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The Journal of the Royal College of... Apr 2024We report two cases of myxoedema coma that presented to the acute medical take with severe bradycardia. These patients were initially misdiagnosed as bradyarrhythmia of... (Review)
Review
We report two cases of myxoedema coma that presented to the acute medical take with severe bradycardia. These patients were initially misdiagnosed as bradyarrhythmia of primary cardiac origin. They were then diverted to the cardiology service at another district general hospital (DGH) for admissions. Both cases were subsequently diagnosed with myxoedema coma having screened thyroid function tests on arrival at the cardiology unit. Despite being treated for myxoedema coma, both patients unfortunately succumbed to the disease and later died in the hospital. These cases highlight that clinical suspicion and recognition of myxoedema coma remain significant challenges in a developed world despite readily available and highly sensitive thyroid hormone assays.
PubMed: 38600777
DOI: 10.1177/14782715241244840 -
Journal of Medical Case Reports Oct 2023Hoffmann's syndrome is a rare form of hypothyroid myopathy in adults, which is mainly characterized by muscular weakness and muscular pseudohypertrophy.
BACKGROUND
Hoffmann's syndrome is a rare form of hypothyroid myopathy in adults, which is mainly characterized by muscular weakness and muscular pseudohypertrophy.
CASE PRESENTATION
We report about a 61-year-old Western European man with myalgia, myxedema and pseudohypertrophy of the calf muscles. Laboratory tests revealed significantly elevated thyroid stimulating hormone (TSH) and creatine kinase (CK). Muscle MRI showed muscular hypertrophy of the lower limbs, but no signs of myositis or myopathy (no gadolinium enhancement, no edema, no fatty degeneration). In addition, electromyography (EMG) detected spontaneous activity. After the beginning of thyroxin-therapy it took six months until the muscle weakness improved and the myalgia regressed.
CONCLUSIONS
Here, we focus on diagnostic routines and typical findings to differentiate Hoffmann's syndrome from other myopathies. Clinical hallmarks of Hoffmann's syndrome are pseudohypertrophy and weakness of the calf muscles in combination with elevated CK and elevated TSH. EMG is well suited to detect the involvement of the muscles and muscle MRI helps to differentiate it from other myopathies. Hoffmann's syndrome is a rare myopathy due to hypothyroidism and plays a role in the differential diagnosis of myopathic complaints even if hypothyroidism has not been detected before.
Topics: Male; Adult; Humans; Middle Aged; Myalgia; Muscular Diseases; Congenital Hypothyroidism; Muscle Weakness; Hypertrophy; Thyrotropin
PubMed: 37907975
DOI: 10.1186/s13256-023-04184-6 -
Cureus Mar 2024Myxedema psychosis (MP), a rare psychiatric manifestation of hypothyroidism, presents significant diagnostic and therapeutic challenges. This case report details the...
Myxedema psychosis (MP), a rare psychiatric manifestation of hypothyroidism, presents significant diagnostic and therapeutic challenges. This case report details the presentation, diagnosis, and successful management of a 60-year-old woman with MP, who was initially admitted to the psychiatric department for new-onset psychosis following the cessation of hormone replacement therapy after a subtotal thyroidectomy performed 20 years prior. Despite the rarity of psychosis as an initial presentation of hypothyroidism, this case underscores the critical importance of considering endocrine disorders in the differential diagnosis of unexplained psychotic symptoms. The clinical findings included a polymorphic delusional system and auditory hallucinations, without significant abnormalities on magnetic resonance imaging. Elevated thyroid-stimulating hormone (TSH) levels confirmed hypothyroidism, leading to the diagnosis of MP. Treatment with l-thyroxine resulted in complete resolution of symptoms in three weeks, highlighting the efficacy of hormone replacement therapy. This case contributes to the limited literature on MP and echoes the need for awareness among clinicians to ensure timely and accurate diagnosis and treatment.
PubMed: 38686274
DOI: 10.7759/cureus.57259 -
Problemy Endokrinologii Aug 2023Graves' disease (GD) is one of the urgent problems of modern endocrinology, characterized by a high frequency, polysystemic damage to the body, a steadily progressive...
[An integrated approach to the treatment of pretibial myxedema based on pulse therapy with prednisolone and electrical neuromyostimulation (FREMS-therapy) in a patient with Graves' disease and thyroid eye disease].
Graves' disease (GD) is one of the urgent problems of modern endocrinology, characterized by a high frequency, polysystemic damage to the body, a steadily progressive course, diagnostic difficulties, a high degree of disability and often resistance to therapy. The manifestations of the disease include: thyrotoxicosis syndrome with impaired lipid and carbohydrate metabolism, and activation of multiple organ pathology in the form of thyroid eye disease (TED), pretibial myxedema, cardiovascular insufficiency, acropathy, lesions of the nervous, osteoarticular system, and other lesions. The development of multiple organ pathology can have a different sequence, different time intervals and different degrees of severity. Any developments in the direction of clarifying the etiopathogenetic, clinical diagnostic and treatment-rehabilitation measures are of undoubted significance. We present a clinical case of GD, TED and pretibial myxedema, in which an integrated approach was tested in the tactics of treating pretibial myxedema (a combination of pulse therapy with prednisolone and FREMS-therapy), as a result of which positive results were obtained within a short time.
Topics: Humans; Graves Disease; Graves Ophthalmopathy; Myxedema; Patients; Prednisolone
PubMed: 37694865
DOI: 10.14341/probl12888 -
The American Journal of Case Reports Sep 2023BACKGROUND Pericardial effusions are considered to be present when accumulated fluid within the pericardial sac exceeds the small amount that is normally present,...
BACKGROUND Pericardial effusions are considered to be present when accumulated fluid within the pericardial sac exceeds the small amount that is normally present, causing impairment in the diastolic filling of the right heart. This case demonstrates an uncommon presentation of a large pericardial effusion by showing its relationship to myxedema in a patient with untreated hypothyroidism. CASE REPORT A 42-year-old man with a past medical history of hypertension, diabetes mellitus, and opioid abuse presented to the emergency department due to altered mental status, for which he received Narcan without resolution of symptoms. Computed tomography (CT) of the brain was without any acute intracranial abnormalities to explain the patient's altered mental status. CT chest reported a pericardial effusion, with a subsequent transthoracic echocardiogram (TTE) showing a moderate-to-large circumferential effusion without right atrial/ventricular collapse and no cardiac tamponade physiology. On further investigation, he was found to have severe hypothyroidism with elevated thyroid peroxidase antibodies. Endocrinology was consulted to start IV levothyroxine and liothyronine to treat autoimmune Hashimoto's thyroiditis. Subsequent TTE after starting hypothyroidism treatment showed an ejection fraction (EF) of 45-50% with mildly reduced left ventricular systolic function and moderate-to-large pericardial effusion, with no evidence of tamponade physiology. After treatment of hypothyroidism, the thyroid panel, EF, and pericardial effusion improved significantly. CONCLUSIONS This case illustrates the potential for suffering a large pericardial effusion secondary to generalized myxedema in a patient with severe hypothyroidism from undiagnosed Hashimoto's thyroiditis. It is important to recognize this condition for appropriate therapy and prevention of worsening cardiac conditions.
Topics: Male; Humans; Adult; Myxedema; Pericardial Effusion; Hypothyroidism; Hashimoto Disease; Thyroxine
PubMed: 37718508
DOI: 10.12659/AJCR.940631 -
Indian Journal of Dermatology 2023
PubMed: 38099109
DOI: 10.4103/ijd.ijd_147_23 -
Journal of the European Academy of... Jul 2023Primary cutaneous mucinoses (PCM) are rare diseases characterized by dermal or follicular mucin deposits.
BACKGROUND
Primary cutaneous mucinoses (PCM) are rare diseases characterized by dermal or follicular mucin deposits.
OBJECTIVES
A retrospective study characterizing PCM to compare dermal with follicular mucin to identify its potential origin on a single-cell level.
MATERIAL AND METHODS
Patients diagnosed with PCM between 2010 and 2020 at our department were included in this study. Biopsy specimens were stained using conventional mucin stains (Alcian blue, PAS) and MUC1 immunohistochemical staining. Multiplex fluorescence staining (MFS) was used to investigate which cells were associated with MUC1 expression in select cases.
RESULTS
Thirty-one patients with PCM were included, 14 with follicular mucinosis (FM), 8 with reticular erythematous mucinosis, 2 with scleredema, 6 with pretibial myxedema and one patient with lichen myxedematosus. In all 31 specimens, mucin stained positive for Alcian blue and negative for PAS. In FM, mucin deposition was exclusively found in hair follicles and sebaceous glands. None of the other entities showed mucin deposits in follicular epithelial structures. Using MFS, all cases showed CD4+ and CD8+ T cells, tissue histiocytes, fibroblasts and pan-cytokeratin+ cells. These cells expressed MUC1 at different intensities. MUC1 expression in tissue histiocytes, fibroblasts, CD4+ and CD8+ T cells, and follicular epithelial cells of FM was significantly higher than the same cell types in the dermal mucinoses (pā<ā0.001). CD8+ T cells were significantly more involved in expression of MUC1 than all other analysed cell types in FM. This finding was also significant in comparison with dermal mucinoses.
CONCLUSION
Various cell types seem to contribute to mucin production in PCM. Using MFS, we showed that CD8+ T cells seem to be more involved in the production of mucin in FM than in dermal mucinoses, which could indicate that mucin in dermal and follicular epithelial mucinoses have different origins.
Topics: Humans; Mucinoses; Mucins; Retrospective Studies; Alcian Blue; Scleromyxedema; Staining and Labeling
PubMed: 36807595
DOI: 10.1111/jdv.18992 -
The American Journal of Case Reports Nov 2023BACKGROUND Myxedema coma is a rare, life-threatening condition caused by a severe form of hypothyroidism. The dangerously low levels of circulating thyroid hormone can...
BACKGROUND Myxedema coma is a rare, life-threatening condition caused by a severe form of hypothyroidism. The dangerously low levels of circulating thyroid hormone can lead to progressive mental status changes and numerous organ dysfunctions, including serious cardiac abnormalities. CASE REPORT We present a case of a 59-year-old woman who presented with altered mental status and fall who was originally thought to have a cerebrovascular accident but was later diagnosed with myxedema coma, after multiple cardiac arrests. It was discovered that the patient had not been taking any of her medications for the last several weeks, after her primary care provider retired from practice. Initial laboratory evaluation was significant for a TSH level of 159.419 mIU/L and an undetectable free T4 level. Complications of the myxedema coma resulted in QTC interval prolongation, causing torsades de pointes and sustained polymorphic ventricular tachycardia, requiring cardioversion. CONCLUSIONS This case demonstrates the importance of early detection and treatment of myxedema coma, as it can cause life-threatening cardiac arrhythmias. It also emphasizes the need to ensure proper medication adherence in patients with chronic medical conditions, as non-compliance can result in dire consequences.
Topics: Female; Humans; Middle Aged; Myxedema; Coma; Hypothyroidism; Torsades de Pointes; Tachycardia, Ventricular; Medication Adherence
PubMed: 37925597
DOI: 10.12659/AJCR.941414 -
Cureus Sep 2023Myxedema coma is a rare and potentially life-threatening condition that occurs when severe hypothyroidism is untreated or inadequately managed. It is characterized by a...
Myxedema coma is a rare and potentially life-threatening condition that occurs when severe hypothyroidism is untreated or inadequately managed. It is characterized by a rapid drop in mental status, hypothermia, respiratory failure, hypotension, and other symptoms of severe metabolic dysfunction. The condition primarily affects older women with a history of thyroid dysfunction but can occur in any age or gender group. A common trigger for this condition is seen with a drop in atmospheric temperatures or during the cold winter months. However, a rare, poorly documented trigger is recent antipsychotic use in severe hypothyroid states. The diagnosis of myxedema coma requires prompt recognition and treatment, as delays can result in significant morbidity and mortality which is the objective of this case report.
PubMed: 37842468
DOI: 10.7759/cureus.45190 -
Cureus Apr 2024Pleural effusions can be secondary to several different etiologies. Sometimes, they can be related to hypothyroidism. We present a case of massive pleural effusion...
Pleural effusions can be secondary to several different etiologies. Sometimes, they can be related to hypothyroidism. We present a case of massive pleural effusion resulting from hypothyroidism. A 75-year-old male with a history of liver cirrhosis, hypothyroidism, and medication non-adherence presented to the emergency department (ED) with shortness of breath and altered mental status. Physical exam and chest imaging were consistent with right-sided pleural effusion. Effusion was exudative. Multiple recurrences complicated the hospitalization despite thoracentesis and pleurodesis. Labs revealed hypothyroidism, and finally, the patient was started on hormone replacement, resulting in the resolution of the effusion. Pleural effusion is a rare manifestation of hypothyroidism, thought to be mediated by vascular endothelial factors. Pleural fluid analysis shows both exudative and transudative patterns. Hormonal replacement is the mainstay of treatment. Clinicians need to be aware of the rare etiologies of pleural effusion. Depending on the patient's presentation, due work-up should be done to ensure a timely diagnosis and management.
PubMed: 38738057
DOI: 10.7759/cureus.58072