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Elmenyar E, Aoun S, Al Saadi Z, Barkumi A, Cander B, Al-Thani H, El-Menyar A. Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock. Diagnostics (Basel) 2023; 13:3028. [PMID: 37835772 PMCID: PMC10572182 DOI: 10.3390/diagnostics13193028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Thyroid storm (TS) is a rare and fatal endocrine emergency that occurs due to undiagnosed and inadequately treated hyperthyroidism after stressful conditions in patients with thyroid disorders. The objective of this systematic scoping review was to better understand the pathophysiology of TS and its complications, in terms of myocardial affection, tachyarrhythmia, and cardiogenic shock. In addition, we explored the pharmacological, mechanical, and surgical treatments for TS. We also evaluated the outcomes of TS according to sex and cardiac involvement. Additionally, analytical analysis was performed on the selected data. A literature review of peer-reviewed journals was carried out thoroughly using medical terms, MeSH on PubMed, Google Scholar, and combinations such as thyrotoxicosis-induced cardiomyopathy, thyroid storm, cardiogenic shock, myocardial infarction, endocrine emergency, Burch-Wartofsky score, extracorporeal circulatory support, and thyroidectomy. A total of 231 papers were eligible (2 retrospective studies, 5 case series, and 224 case reports) with a total of 256 TS patients with cardiac involvement between April 2003 and August 2023. All age groups, sexes, patients with TS-induced cardiomyopathy, non-atherosclerotic myocardial infarction, tachyarrhythmia, heart failure, shock, and different forms of treatment were discussed. Non-English language articles, cases without cardiac involvement, and cases in which treatment modalities were not specified were excluded. Female sex was predominant, with 154 female and 102 male patients. Approximately 82% of patients received beta-blockers (BBs), 16.3% were placed on extracorporeal membrane oxygenation (ECMO) support, 16.3% received therapeutic plasma exchange (TPE), and 13.8% underwent continuous renal replacement therapy (CRRT), continuous venovenous hemofiltration (CVVHD), or dialysis. Overall, 18 females and 16 males died. BB-induced circulatory collapse, acute renal failure, CRRT, and ventricular fibrillation were significantly associated with mortality. Awareness of TS and not only thyrotoxicosis is vital for timely and appropriate treatment. The early diagnosis and management of TS in cardiac settings, including pharmacological, mechanical, and surgical modalities, can save high-risk patients. Sex matters in the presentation, treatment, and mortality of this population. However, further large-scale, and well-designed studies are required.
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Affiliation(s)
- Eman Elmenyar
- Faculty of Medicine, Internship, Bahcesehir University, Istanbul 34734, Turkey; (E.E.); (S.A.); (Z.A.S.); (A.B.)
| | - Sarah Aoun
- Faculty of Medicine, Internship, Bahcesehir University, Istanbul 34734, Turkey; (E.E.); (S.A.); (Z.A.S.); (A.B.)
| | - Zain Al Saadi
- Faculty of Medicine, Internship, Bahcesehir University, Istanbul 34734, Turkey; (E.E.); (S.A.); (Z.A.S.); (A.B.)
| | - Ahmed Barkumi
- Faculty of Medicine, Internship, Bahcesehir University, Istanbul 34734, Turkey; (E.E.); (S.A.); (Z.A.S.); (A.B.)
| | - Basar Cander
- Department of Emergency Medicine, Kanuni Sultan Süleyman Training & Research Hospital, Istanbul 34303, Turkey;
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha 3050, Qatar;
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha 3050, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha 24144, Qatar
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Omar AMA, Knott K, Saba MM, Lim PO. Cardiac arrest in myocardial infarction with non-obstructive coronary artery (MINOCA) secondary to thyroid dysfunction. BMJ Case Rep 2023; 16:e253500. [PMID: 36764737 PMCID: PMC9923301 DOI: 10.1136/bcr-2022-253500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
A man in his 40s who was previously well had an out-of-hospital cardiac arrest. Postresuscitation ECG showed ST-elevation myocardial infarction (MI). Emergency coronary angiogram revealed MI with non-obstructive coronary arteries (MINOCA) with evidence of spasm in the right coronary artery. Both his echocardiogram and cardiac MRI revealed a normal heart. Further workup showed markedly elevated free T4 (99.5 pmol/L) and free T3 (26.7 pmol/L) with low thyroid stimulating hormone (<0.02 pmol/L) in keeping with thyroid storm. He also had an elevated adjusted calcium level (2.84 mmol/L), which could have contributed to his coronary artery spasm. His peak troponin T was elevated at 798 ng/L (<14) suggesting myocardial damage. He was treated with propylthiouracil, steroids, beta-blocker, calcium channel blocker and intravenous fluids. The patient achieved a full recovery and was discharged home. This is an unusual case of thyroid dysfunction resulting in coronary artery spasm, cardiac arrest and MINOCA.
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Affiliation(s)
- Ahmed Moemen A Omar
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kristopher Knott
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Magdi M Saba
- Advanced Ventricular Arrythmia Training and Research Program, Department of Cardiology, St George's Hospital, London, UK
| | - Pitt O Lim
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
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Shang W, Ma QB. <p>Malignant Arrhythmias as the Unmasked Manifestation of Thyroid Storm</p>. Int J Gen Med 2020; 13:693-698. [PMID: 33061537 PMCID: PMC7522412 DOI: 10.2147/ijgm.s265833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022] Open
Abstract
Thyroid storm is usually due to a severe exacerbation of a preexisting thyrotoxicosis, which later leads to decompensation in different organ systems. Thyroid storm with malignant arrhythmia is rare, but the mortality rate is high. Malignant arrhythmia has usually occurred in some patients with hypokalemia or ischemic heart disease. The presentation of these arrhythmias in the initial phase of the disease is much less common, and only a few isolated cases are described in the scientific literature. This paper analyzes and summarizes the clinical characteristics of this disease through literature reviews, for clinicians early detection and diagnosis of this disease. We report a 51-year-old woman with diarrhoea, fever, thyroid storm, ventricular fibrillation and no potential heart disease. The case report is discussed using relevant data from literature. A total of 9 patients were reported in the literature, totalling 10 cases with ours, including 7 cases of ventricular fibrillation and 3 cases of ventricular tachycardia. Most of the treatments were antithyroid drugs, hormones and beta-receptor blockers, and 3 death cases. Patients with thyroid crisis need to be closely monitored for malignant arrhythmias. Early diagnosis and treatment may save lives.
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Affiliation(s)
- Wen Shang
- Department of Emergency, Perking University Third Hospital, Beijing100191, People’s Republic of China
| | - Qing-Bian Ma
- Department of Emergency, Perking University Third Hospital, Beijing100191, People’s Republic of China
- Correspondence: Qing-Bian MaDepartment of Emergency, Perking University Third Hospital, 49 Huayuan North Road, Beijing100191, People’s Republic of ChinaTel +86-10-82264047Fax +86-10-82264040 Email
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Roomi S, Ullah W, Iqbal I, Ahmad A, Saleem S, Sattar Z. Thyrotoxicosis factitia: a rare cause of junctional rhythm and cardiac arrest. J Community Hosp Intern Med Perspect 2019; 9:258-263. [PMID: 31258870 PMCID: PMC6586092 DOI: 10.1080/20009666.2019.1618668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/09/2019] [Indexed: 11/02/2022] Open
Abstract
Thyrotoxicosis factitia is a hyperthyroid state due to the accidental or deliberate thyroxine ingestion. It can have many complications depending upon the organ involved. We present a case of a heavy built athlete presenting with cardiac arrest, who was found to be abused the thyroxine hormone for bodybuilding. Electrocardiogram (EKG) was significant for junctional arrhythmias along with interval supraventricular tachycardia (SVT) and bradycardia. The patient ultimately expired due to a failed resuscitation. To our knowledge, this is the first reported case of junctional arrhythmias caused by exogenous thyroxine.
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Affiliation(s)
- Sohaib Roomi
- Department of Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
| | - Waqas Ullah
- Department of Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
| | - Iqra Iqbal
- Department of Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
| | - Asrar Ahmad
- Department of Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
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Chen Z, Hu B, Feng Y, Wang Z, Jiang X, Cheng Y, He D, Zhu D, Xiao Z, Wang H, Mao Z. Incidence rate and risk factors of early repolarization in patients with growth hormone-secreting pituitary adenoma: a cohort study. Ther Clin Risk Manag 2019; 15:65-72. [PMID: 30643415 PMCID: PMC6314049 DOI: 10.2147/tcrm.s185929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the incidence and risk factors for early repolarization (ER) in patients with growth hormone (GH)-secreting pituitary adenomas. Methods From August 2014 to August 2016, patients with GH-secreting pituitary adenomas and non-functioning pituitary adenomas admitted to the First Affiliated Hospital, Sun Yat-sen University, were prospectively enrolled. Logistic regression analysis was used to investigate risk factors for ER development. Results A total of 118 patients with GH-secreting pituitary adenomas (41 with concomitant ER) and 103 patients with non-functioning pituitary adenomas were included. Compared with the non-functioning adenoma group GH and IGF-1 levels, left ventricular mass index (LVMI), and incidence of ER were significantly higher in the GH-secreting pituitary adenoma group (all P<0.05). LVMI was an independent risk factor for ER. Bivariate correlation analysis showed that course of disease, GH, IGF-1, and diabetes were correlated with LVMI. Course of disease and IGF-1 were directly correlated with LVMI. Two-year follow-up of patients who underwent transsphenoidal resection showed that incidence of ER was significantly decreased in patients with normal GH and IGF-1 levels. Conclusion Compared with non-functioning pituitary adenoma patients, patients with GH-secreting pituitary adenomas have a significantly higher incidence of ER. Elevation of serum GH and IGF-1 had positive correlations with cardiac muscle cell hypertrophy and increased LVMI.
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Affiliation(s)
- Zhiyong Chen
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, SunYat-sen University, Guangzhou, People's Republic of China, ; .,Department of Neurosurgery, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Bin Hu
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, SunYat-sen University, Guangzhou, People's Republic of China, ;
| | - Yajuan Feng
- Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zongming Wang
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, SunYat-sen University, Guangzhou, People's Republic of China, ;
| | - Xiaobing Jiang
- Department of Neurosurgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yunjiu Cheng
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Dongsheng He
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, SunYat-sen University, Guangzhou, People's Republic of China, ;
| | - Dimin Zhu
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, SunYat-sen University, Guangzhou, People's Republic of China, ;
| | - Zheng Xiao
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, SunYat-sen University, Guangzhou, People's Republic of China, ;
| | - Haijun Wang
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, SunYat-sen University, Guangzhou, People's Republic of China, ;
| | - Zhigang Mao
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, SunYat-sen University, Guangzhou, People's Republic of China, ;
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Karashima S, Tsuda T, Wakabayashi Y, Kometani M, Demura M, Ichise T, Kawashiri MA, Takeda Y, Hayashi K, Yoneda T. Ventricular Fibrillation Associated With Dynamic Changes in J-Point Elevation in a Patient With Silent Thyroiditis. J Endocr Soc 2018; 2:135-139. [PMID: 29383332 PMCID: PMC5789035 DOI: 10.1210/js.2017-00276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 12/01/2017] [Indexed: 11/19/2022] Open
Abstract
A J wave is a common electrocardiographic finding in the general population. Individuals with prominent J waves in multiple electrocardiogram (ECG) leads have a higher risk of lethal arrhythmias than those with low-amplitude J waves. There are few reports about the relationship between thyroid function and J-wave amplitude. We report the case of a 45-year-old man who had unexpected ventricular fibrillation (VF). He had dynamic J-point elevation in multiple ECG leads. Possible early repolarization syndrome was diagnosed. He also had thyrotoxicosis caused by silent thyroiditis, and his J-wave amplitude decreased according to changes in thyroid function because of spontaneous remission of silent thyroiditis. There was a positive correlation between serum triiodothyronine levels and J-wave amplitudes. The findings in case suggested silent thyroiditis may contribute to the occurrence of VF in a patient with dynamic changes in J-point elevation in multiple ECG leads. Thyrotoxicosis is a relatively common endocrine disease; therefore, clinicians should pay attention to J-wave amplitude in the ECG of patients with thyrotoxicosis.
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Affiliation(s)
- Shigehiro Karashima
- Division of Endocrinology and Metabolism, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8691, Japan
| | - Toyonobu Tsuda
- Division of Cardiovascular Medicine, Graduate School of Medicine, Kanazawa University, Kanazawa 920-8691, Japan
| | - Yusuke Wakabayashi
- Division of Endocrinology and Metabolism, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8691, Japan
| | - Mitsuhiro Kometani
- Division of Endocrinology and Metabolism, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8691, Japan
| | - Masashi Demura
- Division of Endocrinology and Metabolism, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8691, Japan
- Departments of Hygiene, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8691, Japan
| | - Taro Ichise
- Division of Cardiovascular Medicine, Graduate School of Medicine, Kanazawa University, Kanazawa 920-8691, Japan
| | - Masa-aki Kawashiri
- Division of Cardiovascular Medicine, Graduate School of Medicine, Kanazawa University, Kanazawa 920-8691, Japan
| | - Yoshiyu Takeda
- Division of Endocrinology and Metabolism, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8691, Japan
| | - Kenshi Hayashi
- Division of Cardiovascular Medicine, Graduate School of Medicine, Kanazawa University, Kanazawa 920-8691, Japan
| | - Takashi Yoneda
- Division of Endocrinology and Metabolism, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8691, Japan
- Program Management Office for Paradigms Establishing Center for Fostering Medical Researchers of the Future, Kanazawa University, Kanazawa 920-8691, Japan
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Sugiyama Y, Tanaka R, Yoshiyama Y, Ichino T, Hishinuma N, Shimizu S, Imai N, Mitsuzawa K, Kawamata M. A case of sudden onset of thyroid storm just before cesarean section manifesting congestive heart failure and pulmonary edema. JA Clin Rep 2017; 3:20. [PMID: 29457064 PMCID: PMC5804602 DOI: 10.1186/s40981-017-0088-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 04/20/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Since acute respiratory failure (ARF) is a life-threatening complication, particularly in the gestational period, differential diagnosis and rapid treatment are required. Among the various causes of sudden onset of ARF, thyroid storm is a rare cause in a parturient complicated with well-controlled hyperthyroidism. In this case report, we describe a parturient with hyperthyroidism in whom a thyroid storm manifesting congestive heart failure and pulmonary edema developed just before an emergency ceasarean section, even though hyperthyroidism was well-controlled with antithyroid drugs. CASE PRESENTATION A 36-year-old pregnant woman was diagnosed as having clinical chorioamnionitis, and an emergency cesarean section was performed at 25 weeks of pregnancy. She had a complication of hyperthyroidism accompanied by mild mitral regurgitation, and she had been treated with methimazole. She was treated with ritodrine and MgSO4 for the threat of premature delivery. At the preoperative consultation, her percutaneous oxygen saturation (SpO2) was 98% on room air. When she was admitted to the operating room, her heart rate and blood pressure were 130 beats/min and 196/78 mmHg, respectively. SpO2 was 88% on room air without any symptoms; however, just after starting oxygen administration via a facemask, she complained of severe respiratory distress and became agitated. Partial pressure of arterial oxygen was 108 mmHg with an inspiratory oxygen fraction of 1.0. Chest radiography revealed pulmonary congestion, and transesophageal echocardiography revealed normal right ventricular function without an embolus and severe mitral regurgitation with preserved left ventricular function. Contrast-enhanced computed tomography after the operation revealed no pulmonary embolus but revealed a pulmonary effusion, and free triiodothyronine level was increased at the onset of dyspnea. Therefore, we diagnosed the causes of sudden onset of dyspnea as pulmonary edema and congestive heart failure induced by a thyroid storm. CONCLUSION Sudden onset of a thyroid storm just before a cesarean section occurred in a patient with several risk factors of thyroid storm and pulmonary edema, including pregnancy, treatment with tocolytic agents, and infection. The involvement of these multiple factors was considered to be the cause of the sudden onset of the thyroid storm and the cause of rapidly progressive pulmonary edema.
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Affiliation(s)
- Yuki Sugiyama
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano 390-8621 Japan
| | - Ryusuke Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano 390-8621 Japan
| | - Yuki Yoshiyama
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano 390-8621 Japan
| | - Takashi Ichino
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano 390-8621 Japan
| | - Norimasa Hishinuma
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano 390-8621 Japan
| | - Sari Shimizu
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano 390-8621 Japan
| | - Noriko Imai
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano 390-8621 Japan
| | - Kunihiro Mitsuzawa
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano 390-8621 Japan
| | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano 390-8621 Japan
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Shen Y, Mao H, Huang M, Chen L, Chen J, Cai Z, Wang Y, Xu N. Long Noncoding RNA and mRNA Expression Profiles in the Thyroid Gland of Two Phenotypically Extreme Pig Breeds Using Ribo-Zero RNA Sequencing. Genes (Basel) 2016; 7:genes7070034. [PMID: 27409639 PMCID: PMC4962004 DOI: 10.3390/genes7070034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/24/2016] [Accepted: 07/05/2016] [Indexed: 11/16/2022] Open
Abstract
The thyroid gland is an important endocrine organ modulating development, growth, and metabolism, mainly by controlling the synthesis and secretion of thyroid hormones (THs). However, little is known about the pig thyroid transcriptome. Long non-coding RNAs (lncRNAs) regulate gene expression and play critical roles in many cellular processes. Yorkshire pigs have a higher growth rate but lower fat deposition than that of Jinhua pigs, and thus, these species are ideal models for studying growth and lipid metabolism. This study revealed higher levels of THs in the serum of Yorkshire pigs than in the serum of Jinhua pigs. By using Ribo-zero RNA sequencing—which can capture both polyA and non-polyA transcripts—the thyroid transcriptome of both breeds were analyzed and 22,435 known mRNAs were found to be expressed in the pig thyroid. In addition, 1189 novel mRNAs and 1018 candidate lncRNA transcripts were detected. Multiple TH-synthesis-related genes were identified among the 455 differentially-expressed known mRNAs, 37 novel mRNAs, and 52 lncRNA transcripts. Bioinformatics analysis revealed that differentially-expressed genes were enriched in the microtubule-based process, which contributes to THs secretion. Moreover, integrating analysis predicted 13 potential lncRNA-mRNA gene pairs. These data expanded the repertoire of porcine lncRNAs and mRNAs and contribute to understanding the possible molecular mechanisms involved in animal growth and lipid metabolism.
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Affiliation(s)
- Yifei Shen
- College of Animal Science, Zhejiang University, Hangzhou 310058, China.
| | - Haiguang Mao
- College of Animal Science, Zhejiang University, Hangzhou 310058, China.
| | - Minjie Huang
- College of Animal Science, Zhejiang University, Hangzhou 310058, China.
| | - Lixing Chen
- College of Animal Science, Zhejiang University, Hangzhou 310058, China.
| | - Jiucheng Chen
- College of Animal Science, Zhejiang University, Hangzhou 310058, China.
| | - Zhaowei Cai
- Laboratory of Animal Research Center, Zhenjiang Chinese Medical University, Hangzhou 310053, China.
| | - Ying Wang
- College of Mechanics, Taiyuan University of Technology, Taiyuan 030024, China.
| | - Ningying Xu
- College of Animal Science, Zhejiang University, Hangzhou 310058, China.
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Kobayashi H, Haketa A, Abe M, Tahira K, Hatanaka Y, Tanaka S, Ueno T, Soma M. Unusual Manifestation of Graves' Disease: Ventricular Fibrillation. Eur Thyroid J 2015; 4:207-12. [PMID: 26558239 PMCID: PMC4637814 DOI: 10.1159/000437225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/25/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is well known that thyrotoxicosis causes rhythm disorders including sinus tachycardia, atrial fibrillation, and atrial flutter. Atrial fibrillation is the most common arrhythmia in thyrotoxicosis, occurring in 5-15% of patients over 60 years of age, whereas ventricular arrhythmia is an unusual manifestation. CASE REPORT An 18-year-old Japanese woman was admitted to our emergency department because of loss of consciousness caused by ventricular fibrillation. She had been diagnosed with Graves' disease only 5 days earlier and had no other past medical history. Blood examination showed no obvious abnormality except thyrotoxicosis, and coronary angiography revealed patent coronary arteries. She was diagnosed with thyroid storm due to Graves' disease and is currently healthy during outpatient follow-up. CONCLUSION This case highlights that thyrotoxicosis can, albeit extremely rarely, cause ventricular fibrillation even in the absence of hypokalemia or underlying cardiovascular disease.
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Affiliation(s)
| | - Akira Haketa
- *Akira Haketa, MD, Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-chou, Itabashi-ku, Tokyo 173-8610 (Japan), E-Mail
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Abstract
A 23-year-old man became unconscious while jogging. He immediately received basic life support from a bystander and was transported to our hospital. On arrival, his spontaneous circulation had returned from a state of ventricular fibrillation and pulseless electrical activity. Following admission, hyperthyroidism led to a suspicion of thyroid storm, which was then diagnosed as a possible cause of the cardiac arrest. Although hyperthyroidism-induced cardiac arrest including ventricular fibrillation is rare, it should be considered when diagnosing the cause of treatable cardiac arrest.
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Affiliation(s)
- Yutaka Nakashima
- Department for Support of Rural Medicine, Yamaguchi Grand Medical Center, Shimotsuke, Japan
| | - Tsuneaki Kenzaka
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Masanobu Okayama
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Eiji Kajii
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
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