Use of esmolol in managing a thyrotoxic patient needing emergency surgery
Article Abstract:
Hyperthyroidism, the increased activity of the thyroid gland, is associated with the risk of developing a thyroid storm, a potentially fatal complication. A thyroid storm is a toxic condition of hyperactivity characterized by fever, sweating, rapid heartbeat, accumulation of fluid in the lungs, tremulousness, and restlessness. This disorder occurs in patients with poorly controlled hyperthyroidism and may be triggered by infection, injury, or emergency surgery. A thyroid storm is treated by catecholamine inhibitors, drugs that prevent the actions of catecholamine hormones, which are involved in activating various cell processes. A case is described of a 20-year-old woman who suffered a thyroid storm due to appendicitis and was unresponsive to propranolol, which is commonly used to treat thyroid crises. However, the thyroid storm was successfully treated with the beta blocker esmolol, which has a very short duration of action. Beta blocking agents prevent the activation of beta receptors, which are membrane proteins that bind catecholamine hormones, and thereby activate various cell responses such as heart rate and contraction. In this case, beta blockade resulted in a decrease in heart rate from 132 to 150 beats per minute to 100 beats per minute after treatment with esmolol. Because esmolol has a very short duration of action, lasting 10 to 20 minutes, the dose can be closely monitored and controlled to achieve the desired effect. Ultrashort-acting agents such as esmolol are useful when prevention of effects of excess thyroid hormone is rapidly needed. This case shows that esmolol is effective in treating thyrotoxic patients who require emergency surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Local reactions to radioiodine in the treatment of thyroid cancer
Article Abstract:
Radioactive iodine, I-131, is used to treat hyperthyroidism, a condition associated with increased activity of the thyroid gland, and thyroid cancer. Some rare adverse effects of I-131 treatment of hyperthyroidism include thyroiditis, or inflammation of the thyroid gland, and worsening of the hyperthyroidism. There are even fewer reports of complications associated with radioiodine treatment of thyroid cancer. The incidence of complications associated with I-131-induced elimination of thyroid cancer was assessed in 49 patients who had extensive surgery to remove the thyroid gland and 10 patients with residual intact thyroid tissue. Neck pain or tenderness developed after radioiodine treatment in 60 percent of patients with residual thyroid tissue, whereas only 6 percent of patients who underwent extensive surgery developed complications after radioiodine treatment. Patients who had undergone extensive surgery did not develop severe reactions. These findings reveal a higher incidence of complications in patients with residual thyroid tissue than in patients who undergo extensive surgery to remove the thyroid gland. Patients should be made aware of the potential complications of radioiodine treatment; a dose of less than 30 millicuries of I-131 is recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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