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Cureus Jun 2023A 53-year-old Caucasian man with a history of alcohol use disorder, hypertension, and hypothyroidism presented with a myxedema coma requiring intubation. He had a...
A 53-year-old Caucasian man with a history of alcohol use disorder, hypertension, and hypothyroidism presented with a myxedema coma requiring intubation. He had a complicated hospital course with ventilator-associated pneumonia with MRSA, sepsis with candida, and abdominal compartment syndrome requiring decompressive laparotomy. The patient slowly recovered during 43 days of hospitalization. During the intensive care unit (ICU) stay, a flexi-seal rectal tube was placed due to fecal incontinence. After being moved to a regular medicine unit, he started having loose watery stools with leukocytosis and neutrophilia. Clostridium difficile (C. diff.) colitis was suspected, and he was placed on oral vancomycin empirically. His stool test for C. diff. came back negative, and his rectal tube was subsequently removed. Imaging did not show any abscess, perforated viscus, or fistula formations. His stool culture grew a heavy colony of Pseudomonas aeruginosa (P. aeruginosa). Vancomycin was stopped, and he was started on oral ciprofloxacin 750 mg twice a day with complete resolution of his diarrhea and leukocytosis.
PubMed: 37325686
DOI: 10.7759/cureus.39978 -
The American Surgeon Sep 2023Multiple vitamin deficiencies together with endocrinopathy may be encountered in individuals presenting with critical illness. Following the surprise postmortem...
Multiple vitamin deficiencies together with endocrinopathy may be encountered in individuals presenting with critical illness. Following the surprise postmortem diagnosis of concomitant scurvy, Wernicke, and hypothyroidism in an elderly woman presenting with a mix of atypical symptoms, patients considered at risk were tested for TSH, vitamin C, and thiamin levels. Between September 1, 2018, and December 31, 2022, 801 vitamin C levels in 679 patients were measured in our rural hospital and 309 (39%) were found <0.4 mg/dL. In this population, 39% of 626 thiamin levels were found to be low. Twenty-two patients with vitamin C and/or thiamin deficiency and elevated TSH levels were identified. Two patients died from scurvy; one also had myxedema. The incidence of vitamin C and thiamin deficiency in our patient population was higher than expected. Further studies should determine if this is unique to our rural setting or part of a bigger trend associated with poor dietary choices.
Topics: Female; Humans; Aged; Ascorbic Acid; Scurvy; Thiamine; Hypothyroidism; Thyrotropin
PubMed: 37278003
DOI: 10.1177/00031348231175098 -
JAAD Case Reports Jun 2023
PubMed: 37255864
DOI: 10.1016/j.jdcr.2023.04.005 -
The Pan African Medical Journal 2023
Topics: Humans; Myxedema; Iodine Radioisotopes; Graves Disease; Hyperthyroidism
PubMed: 37193106
DOI: 10.11604/pamj.2023.44.85.36177 -
Children (Basel, Switzerland) Mar 2023In children, hypothyroidism usually presents non-specific symptoms; symptoms can emerge gradually, compromising a timely diagnosis. We report the case of a 13-year-old...
In children, hypothyroidism usually presents non-specific symptoms; symptoms can emerge gradually, compromising a timely diagnosis. We report the case of a 13-year-old male, who was admitted to the hospital due to swelling of the torso and neck. Besides these symptoms, the child was healthy, except for a significant growth delay. Ultrasound evaluation and blood tests led to the diagnosis of myxedema secondary to severe hypothyroidism, which was due to autoimmune thyroiditis. Further investigations revealed pericardial effusion and pituitary hyperplasia, with hyper-prolactinemia. Treatment with levothyroxine led to edema regression and clinical, hemato-chemical and radiological improvement. After 6 months, growth velocity increased, although the recovery of growth already lost was not guaranteed. Brain MRI showed regression of pituitary hyperplasia. The diagnostic delay in this case was probably due to the patient's apparent good health, and the underestimation of growth restriction. This report underlines the importance of growth monitoring in adolescence, a critical period for identifying endocrine conditions; if undiagnosed, these conditions can lead to serious complications, such as myxedema in hypothyroidism, with potential effects beyond growth on multiple organs.
PubMed: 37189863
DOI: 10.3390/children10040614 -
Medicina (Kaunas, Lithuania) Apr 2023In 15-20% of cases, Graves' disease (GD) shifts to Hashimoto's thyroiditis (HT), while the shift from HT to GD is rare. We present a case of a patient in whom HT shifted... (Review)
Review
In 15-20% of cases, Graves' disease (GD) shifts to Hashimoto's thyroiditis (HT), while the shift from HT to GD is rare. We present a case of a patient in whom HT shifted to GD, along with a literature review. A 50-year-old woman with myxedema was diagnosed with Hashimoto's disease due to hypothyroidism and the presence of antibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TgAb); she also had thyroid stimulating antibodies (TSAb) without any signs of GD. Although thyroid hormone replacement therapy improved her thyroid function, 2 months later, hyperthyroidism appeared and did not improve after discontinuation of the replacement therapy. The patient was diagnosed with GD, which improved with antithyroid agent administration. To date, only 50 cases regarding conversion from HT to GD have been reported. The median age is 44 years (range, 23-82 years), and the median time of conversion is 7 years (range, 0.1-27 years). The male-to-female ratio of HT conversion to GD is 1:9, closer to that of regular GD (1:10) than that of general HT (1:18). All patients received thyroid hormone replacement therapy for hypothyroidism due to HT. Continuous evaluation of TSAb levels is recommended in HT, particularly in cases of TSAb-positive and those under replacement, since it may help predict conversion to GD. Evaluating the clinical characteristics of patients with HT preceding GD is crucial to ensure appropriate treatment and reduce the risk of adverse events.
Topics: Humans; Male; Female; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Hashimoto Disease; Thyroiditis, Autoimmune; Graves Disease; Hypothyroidism; Hyperthyroidism
PubMed: 37109715
DOI: 10.3390/medicina59040757 -
Dermatology Online Journal Feb 2023Pretibial myxedema, more generally thyroid dermopathy, results from mucopolysaccharide accumulation in the dermis, typically between the knee and dorsal foot. Thyroid...
Pretibial myxedema, more generally thyroid dermopathy, results from mucopolysaccharide accumulation in the dermis, typically between the knee and dorsal foot. Thyroid dermopathy presents in Graves disease, but can occur in Hashimoto thyroiditis, primary hypothyroidism, and euthyroid patients. Treatment of thyroid eye disease with teprotumumab is established in the literature, with few case reports also showing improvement in pretibial myxedema. Reported is a 76-year-old man with thyroid eye disease and pretibial myxedema treated with teprotumumab; improvement was demonstrated in both conditions. He developed "muffled" hearing as an adverse effect, a complication not widely published in the dermatology literature. At 18 months post-treatment, his symptoms are stable without recurrence, but hypoacusis persists. Given the long-term efficacy and side-effects, dermatologists should recognize the potential benefits and risks of using teprotumumab for thyroid dermopathy. A baseline audiogram may be considered prior to therapy. Additionally, longitudinal data is needed to document the benefits and risks of this novel therapy.
Topics: Male; Humans; Aged; Myxedema; Leg Dermatoses; Ototoxicity; Graves Ophthalmopathy; Drug-Related Side Effects and Adverse Reactions
PubMed: 37040908
DOI: 10.5070/D329160211 -
Endokrynologia Polska 2023Not required for Clinical Vignette.
Not required for Clinical Vignette.
Topics: Humans; Thyroxine; Myxedema; Coma
PubMed: 37039496
DOI: 10.5603/EP.a2023.0017 -
Cureus Feb 2023Graves' disease (GD) is an autoimmune thyroid disease, which is considered the most common cause of primary hyperthyroidism. GD usually manifests with symptoms such as...
Graves' disease (GD) is an autoimmune thyroid disease, which is considered the most common cause of primary hyperthyroidism. GD usually manifests with symptoms such as tremors, palpitations, heat intolerance, weight loss, and specific signs on physical examination (proptosis and pretibial myxedema). However, systemic involvement is also recognized, for example, hepatic involvement in patients with GD may range from asymptomatic laboratory findings of liver function derangement (either transaminases elevations or intrahepatic cholestasis) up to hepatic failure. We describe a rare case of Graves' thyrotoxicosis presenting with severe cholestasis and non-parathyroid hormone-related hypercalcemia. An extensive evaluation for hepatobiliary causes of cholestasis, including hepatic biopsy, was entirely negative. The patient was successfully treated with methimazole with subsequent clinical and biochemical improvement.
PubMed: 36960248
DOI: 10.7759/cureus.35206