most cases. Both HC and TS are triggered by precipitating factors, which occur in patients with severe hypothyroidism or thyrotoxicosis, respectively. The pillars of HC therapy are high-dose l-thyroxine and/or tri-iodothyroinine; i.v. glucocorticoids; treatment of hydro-electrolyte imbalance (mainly, hyponatraemia); treatment of hypothermia; often, endotracheal intubation and assisted mechanic ventilation are needed. Therapy of TS is based on beta-blockers, thyrostatics, and i.v. glucocorticoids; eventually, high-dose of iodide compounds or lithium carbonate may be of benefit. Surgery represents the gold standard treatment in patients with euthyroid massive nodular goiter, although new techniques – e.g., percutaneous laser ablation – are helpful in subjects at high surgical risk or refusing operation.

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Section: Thyrotoxic Stormmentioning

confidence: 99%

Clinical Concepts on Thyroid Emergencies

2014

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General gynecology

Aeby¹

2014

Acute Care and Emergency Gynecology

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A 45-year-old gravida 6, para 6 woman presents to the emergency department with a complaint of 2 days of heavy vaginal bleeding and passing clots. She is light-headed and short of breath. Previously she had regular but heavy periods. A few days prior to this bleeding episode she noted increasing pelvic pressure and a malodorous vaginal discharge. Her past medical history is significant for recurrent anemia thought to be from abnormal uterine bleeding. Her surgical history is significant for a previous postpartum tubal ligation. She takes no medications. Physical examination General appearance: Well-developed, moderately obese woman in moderate distress Vital signs: Temperature: 38.1°C Pulse: 120 beats/min Blood pressure: 92/68 mmHg Respiratory rate: 18 breaths/min Oxygen saturation: 98% on room air Abdomen: Soft with suprapubic tenderness to deep palpation, no guarding or rebound Pelvic: Active vaginal bleeding and a large firm mass presenting at the vaginal introitus (Fig. 1.1). You are unable to do a speculum or bimanual examination Laboratory studies: Urine pregnancy test: Negative WBCs: 21 000/μL (normal 3.8-11.2 × 10 9 /L) Hb: 4.8 g/dL (normal 11.6-15.1 g/dL) Ht: 16.2% (normal 34.1-44.2%) How would you manage this patient? This patient clearly has a prolapsing submucous myoma complicated by severe anemia, hypovolemia, and likely infection. Her management requires immediate fluid resuscitation and correction of her anemia, in preparation for surgical removal of the myoma. With a 96% success rate, vaginal myomectomy in the operating room, under general or regional anesthesia, is the therapy of choice. Given her fever, elevated white blood cell count, and malodorous discharge, preoperative broad spectrum intravenous antibiotics are warranted. Prolapsing submucous myomas Uterine myomas are the most common tumors of the female reproductive tract, occurring in 20-40% of women [1]. Submucous myomas (those that lie just beneath the endometrial lining) Acute Care and Emergency Gynecology, ed.

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Acute fever and tachycardia in a 21-year-old woman during laparoscopy

Peng¹

2014

Acute Care and Emergency Gynecology

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Ruptured ectopic pregnancy concealing thyroid storm

Cited by 3 publications

References 2 publications

Clinical Concepts on Thyroid Emergencies

Clinical Concepts on Thyroid Emergencies

General gynecology

Acute fever and tachycardia in a 21-year-old woman during laparoscopy

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