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Annales D'endocrinologie Apr 2024A 70-year-old female had a history of thyroid surgery for benign nodules and Graves' disease. Following mRNA COVID-19 vaccination, she presented Graves' orbitopathy and...
A 70-year-old female had a history of thyroid surgery for benign nodules and Graves' disease. Following mRNA COVID-19 vaccination, she presented Graves' orbitopathy and pretibial myxedema. Symptoms of thyroid eye disease and thyroid dermopathy improved after 500-mg methylprednisolone infusions.
Topics: Female; Humans; Aged; Myxedema; Graves Ophthalmopathy; COVID-19 Vaccines; COVID-19; Graves Disease; RNA, Messenger
PubMed: 37866430
DOI: 10.1016/j.ando.2023.10.004 -
Cureus Sep 2023Myxedema Coma (MC) is a life-threatening medical emergency that occurs as a severe complication of untreated or poorly managed hypothyroidism. Prompt diagnosis is...
Myxedema Coma (MC) is a life-threatening medical emergency that occurs as a severe complication of untreated or poorly managed hypothyroidism. Prompt diagnosis is crucial as the condition can rapidly deteriorate and lead to life-threatening complications. Timely treatment of myxedema coma with intravenous levothyroxine is the cornerstone of treatment, along with glucocorticoids to support adrenal function. This condition is associated with cardiovascular manifestations that contribute to its high mortality rate. The heart in hypothyroidism typically shows reversible dysfunction that can be corrected with hormonal supplementation, and in some cases, requires inotropic and aminergic support. This case involves a patient who was admitted to the intensive care unit with suspected MC, and necessitated life-saving hormonal and cardiovascular support to manage the condition.
PubMed: 37842478
DOI: 10.7759/cureus.45164 -
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 -
La Revue de Medecine Interne Dec 2023Pretibial myxedema is a rare manifestation of Graves' disease, and pseudotumoral forms may be confused with lower limb lymphedema.
INTRODUCTION
Pretibial myxedema is a rare manifestation of Graves' disease, and pseudotumoral forms may be confused with lower limb lymphedema.
OBSERVATIONS
We reported 3 cases of pretibial myxedema in 2 women and 1 man, aged 72, 66, and 49 years, treated for Graves' disease 3, 25 and 32 years previously. Two patients were active smokers. Lymphedema diagnosis of the lower limbs was suspected in the presence of bilateral pseudotumoral lesions of the feet, toes and ankles and the presence of a Stemmer's sign (skin thickening at the base of the 2nd toe, pathognomonic of lymphedema). Lymphoscintigraphy in one case was normal, not confirming lymphedema.
CONCLUSION
Pretibial pseudotumoral myxedema is a differential diagnosis of lower limb lymphedema. This diagnosis is confirmed by questioning the patient about preexisting Graves' disease, the underlying etiology, to decide the appropriate treatment and to encourage cessation of smoking, which is a risk factor for pretibial myxedema.
Topics: Male; Humans; Female; Myxedema; Diagnosis, Differential; Graves Disease; Lower Extremity; Toes; Leg Dermatoses
PubMed: 37827928
DOI: 10.1016/j.revmed.2023.09.003 -
Emergency Medicine Clinics of North... Nov 2023Thyroid hormone affects every human organ system and is a vital component of metabolism. Common and easily treatable, hypothyroidism does not usually require emergency... (Review)
Review
Thyroid hormone affects every human organ system and is a vital component of metabolism. Common and easily treatable, hypothyroidism does not usually require emergency management. However, myxedema coma is the decompensated form of hypothyroidism and can be life threatening if not treated expediently.
PubMed: 37758421
DOI: 10.1016/j.emc.2023.07.006 -
Cureus Aug 2023Myxedema coma is a rare, but potentially fatal condition due to severe hypothyroidism, and most commonly seen in patients with long standing, untreated hypothyroidism....
Myxedema coma is a rare, but potentially fatal condition due to severe hypothyroidism, and most commonly seen in patients with long standing, untreated hypothyroidism. Here, I report a case of a 75-year-old male who presented to the emergency department with acute respiratory failure and altered mental status. Interestingly, this case led to a new diagnosis of hypothyroidism presenting in its most severe form - myxedema coma. This case highlights the diagnostic challenges in identifying patients with myxedema coma and recognizing its potential role as a cause of respiratory failure.
PubMed: 37727154
DOI: 10.7759/cureus.43747 -
Cureus Aug 2023Myxedema coma is a rare and life-threatening manifestation of severe hypothyroidism. Myxedema refers to altered mental status observed in these patients. Clinical...
Myxedema coma is a rare and life-threatening manifestation of severe hypothyroidism. Myxedema refers to altered mental status observed in these patients. Clinical characteristics observed include hypothermia, bradycardia, respiratory failure, hyponatremia, and altered mental status. We present the case of a 57-year-old female who was brought into the hospital with a history of collapse and a long lie. On initial assessment, she was hypothermic, hypotensive, bradycardic, and hypoglycemic with elevated infection markers, acute kidney injury, and electrolyte derangement. Her thyroid function tests on admission were severely impaired with a TSH (thyroid stimulating hormone) level of 144.46 mU/L and Free T4 (thyroxine) levels of 3.4 pmol/L. She was admitted to the intensive care unit and was started on intravenous antibiotics, intravenous liothyronine, oral levothyroxine, and intravenous hydrocortisone. Initially, her hypothermia and bradycardia were slow to respond to treatment measures, but following the introduction of liothyronine, she showed marked improvement. Over the next few days, her infection markers improved, her acute kidney injury resolved, and her thyroid function tests normalized. Liothyronine was stopped after 6 days, levothyroxine was continued at her regular dose of 175 micrograms, and she was safely discharged with outpatient endocrinology follow-up.
PubMed: 37719600
DOI: 10.7759/cureus.43574 -
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 -
Dental Clinics of North America Oct 2023Hypothyroidism is a condition characterized by thyroid hormone deficiency and can be caused by a variety of factors. Untreated or chronic hypothyroidism can present in... (Review)
Review
Hypothyroidism is a condition characterized by thyroid hormone deficiency and can be caused by a variety of factors. Untreated or chronic hypothyroidism can present in adult patients as myxedema, which is characterized by symptoms including fatigue, generalized slower metabolism, weight gain, depressed mood, dry skin, and brittle hair. Hypothyroidism can have various oral manifestations, particularly in children, in whom it can delay the eruption of the dentition. Dental management of patients with hypothyroidism depends on the etiology and status of the disease and requires the consideration of other organ systems affected.
Topics: Adult; Child; Humans; Hypothyroidism; Oral Surgical Procedures
PubMed: 37714604
DOI: 10.1016/j.cden.2023.05.017 -
Dental Clinics of North America Oct 2023Thyroid gland dysfunctions can adversely affect patients' systemic health and well-being. Thyroid disease is the most common endocrine disorder. Recognizing early signs... (Review)
Review
Thyroid gland dysfunctions can adversely affect patients' systemic health and well-being. Thyroid disease is the most common endocrine disorder. Recognizing early signs and symptoms of hypothyroidism is crucial in the early diagnosis of hypothyroidism. Oral health care providers must obtain comprehensive medical records from patients with hypothyroidism before dental treatments.
Topics: Humans; Hashimoto Disease; Molar, Third; Hypothyroidism; Health Personnel
PubMed: 37714601
DOI: 10.1016/j.cden.2023.05.007