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Clinical Case Reports Mar 2021Pericardial effusion may be the tipping point to unravel hypothyroidism. Large effusions may not correlate with severity of cardiovascular compromise. Medical therapy...
Pericardial effusion may be the tipping point to unravel hypothyroidism. Large effusions may not correlate with severity of cardiovascular compromise. Medical therapy over surgical intervention is appropriate if no evidence of cardiac tamponade.
PubMed: 33768953
DOI: 10.1002/ccr3.3857 -
Cancers Dec 2023Malignant neoplasms are currently one of the leading causes of morbidity and mortality worldwide, posing a major public health challenge. However, recent advances in... (Review)
Review
Malignant neoplasms are currently one of the leading causes of morbidity and mortality worldwide, posing a major public health challenge. However, recent advances in research in cancer biology and immunity have led to the development of immunotherapy, which is now used on an everyday basis in cancer treatment in addition to surgical treatment, classical cytostatics, and radiotherapy. The efficacy of immunotherapy has promoted the great popularity of this treatment among patients, as well as significant research interest. The increasing number of patients being treated with immunotherapy not only reassures physicians of the efficacy of this technique but also shows the wide spectrum of side effects of this therapy, which has not been considered before. Immune-related adverse events may affect many systems and organs, such as digestive, cardiovascular, respiratory, skin, or endocrine organs. Most complications have a mild or moderate course, but there are life-threatening manifestations that are essential to be aware of because if they are not properly diagnosed and treated on time, they can have fatal consequences. The purpose of this paper was to present the results of a literature review on the current state of knowledge on life-threatening endocrine side effects (such as adrenal crisis, thyroid storm, myxoedema crisis, diabetic ketoacidosis, and severe hypocalcaemia) of immune checkpoint inhibitors to provide information on symptoms, diagnostics, and management strategies.
PubMed: 38136332
DOI: 10.3390/cancers15245786 -
Frontiers in Endocrinology 2019Thyroid hormone replacement for hypothyroidism can be achieved via several approaches utilizing different preparations of thyroid hormones, T3, and/or T4. "Combination... (Review)
Review
Thyroid hormone replacement for hypothyroidism can be achieved via several approaches utilizing different preparations of thyroid hormones, T3, and/or T4. "Combination therapy" involves administration of both T3 and T4, and was technically the first treatment for hypothyroidism. It was lauded as a cure for the morbidity and mortality associated with myxedema, the most severe presentation of overt hypothyroidism. In the late nineteenth and the early Twentieth centuries, combination therapy could consist of thyroid gland transplant, or more commonly, consumption of desiccated animal thyroid, thyroid extract, or thyroglobulin. Combination therapy remained the mainstay of therapy for decades despite development of synthetic formulations of T4 and T3, because it was efficacious and cost effective. However, concerns emerged about the consistency and potency of desiccated thyroid hormone after cases were reported detailing either continued hypothyroidism or iatrogenic thyrotoxicosis. Development of the TSH radioimmunoassay and discovery of conversion of T4-to-T3 in humans led to a major transition in clinical practices away from combination therapy, to adoption of levothyroxine "monotherapy" as the standard of care. Levothyroxine monotherapy has a favorable safety profile and can effectively normalize the serum TSH, the most sensitive marker of hypothyroidism. Whether levothyroxine monotherapy restores thyroid hormone signaling within all tissues remains controversial. Evidence of persistent signs and symptoms of hypothyroidism during levothyroxine monotherapy at doses that normalize serum TSH is mounting. Hence, in the last decade there has been acknowledgment by all thyroid professional societies that there may be a role for the use of combination therapy; this represents a significant shift in the clinical practice guidelines. Further bolstering this trend are the recent findings that the Thr92AlaD2 polymorphism may reduce thyroid hormone signaling, resulting in localized and systemic hypothyroidism. This strengthens the hypothesis that treatment options could be personalized, taking into consideration genotypes and comorbidities. The development of long-acting formulations of liothyronine and continued advancements in development of thyroid regenerative therapy, may propel the field closer to adoption of a physiologic thyroid hormone replacement regimen with combination therapy.
PubMed: 31354624
DOI: 10.3389/fendo.2019.00446 -
Dermatopathology (Basel, Switzerland) Jun 2021A 64-year old male presented with a several-year history of an insidious-onset tender, itchy and xerotic rash on his lower legs. Past medical history was significant for...
A 64-year old male presented with a several-year history of an insidious-onset tender, itchy and xerotic rash on his lower legs. Past medical history was significant for Graves' disease and Graves' ophthalmopathy. The examination revealed peau d'orange-appearing plaques on his shins clinically consistent with pretibial myxedema. A punch biopsy showed separation of collagen bundles with extensive dermal mucin deposition, confirming the diagnosis of pretibial myxedema. After initially failing treatment with a topical clobetasol 0.05% ointment, the patient switched to regular pentoxifylline and triamcinolone 0.1% ointment under occlusion. He remains under follow-up.
PubMed: 34204035
DOI: 10.3390/dermatopathology8020024 -
The Journal of Clinical and Aesthetic... Jan 2021Pretibial myxedema (PM) is a rare extrathyroid condition seen in about 0.5 to 4.3 percent of individuals with hyperthyroidism due to Graves' disease, often presenting...
Pretibial myxedema (PM) is a rare extrathyroid condition seen in about 0.5 to 4.3 percent of individuals with hyperthyroidism due to Graves' disease, often presenting with associated thyroid orbitopathy. In most cases, patients with PM have elevated levels of thyroid antibodies, such as thyroid peroxidase (TPO), thyroglobulin, and-most especially-thyroid-stimulating hormone receptor antibodies. We present a rare case of biopsy-proven PM in a euthyroid patient with no history of Graves' disease or Hashimoto's disease. TPO and thyroglobulin antibody counts were slightly elevated but less than what is typically seen in PM and thyroid-stimulating hormone receptor antibodies (thyrotrophin-binding inhibitor immunoglobulin) were negative.
PubMed: 33584962
DOI: No ID Found -
American Journal of Ophthalmology Case... Sep 2020Periorbital myxedema is one the most challenging symptoms for patients with Graves' eye disease (GED). The treatment of this condition is complex and often...
PURPOSE
Periorbital myxedema is one the most challenging symptoms for patients with Graves' eye disease (GED). The treatment of this condition is complex and often unsatisfactory. This case demonstrates the use of intralesional hyaluronidase to treat cosmetically concerning periorbital myxedema.
OBSERVATIONS
Follow up showed no clinically significant recurrence of myxedema over one year.
CONCLUSION
Intralesional hyaluronidase represented an effective and safe treatment of periorbital myxedema in a patient with Graves' eye disease.
PubMed: 32490285
DOI: 10.1016/j.ajoc.2020.100751 -
Case Reports in Psychiatry 2020. Hypothyroidism is a prevalent endocrine disorder, often presenting with a spectrum of symptoms reflecting a hypothyroid state. It is also generally linked to causing...
. Hypothyroidism is a prevalent endocrine disorder, often presenting with a spectrum of symptoms reflecting a hypothyroid state. It is also generally linked to causing mood swings, psychomotor slowing, and fatigue; however, in rare instances, it may lead to or induce acute psychosis, a condition referred to as myxedema psychosis (MP). We report a case of myxedema psychosis and present a literature review discussing its presentation, diagnosis, management, and prognosis. . A 36-year-old lady presented with one-week history of persecutory and paranoid delusions, along with visual and auditory hallucinations. She had no prior history of psychiatric illnesses. She underwent total thyroidectomy three years before the current presentation due to papillary thyroid cancer. She was not on regular follow-up, nor any specific therapy. On examination, she was agitated and violent. There were no signs of myxedema, and the physical exam was unremarkable. The initial workup showed a mild elevation in serum creatinine. Additional investigations revealed a high thyroid-stimulating hormone (TSH) of 56.6 mIU/L, low free T4 < 0.5 pmol/L, elevated creatine kinase of 3601 U/L, and urine dipstick positive for blood, suggestive of myoglobinuria. MRI of the head was unremarkable. We diagnosed her as a case of myxedema psychosis and mild rhabdomyolysis. She was started on oral thyroxine 100 mcg/day, fluoxetine 20 mg daily, and as-needed haloperidol. She was closely followed and later transferred to the Psychiatry Hospital for further management. Within one week, her symptoms improved completely, and she was discharged off antipsychotics with additional scheduled follow-ups to monitor TFTs and observe for any recurrence. . Myxedema psychosis is a rare presentation of hypothyroidism-a common endocrine disorder. Scarce data are describing this entity; hence, there is currently a lack of awareness amongst clinicians regarding proper identification and management. Moreover, the atypical nature of presentations occasionally adds to a diagnostic dilemma. Thus, any patient with new-onset psychosis should be screened for hypothyroidism, and awareness of this entity must be emphasized amongst clinicians and guideline makers.
PubMed: 32655962
DOI: 10.1155/2020/7801953 -
Cureus Aug 2020We present the case of a male patient, initially treated for myxedema coma secondary to Hashimoto's thyroiditis, who was discharged on levothyroxine and a low-dose... (Review)
Review
We present the case of a male patient, initially treated for myxedema coma secondary to Hashimoto's thyroiditis, who was discharged on levothyroxine and a low-dose steroid taper but was re-admitted for the treatment of status epilepticus. During the second admission, the patient developed encephalopathy and cognitive dysfunction. Thyroid peroxidase (TPO) antibodies (Abs) were elevated and the patient was treated with high-dose steroids with clinical improvement. The patient was determined to have Hashimoto's encephalopathy (HE) due to the clinical picture as well as the response to high-dose glucocorticoid therapy. Cerebrospinal fluid (CSF) analysis demonstrated elevated protein, immunoglobulin G (IgG) index, and IgG synthesis rate; however, albumin index was elevated, indicating a disrupted blood-brain barrier. We suggest that HE be considered in the differential diagnosis for patients presenting with seizures, coma, stroke-like symptoms, behavior changes, and unexplained encephalopathy. After ruling out more common pathologies, HE should be considered by testing for anti-TPO Abs.
PubMed: 32923205
DOI: 10.7759/cureus.9601 -
Heliyon Dec 2023Hypothyroidism has been suggested to play a role in tumor progression. However, the causal association between hypothyroidism and lung cancer remains unknow. To...
Hypothyroidism has been suggested to play a role in tumor progression. However, the causal association between hypothyroidism and lung cancer remains unknow. To elucidate the potential association between hypothyroidism and lung cancer risk, we employ a Mendelian randomization (MR) approach. MR was performed to analyze pooled data from the International Lung Cancer Consortium (11,348 cases and 15,861 controls; European ancestry) to determine the causal relationship between hypothyroidism and lung cancer. We used 36, 83, and 14 single nucleotide polymorphisms as instrumental variables for hypothyroidism/myxoedema, hypothyroidism, and exercise, respectively. We further investigated the mechanisms involved in transcriptome analysis using data from The Cancer Genome Atlas and Genotype-Tissue Expression database. We conducted an initial validation of intermediary factor using a two-step MR analysis. Genetically predicted hypothyroidism was significantly related to the risk of overall lung cancer, specifically the risk of lung squamous cell cancer (LSCC) but not with the risk of lung adenocarcinoma (LUAD) as assessed using the inverse-variance weighted (IVM) method. A similar causal association was found between hypothyroidism/myxoedema and the risk of lung cancer, LSCC, and LUAD. Transcriptome analysis showed that genes associated with hypothyroidism, lung cancer, and LSCC were enriched in the PI3K/Akt signaling pathway and oxidative stress response. However, genes related to hypothyroidism and LUAD did not exhibit enrichment in these pathways. Hypothyroidism was significantly associated with strenuous sports or other exercises. Moreover, genetically predicted exercise was significantly related to the risk of overall lung cancer, and LSCC, but not LUAD. We detected no horizontal pleiotropy using the MR-PRESSO and MR Egger regression intercept. Hypothyroidism was causally associated with a lower risk of lung cancer, and these effects might be mediated by the oxidative stress response and the PI3K/Akt signaling pathway. Therefore, our study suggests that the potential factors and viable etiologies of hypothyroidism that contributed to lung cancer risk deserve further investigation.
PubMed: 38107290
DOI: 10.1016/j.heliyon.2023.e22661 -
Thyroid Research Mar 2021Pretibial myxedema also known as localized myxedema, thyroid dermopathy, or infiltrative dermopathy and rarely as localized mucinosis is an infrequent manifestation of...
BACKGROUND
Pretibial myxedema also known as localized myxedema, thyroid dermopathy, or infiltrative dermopathy and rarely as localized mucinosis is an infrequent manifestation of Graves' disease. It can appear before, during, or after the thyrotoxic state. Euthyroid pretibial myxedema is a rare presentation with few case reports in the literature. This case highlights the importance of considering pretibial myxedema when characteristic skin lesions are observed in a euthyroid patient.
CASE PRESENTATION
A 72-year old male Ethiopian patient with a very rare presentation of biopsy-proven pretibial myxedema in a euthyroid state without history of thyroid disease and absence of thyroid autoimmune markers. Resolution of skin lesion was achieved after topical corticosteroid application.
CONCLUSION
Absence of history of thyroid disorder and normal thyroid function tests should not exclude the diagnosis of pretibial myxedema.
PubMed: 33648506
DOI: 10.1186/s13044-021-00096-z