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185 results for

Subacute Lymphocytic Thyroiditis

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161. Oral Manifestations of Systemic Diseases (Diagnosis)

systemic evaluation, including referral for and biopsy with histopathologic correlation. The most common histologic findings in both oral and intestinal Crohn disease are noncaseating granulomas and both acute and chronic inflammation with lymphocytic and giant cell perivascular infiltrates. Also see . Pyostomatitis vegetans Although relatively rare, most PSV cases occur concurrently with either Crohn disease or UC. [ ] As such, PSV is considered a specific finding of IBD, and its presence can precede (...) based on clinical presentation. Reticular LP, the most common form, presents as white papules or plaques on a bed of erythema with Wickham striae. [ , ] The buccal mucosa, tongue, and gingivae may be involved. It is generally asymptomatic. [ ] Other less common forms of LP include erosive LP, erythematous (or atrophic) LP, and papular (or plaquelike) LP. [ , ] Rarely, bullous LP may be observed. [ ] Histology reveals a bandlike lymphocytic infiltrate with a saw-tooth appearance of the rete ridges

2014 eMedicine.com

162. Paraneoplastic Autonomic Neuropathy (Diagnosis)

paraneoplastic neurological syndromes include: Encephalomyelitis Limbic encephalitis Subacute cerebellar degeneration Opsoclonus-myoclonus Subacute sensory neuronopathy Chronic gastrointestinal pseudo-obstruction Lambert-Eaton myasthenic syndrome (LEMS) Dermatomyositis The most common non-classical paraneoplastic neurological syndromes include: Brainstem encephalitis Optic neuritis Cancer- or melanoma-associated retinopathy Stiff person syndrome Necrotizing myelopathy Motor neuron diseases Acute sensorimotor (...) neuropathies (ie, Guillain-Barre syndrome or brachial neuritis) Subacute/chronic sensorimotor neuropathies Neuropathies associated with paraproteinemia or vasculitis Autonomic neuropathies Myasthenia gravis Acquired neuromyotonia Acute necrotizing myopathy Patients with a definite PNS include those with the following: A classical syndrome and cancer that develops within 5 years of the diagnosis of the neurological disorder, regardless of the presence of paraneoplastic antibodies, A nonclassical syndrome

2014 eMedicine.com

163. Optic Neuritis, Adult (Diagnosis)

Classically, patients with optic neuritis are young, are often female, and have subacute vision loss associated with pain on eye movement. The patient’s history may reveal the following signs and symptoms of optic neuritis: Preceding viral illness Rapidly developing impairment of vision in 1 eye or, less commonly, both eyes: During an acute attack [ ] Dyschromatopsia (change in color perception) in the affected eye: Occasionally may be more prominent than the decreased vision [ ] Retro-orbital or ocular (...) of patients with optic neuritis See for more detail. Diagnosis The following blood tests can be performed when optic neuropathies other than optic neuritis are suspected: Erythrocyte sedimentation rate Thyroid function tests Antinuclear antibodies Angiotensin-converting enzyme Rapid plasma reagin Mitochondrial deoxyribonucleic acid (DNA) mutation studies Magnetic resonance imaging (MRI) is highly sensitive for and specific in the assessment of inflammatory changes in the optic nerves, and for central

2014 eMedicine.com

164. The Approach to the Painful Joint (Diagnosis)

The synovial membrane is the principal site of inflammation in persons with rheumatoid arthritis (RA) and many other inflammatory arthritides. [ ] Synovitis is characterized pathologically by the following: Neovascularization Infiltration of the synovium with lymphocytes, plasma cells, and macrophages Synovial lining cell hyperplasia These cause synovial proliferation, clinically manifested by warmth, tenderness, and a boggy consistency of the soft tissues overlying the involved joint. The inflamed (...) and the inner aspect of the thigh. Tenderness can be elicited by local palpation of the adductor muscles, especially near their insertion on the front of the pelvis. Pain is increased by passive abduction of the thighs and active adduction against resistance. Treatment of adductor tendinitis consists of rest and ice packs during the acute phase. NSAIDs, ultrasonography, and progressive stretching exercises are used in the subacute phase. Local corticosteroid injections are reserved for patients resistant

2014 eMedicine.com

165. Hyperthyroidism (Diagnosis)

thyroid hormone. A typical nuclear scintigraphy scan shows no radioactive iodine uptake (RAIU) in the thyrotoxic phase of the disease (see the images below). Thyroid hormone levels can be highly elevated in this condition. Absence of iodine 123 (123I) radioactive iodine uptake in patient with thyrotoxicosis and subacute painless or lymphocytic thyroiditis. Laboratory studies at time of scan demonstrated the following: thyroid-stimulating hormone (TSH), less than 0.06 mIU/mL; total thyroxine (T4), 21.2 (...) . This patient also had optic nerve dysfunction and chemosis (conjunctival edema) from thyroid-related orbitopathy. Color flow ultrasonogram in patient with Graves disease. Generalized hypervascularity is visible throughout gland (note red areas), which often can be heard as hum or bruit with stethoscope. Absence of iodine 123 (123I) radioactive iodine uptake in patient with thyrotoxicosis and subacute painless or lymphocytic thyroiditis. Laboratory studies at time of scan demonstrated the following: thyroid

2014 eMedicine.com

166. Hypertrophic Osteoarthropathy (Diagnosis)

of lymphocytes and vascular hyperplasia are responsible for thickening of the vessel walls. Electron microscopy reveals Weibel-Palade bodies and prominent Golgi complexes, confirming structural vessel wall damage. [ ] Vast numbers of arteriovenous anastomoses may also be seen in the nail bed. [ ] Periosteum Subperiosteal new bone formation exists along the distal diaphysis of tubular bones, progressing proximally over time. The irregular periosteal proliferation affects predominantly the distal ends of long (...) of the subsynovial blood vessels and mild lining-layer hyperplasia may occur. [ , ] The edematous synovium becomes mildly infiltrated with lymphocytes, plasma cells, and occasional polymorphonuclear leukocytes, but the results from immunohistologic studies are negative. Electron-dense subendothelial deposits are present in vessel walls. [ , , ] In a study of a patient with primary hypertrophic osteoarthropathy and chronic arthritis, Lauter et al found multilayered basement laminae around small subsynovial blood

2014 eMedicine.com

167. Hypothyroidism (Diagnosis)

with age. Primary hypothyroidism Types of primary hypothyroidism include the following: Chronic lymphocytic (autoimmune) thyroiditis Postpartum thyroiditis Subacute (granulomatous) thyroiditis Drug-induced hypothyroidism Iatrogenic hypothyroidism Chronic lymphocytic (autoimmune) thyroiditis The most frequent cause of acquired hypothyroidism is chronic lymphocytic (autoimmune) thyroiditis (Hashimoto thyroiditis). The body considers the thyroid antigens as foreign, and a chronic immune reaction ensues (...) , resulting in lymphocytic infiltration of the gland and progressive destruction of functional thyroid tissue. The majority of affected individuals will have circulating antibodies to thyroid tissue. Anti–thyroid peroxidase (anti-TPO) antibodies are the hallmark of this disease. It should be noted that antibody levels can vary over time, may not be present early in the disease process, and usually disappear over time. Given this change in antibody concentration, it should be understood that the absence

2014 eMedicine.com

168. Pneumocystis (carinii) jiroveci Pneumonia (Diagnosis)

: Clinical Presentation of Pneumocystis jiroveci Pneumonia Patient history The symptoms of P jiroveci pneumonia (PJP) are nonspecific. PJP in patients with HIV infection tends to run a more subacute indolent course and tends to present much later, often after several weeks of symptoms, compared with PJP associated with other immunocompromising conditions. [ ] Symptoms of PJP include the following: Progressive exertional dyspnea (95%) Fever (>80%) Nonproductive cough (95%) Chest discomfort Weight loss (...) , such findings may be present in patients receiving aerosolized pentamidine for prophylaxis or in patients with advanced HIV infection who are not taking any prophylaxis. They may also occur in the absence of lung involvement. Based on most well-documented findings, Pneumocystis infection may present in almost any organ system, as follows: Central nervous system Bone marrow (may have necrosis with resultant pancytopenia) Lymphadenopathy Eyes (may have retinal cotton-wool spots) Thyroid (may present

2014 eMedicine.com

169. Thyrotoxicosis

-releasing hormone. Neoplasms leading to thyrotoxicosis include autonomously functioning toxic nodules and toxic, multinodular goiters (TMNGs). Infections that can produce thyrotoxicosis include subacute thyroiditis (SAT) and, very rarely, acute suppurative thyroiditis. is a type of thyrotoxicosis in which accelerated thyroid hormone biosynthesis and secretion by the thyroid gland produce thyrotoxicosis. However, hyperthyroidism and thyrotoxicosis are not synonymous. [ ] This is because, although many (...) . Thyroid imaging and radiotracer thyroid uptake measurements, combined with serologic data, enable specific diagnosis and appropriate patient treatment. [ , , , ] The common causes of thyrotoxicosis have different pathophysiologic features and include autoimmune diseases, functioning thyroid adenomas, and infections. Autoimmune diseases resulting in thyrotoxicosis include the following: Graves disease (the most common cause of hyperthyroidism; see the images below) Lymphocytic thyroiditis

2014 eMedicine Radiology

170. Pituitary Adenoma

it controls most of the body's endocrine functions by means of the hypothalamic-pituitary axis (see the images below). The anterior lobe of the pituitary gland secretes 6 hormones: thyroid-stimulating hormone (TSH), previously adrenocorticotropic hormone (ACTH), follicle-stimulating hormone (FSH), leuteinizing hormone (LH), growth hormone (GH), and prolactin (PRL). The posterior pituitary gland secretes vasopressin and oxytocin. T1-weighted sagittal MRI through the pituitary fossa shows a normal (...) or intracavernous carotid arteries. MRI features include a mass of heterogeneous signal intensity due to flow effects and thrombus formation. Low signal intensity is caused by high flow and chronic thrombus; high signal intensity may represent slow flow or subacute thrombus. Flow in the patent lumen may also cause a band of artifact in the phase-encoding direction on spin-echo images. Magnetic resonance angiography (MRA) is useful in confirming an aneurysm. A potential pitfall in diagnosis is a pneumatized

2014 eMedicine Radiology

171. Decubitus Ulcers (Treatment)

, a finding that has theoretical implications for wound healing. Because povidone-iodine can affect thyroid function, it could be contraindicated for some patients. [ ] Acetic acid (0.5%) is specifically effective against Pseudomonas aeruginosa , a particularly difficult and common organism in fungating lesions. Acetic acid can change the color of tissue and can mask potential superinfection. Rinsing with normal saline also is recommended. [ ] Sodium hypochlorite (2.5%) has some germicidal activity (...) of pressure injuries, including direct closure, skin grafting, skin flaps, and musculocutaneous flaps. Such management can provide skin coverage as well as soft tissue coverage. Flaps containing muscle provide a physiologic barrier to infection, eliminate dead space in the wound, and improve vascularity. Improved vascularity enhances local oxygen tension, provides extended soft-tissue penetration for antibiotics, and improves total lymphocyte function. [ , , ] The patient should be medically stable

2014 eMedicine Surgery

172. Thymoma (Overview)

. [ ] Normal thymic epithelium tissue arises from the third branchial cleft and the third and fourth branchial pouches. Dendritic cells and macrophages found in large quantities at the corticomedullary junction arise from mesodermal tissues (bone marrow). The epithelial cells and these other stromal tissues of the thymus influence the selection and maturation of the T lymphocytes. Dysregulation of this system in thymoma is believed to be a cause of accompanying paraneoplastic syndromes. In the normal (...) thymus, bone marrow–derived precursor cells destined to become thymocytes (or T lymphocytes) enter the thymus at the corticomedullary junction and differentiate as they pass through the thymus. These cells can be characterized in their developmental progression by changes in expression of 3 cell surface markers: CD4, CD8, and the T-cell receptor (TCR)–CD3 complex. Initially, the cells undergo positive selection; thus, those cells that fail to receive a signal (ie, do not recognize self) die

2014 eMedicine Pediatrics

173. Cardiomyopathy, Dilated (Diagnosis)

Comprehensive metabolic panel Thyroid function tests Cardiac biomarkers B-type natriuretic peptide assay Chest radiography Echocardiography Cardiac magnetic resonance imaging (MRI) Electrocardiography (ECG) In many cases of cardiomyopathy, endomyocardial biopsy is class II (uncertain efficacy and may be controversial) or class III (generally not indicated). Class II indications for endomyocardial biopsy include the following: Recent onset of rapidly deteriorating cardiac function Patients receiving (...) ventricular dysfunction. Interleukin (IL)–1b has been shown to depress myocardial function. One theory is that elevated levels of IL-2R in patients with class IV CHF suggest that T-lymphocytes play a role in advanced stages of heart failure. IL-6 stimulates hepatic production of C-reactive protein, which serves as a marker of inflammation. IL-6 has also been implicated in the development of myocyte hypertrophy, and elevated levels have been found in patients with CHF. IL-6 has been found to correlate

2014 eMedicine Emergency Medicine

174. Hepatitis (Diagnosis)

lymphocytic sialadenitis, autoimmune thyroiditis, , lichen planus, and Mooren corneal ulcer. Some cases of can be attributed to HCV infection. Previous Next: Patient Education Refer patients with infectious hepatitis to their primary care providers for further counseling specific to their disease; the precise etiologic virus is unlikely to be known at the time of discharge from the emergency department. Counsel patients regarding the importance of follow-up care to monitor for evidence of disease (...) experience several relapses during the course of a year. Less than 1% of cases result in fulminant hepatic failure (FHF). HAV infection does not persist and does not lead to chronic hepatitis. Hepatitis B Hepatitis B virus (HBV) may be directly cytopathic to hepatocytes. However, immune system–mediated cytotoxicity plays a predominant role in causing liver damage. The immune assault is driven by human leukocyte antigen (HLA) class I–restricted CD8 cytotoxic T lymphocytes that recognize hepatitis B core

2014 eMedicine Emergency Medicine

175. Alogliptin and alogliptin/pioglitazone

which describes an increase in common infections, such as nasopharyngitis, UTI, and URI. • Malignancy (including bladder, thyroid, and pancreatic cancer): The incidence of these AEs was similar in the three treatment groups (0.6-0.7%). The incidence of AEs of malignancy which led to discontinuation was also similar between the treatment groups (0.1-0.2%). Therefore, in the population and for the duration studied, alogliptin does not appear to increase the risk of malignancy. Although pioglitazone

2012 FDA - Drug Approval Package

176. Scintimun - besilesomab

blood), there was decreased platelet aggregation. Concentrations of 18 µg/ml and higher caused haemolysis, increased the proportion of segmented neutrophils and decreased lymphocytes. PTP was not found to be mutagenic in a reverse mutation test at any concentration tested (10 to 2500 µg/plate), either in the presence or absence of metabolic activation, nor clastogenic in a micronucleus test in mice at an intraperitoneal dose of 30mg/kg. For protein A, mice were given a single intravenous dose at 10

2010 European Medicines Agency - EPARs

177. Hyperthyroidism

disease, toxic solitary and multinodular goiters usually do not remit. Inflammatory thyroid disease (thyroiditis) includes subacute granulomatous thyroiditis, Hashimoto thyroiditis, and , a variant of Hashimoto thyroiditis. Hyperthyroidism is more common in subacute granulomatous thyroiditis and results from destructive changes in the gland and release of stored hormone, not from increased synthesis. Hypothyroidism may follow. Inappropriate TSH secretion is a rare cause. Patients with hyperthyroidism (...) of the Endocrine System Which of the following hormones regulates gene function and interacts with receptors inside cells? Antidiuretic hormone Growth hormone Thyroid hormone Thyrotropin-releasing hormone NEWS & VIDEOS Endogenous Testosterone Linked to Cardiovascular Disease THURSDAY, March 7, 2019 (HealthDay News) -- In men, endogenous testosterone may have a causal role in thromboembolism, heart failure, and myocardial infarction, according to a study published... 3D Model Female Endocrine System Video

2013 Merck Manual (19th Edition)

178. Paraneoplastic Syndromes

thyroid carcinoma), and thyroid-stimulating hormone (from gestational choriocarcinoma). PTHRP causes hypercalcemia and its associated symptoms (polyuria, dehydration, constipation, muscle weakness); calcitonin causes a fall in the serum calcium level, leading to muscle twitching and cardiac arrhythmias. GI paraneoplastic syndromes Watery diarrhea with subsequent dehydration and electrolyte imbalances may result from tumor-related secretion of prostaglandins or vasoactive intestinal peptide. Implicated (...) or cell lines. Neurologic paraneoplastic syndromes Several types of peripheral neuropathy are among the neurologic paraneoplastic syndromes. Cerebellar syndromes and other central neurologic paraneoplastic syndromes also occur. Peripheral neuropathy is the most common neurologic paraneoplastic syndrome. It is usually a distal sensorimotor polyneuropathy that causes mild motor weakness, sensory loss, and absent distal reflexes. Subacute sensory neuropathy is a more specific but rare peripheral

2013 Merck Manual (19th Edition)

179. List of cutaneous conditions

symmetric lipomatosis of Launois–Bensaude, Madelung's disease) (centrifugal lipodystrophy, lipodystrophia centrifugalis abdominalis infantalis) (erythema nodosum migrans, subacute migratory panniculitis of Vilanova and Piñol, subacute nodular migratory panniculitis) (popsicle panniculitis) (Berardinelli–Seip syndrome) (Köbberling–Dunnigan syndrome) (Ferreira–Marques lipoatrophia) (semicircular lipoatrophy) (chronic panniculitis with lipomembranous changes, hypodermitis sclerodermiformis, sclerosing (...) : Endocrine conditions often present with cutaneous findings as the interacts with the in many ways. (acanthosis nigricans type I) (acanthosis nigricans type III) (acral acanthotic anomaly) (ANOTHER syndrome) (ovarian SAHA syndrome) (acanthosis nigricans type II) (HAIR-AN syndrome) (Wermer syndrome) (multiple endocrine neoplasia type 2A, pheochromocytoma and amyloid-producing medullary thyroid carcinoma, PTC syndrome, Sipple syndrome) (mucosal neuromata with endocrine tumors, multiple endocrine neoplasia

2012 Wikipedia

180. Papillary carcinoma obscured by complication with subacute thyroiditis: sequential ultrasonographic and histopathological findings in five cases. (PubMed)

Papillary carcinoma obscured by complication with subacute thyroiditis: sequential ultrasonographic and histopathological findings in five cases. Subacute thyroiditis (SAT) has been rarely reported to coexist with thyroid carcinomas. The objective of the study was to assess sequential ultrasonographic and histopathological findings of SAT in the context of complicating thyroid carcinomas.Of 1152 patients with SAT who visited our thyroid clinic at Kuma Hospital from 1996 through 2006, 5 cases (...) complicated by papillary carcinoma underwent surgical resection 3-16 months after SAT onset. Ultrasonographic examinations and thyroid function tests were performed in all patients at onset of SAT and just before surgery. Sequential histopathological features of regenerated thyroid and carcinoma involvement were evaluated.Heterogenous areas with microcalcifications in the thyroid or lymphadenopathy in three patients were clues for the nodular involvement with papillary carcinoma on the initial

2008 Thyroid

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