Myxedema Research Articles

Hypothyroidism Presenting as Recurrent Syncopal Attacks: A Missed Diagnosis

Myxedema coma is a severe hypothyroidism which usually occurs due to long-standing, undiagnosed, or untreated hypothyroidism. Fortunately, Myxedema coma is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as most of physicians are familiar with classic signs and symptoms of hypothyroidism and widespread availability of thyroid-stimulating hormone (TSH) assays. However it might be associated with several cardiac arrhythmias including; sinus bradycardia, ventricular tachycardia, and torsade de pointes. We report a case of a 53 year old female who presented with several episodes of syncope that was associated with intermittent torsade de pointes found to have severe hypothyroidism with complete reversal of her symptoms after she was started on thyroid hormonal replacement.

Treatment of pretibial myxedema with local subcutaneous injection of glucocorticoid: Three cases report

To investigate the treatment of hyperthyroidism complicated with pretibial myxedema. Three patients with hyperthyroidism complicated with pretibial myxedema were treated with topical injection of corticosteroid at the skin lesion. All 3 patients were cured with pretibial mucous edema by local injection of corticosteroids. Multi-point injection of glucocorticoid combined with maintaining euthyroid state is effective and has little side effect. Key words: Pretibial myxedema; Glucocorticoids

Familial graves’ disease in a mother and two daughters

Familial Graves’ disease in a mother and two daughtersGraves’ disease is characterized by primary hyperthyroidism, diffuse goitre, and possibly exophthalmos and pretibial myxedema along with autoantibodies. Familial Graves’ disease has been infrequently described in the literature and is underreported in the nation. This report describes an instance of familial Graves’ disease in a mother and two siblings, as well as their findings and treatment using Nuclear medicine techniques. Keywords: Thyrotoxicosis, hyperthyroidism, Graves’ disease, thyroid hormones, Nuclear Medicine

Elephantiasic pretiblal myxedema with involvement of the hand

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Medics maddened by Myxoedema

Medics maddened by Myxoedema

Hypothyroidism: A Silent Killer in Young Patients

Hypothyroidism is considered by many as a “great mimicker” of many common complaints in the emergency department (ED). Thyroid disorders pose a significant threat when prolonged or in the acute presentation, and are potentially serious disorders with symptoms that range from non-specific constitutional to subtle or frank neuropsychiatric symptoms. Untreated disease can lead to myxedema crisis or coma, a life-threatening presentation that is rarely identified in young male patients and carries by itself a high risk of mortality, even in cases that undergo proper medical management. We present a case of a 26-year-old non-smoker Hispanic man with a medical history of hypothyroidism since the age of 13, and bronchial asthma. In a period of 3 - 4 months, he developed generalized malaise, fatigue, cold intolerance and unintentional weight loss. He visited the ED after developing acute abdominal pain associated with non-bloody watery diarrheas. At the initial evaluation, vital signs revealed hypotension, borderline low heart rate, and hypoglycemia. On physical examination, he looked pale, appeared lethargic, with facial puffiness, macroglossia and bilateral hyporeflexia with delayed relaxation on muscle stretch reflexes. The laboratory results showed a thyroid stimulating hormone (TSH) of 314.75 uIU/mL. There was also low sodium and elevated creatinine and hepatic enzymes levels. Abdominopelvic CT scan incidentally revealed a large pericardial effusion that was later confirmed with echocardiogram. A diagnosis of myxedema crisis was established, prompt initiation of intravenous hydrocortisone, levothyroxine and triiodothyronine therapy was administered, and he was transferred to another institution for management of the pericardial effusion. This case raised concerns about the incidence where thyroid disease presentations are not identified and where patients fail to receive adequate medical therapy. We as primary care physicians should encourage patients to adhere to medical therapy and the recommended follow-up instructions to avoid catastrophic complications such as myxedema crisis. J Med Cases. 2017;8(12):404-406 doi: https://doi.org/10.14740/jmc2942w

Myxedema pseudovolvulus: case series and review of the literature

Severe hypothyroid presenting with colonic dilation is a phenomenon known as myxedema pseudo-volvulus. We present two cases of middle-aged males who presented to our institution with sigmoid volvulus and hypothyroidism. We treated one with laparotomy and sigmoid resection and the other was treated conservatively with thyroid hormone replacement and resolution of his symptoms. Here we review the literature and explore treatment options for this rare presentation.

A case of systemic lupus erythematosus complicated by hyperthyroidism and pretibial myxedema

A case of systemic lupus erythematosus complicated by hyperthyroidism and pretibial myxedema

A comparative study of the atypical CT findings and pathological features of bladder leiomyoma

Objective To investigate the relationship between the atypical CT findings and pathological features of bladder leiomyoma. Methods A retrospective analysis of the CT findings and pathological features was conducted in 9 cases of atypical bladder leiomyoma. All the 9 cases were females aged 27 to 53 years (average 38 years). All patients had plain and enhanced spiral CT scans and were treated surgically. Results The atypical CT findings of bladder leiomyomas showed as similar malignant tumor signs (n=3), solid mass with obvious inhomogeneous enhancement (n=5) and solid mass with no enhancement (n=1). All cases had lesions appearing as solid lobulated cystic mass in different degrees, whose solid part showed intermediate density on CT, with heterogeneous enhancement after contrast agent injection. Tumor cell and interstitial cell swelling to varying degrees, vascular hyalinosis, myxoedema, hyalinosis and cystic degeneration were found in these lesions. CT findings showed the consistency with similar malignant tumor signs and pathological showed bigger tumor volume, obvious interstitial edema, red degeneration, cystic degeneration and significantly increasing enlargement circuitous blood vessels. While the CT findings of the obvious inhomogeneous enhancement solid mass and pathological showed moderate tumor size, relatively obvious interstitial edema and cystic degeneration, significantly increasing enlargement circuitous blood vessels were consistent. The consistency was found among mild enhancement solid tumors and pathological showed mild interstitial edema, mild degeneration and no enlargement circuitous blood vessels. Conclusion Through the contrast analysis, atypical CT performance and pathological features might have some certain correlation. Key words: Urinary bladder neoplasms; Leiomyoma; Diagnosis; Tomography, X-ray computed; Pathological features

Hyperthyroid-associated EMA syndrome: four cases report and review of literature

Four patients with hyperthyroid-associated exophthalmos, myxedema, acropachy(EMA)syndrome, including three male patients and one female patient were diagnosed with Graves' diseases and treated by 131I therapy. Complaints of thyrotoxicosis were presented at the onset. Tibia myxedema and acropathy appeared, and eye symptoms aggravated in two patients after anti-thyroid drug therapy and 131I therapy. Four cases were all given clobetasol propionate, miconazole nitrate, neomycin sulfate and urea cream alone or in combination with compound betamethasone local injection treatment, and three cases were given low-dose oral prednisone treatment. Complaints of tibia myxedema and eye symptoms were significantly improved after the treatment. Therefore, we should be wary of the occurrence of hyperthyroid-associated EMA syndrome after 131I therapy. Corticosteroid might be the effective therapy for myxedema and eye symptoms of EMA syndrome.(Chin J Endocrinol Metab, 2015, 31: 790-792) Key words: Hyperthyroidism; EMA syndrome; Anterior tibial myxedema; Topical hormone therapy

Morphea complicated by Hashimoto′s thyroiditis in two sisters

Morphea complicated by Hashimoto′s thyroiditis is reported in two sisters. Case 1: a 64-year-old female presented with skin rashes on the anterior neck, trunk and bilateral anterior shins for 5 years, itching skin rashes on the perineum for 4 years, and Hashimoto′s thyroiditis for 9 years. Physical examination revealed grade 1 enlargement of firm thyroid gland without exophthalmos or pretibial myxedema. Dermatological examination showed pink patches on the neck and breast, sclerosis and atrophy of skin over the back, porcelain-white patches on the perineum. Histopathological findings suggested the diagnosis of morphea on the breast and lichen sclerosus et atrophicus on the perineum. Case 2: a 55-year-old female, who was the younger sister of case 1, suffered from gradual sclerosis and atrophy of skin in the left inframammary region and abdominal region for 4 years, as well as Hashimoto′s thyroiditis for 3 years. Similarly, physical examination revealed grade 1 enlargement of firm thyroid gland without exophthalmos or pretibial myxedema. Hypopigmentation, sclerosis and atrophy of skin were observed in the left inframammary region, abdominal region and central back region. Histopathological examination suggested a di agnosis of morphea. According to the clinical and histopathological manifestations, periodic acid-Schiff staining and thyroid gland function test results, the 2 cases were both diagnosed as morphea complicated by Hashimoto′s thyroiditis. Key words: Scleroderma, localized; Lichen sclerosus et atrophicus; Hashimoto disease; Genetic predisposition to disease; Case reports

Ultraviolet A1 for the treatment of cutaneous diseases

Since ultraviolet A1 (UVA1) can penetrate into deep layers of the skin,induce the apoptosis of T cells,down-regulate multiple cytokines,activate endothelial cells and promote neovascularization,it has been used to treat many dermatoses over the last three decades.There have been evidences from randomized control and cohort studies for the application of UVA1 phototherapy in atopic dermatitis,localized scleroderma and systemic lupus erythematosus.Other indications of UVA1 phototherapy are cutaneous T cell lymphoma,systemic scleroderma,pretibial myxedema,prurigo nodularis,etc.Compared with the other phototherapy regimens,UVA1 phototherapy shows less short-term side effects.However,little is known about long-term side effects of UVA1 phototherapy,and long-term follow-up studies are required. Key words: Dermatitis, atopic ; Scleroderma, systemic ; Dermatology ; Ultraviolet rays

Ureteric myxoedema. A new location in Graves' disease

Ureteric myxoedema. A new location in Graves' disease

Clinical characteristics and diagnostic analysis of thyrotropinoma

Objective To analyze clinical charaCteristics and diagnostic experience on thyrotropinoma (TSHoma).Methods Clinical characteristics,laboratory findings,diagnostic experience,and surgical outcome were summarized from 16 cases of TSHoma in our hospital from January 2006 to September 2011.Results ( 1 )Among 16 cases ( 9 male,7 female ) aged ( 51.63 ± 13.23 ) years,14 ( 87.5 ％ ) cases presented with hyperthyroidism and 2 were diagnosed by physical examination. None of them had exophthalmos, acropachy, or pre-tibial myxedema.( 2 ) Serum FT4 and FT3 levels were all above normal range with serum TSH ( 4.37 ± 2.77 ) μIU/ml.There were 25％ (4/16) cases with positive serum thyroglobulin antibody and/or thyroid peroxidase antibody,none with positive TSH receptor antibody.TRH stimulating test was performed in 9 cases,3 were with positive response ( peak TSH level increased by 5.45-9.20 μIU/ml compared with baseline),and 6 without response (peak TSH level increased by -0.01-3.15 μIU/ml compared with baseline).TSH was suppressed to 27.15％ (5.19％-99.15 ％ ) of the baseline in 11 cases in which somatostatin suppression test was carried out.Prolactin and insulin-like growth factor-Ⅰ levels were increased in 2 cases.MRI performed in 15 patients showed 10 cases of microadenomas and 5 cases of pituitary adenoma.A mass in nasal cavity was found in one case,where no mass was found in the pituitary.( 3 )Surgery was made in 11 cases ( 9 patients underwent transsphenoidal operation,one craniotomy,and one underwent operation via endoscopic nasal septum ). All patients (11/11) were proved to yield pituitary adenoma pathologically.Conclusion Thyrotropinoma should be considered in hyperthyroidism with unsuppressed TSH level,and dynamic tests facilitated early diagnosis.Ectopic thyrotropinoma shoull be considered when normal pituitary morphology was shown by MRI. Key words: Thyrotropinoma; Pituitary tumour; Microadenoma; Dynamic test

Advances in the mechanisms of initiation and progression of pretibial myxedema

In autoimmune thyroid diseases, circulating autoantibodies bind to autoantigens on dermal fibroblasts. IL-16 and RANTES (regulated on activation, normal T cell expressed and secreted) produced by the autoantibody-binding fibroblasts chemoattract CD4 + T lymphocytes to infiltrate nnto the dermis. The infiltrated CD4+ T cells interact with and activate the fibroblasts to produce interleukin (IL)-6, IL-8 and macrophage chemotactic protein (MCP)-1, which recruit more inflammatory leukocytes and result in perivasculitis. In these processes, large amounts of cytokines, autoantibodies, together with the interactions between T lymphocytes and fibroblasts lead to the accumulation of hyalumnan in dermis, which results in pretibial myxedema. Local trauma or infection may initiate the above immunological processes. Large amounts of cytokines and hyaluronan persistently stimulate the fibroblasts to propagate and differentiate into myofibroblasts, as well as to overproduce extracellular matrices, which together causes dermal fibrosis and cutaneous sclerosis. Key words: Myxedema; Immunity; Fibroblasts

Urinary glycosaminoglycans excretion in Graves' disease.

Urinary excretion of glycosaminoglycans was measured in 10 patients with pretibial myxoedema, 7 of whom also had thyroid-associated ophthalmopathy, and in 3 additional patients with ophthalmopathy but no skin changes. Total uronic acid excretion was raised above control levels in only 2 patients, who had both eye and skin disease of recent onset. In these patients excretion was initially three times the control level but declined sharply in subsequent months. This decline was in the absence of effective treatment or spontaneous improvement and would appear to reflect the natural history of the disease. These data show that although glycosaminoglycans excretion may be disturbed in Graves' disease, it provides an unreliable reflection of clinical status and of the effectiveness of treatment.

Keratoderma in association with myxedema

Keratoderma in association with myxedema

Treatment of nontoxic megacolon by colonoscopy.

The indications for colonoscopy in a recent consecutive series of 232 examinations were analyzed. Of these examinations, 30 (13%) were performed for nontoxic megacolon. Nontoxic megacolon is defined as severe dilatation of a segment or the entire colon unaccompanied by signs or symptoms of colon toxicity. Mechanical factors (volvulus, anastomosis, diverticulosis, carcinoma) were responsible for the nontoxic megacolon in 13 of these patients. Nontoxic megacolon was classified as secondary to acute pseudoobstruction (Ogilvie's syndrome, pancolonic megacolon, acute myxedema ileus) in 17 patients. All patients were being evaluated for possible exploratory celiotomy to prevent perforation of the colon because of the massive colonic distention. Colonoscopic examination was performed at the bedside or in the intensive care unit for 11 of 30 patients. No bowel preparation was used. Evacuation of air and fecal material was more efficiently accomplished by use of an external suction device attached to the biopsy part of the endoscope. For 12 of the 13 patients who had a mechanical basis for their nontoxic megacolon the colon was successfully decompressed. All 17 patients with acute pseudoobstruction were successfully treated. There were no iatrogenic perforations. Possible emergency operation was avoided for all patients except one who had a cecal volvulus. Colonoscopy should be considered as the initial treatment for nontoxic megacolon prior to surgical intervention.

Myxedema: Recognition and Treatment

Myxedema: Recognition and Treatment

Myxedema coma with respiratory failure.

Coma, severe hypoxemia, and respiratory acidosis developed in a patient with myxedema. Coma is a rare but serious complication of myxedema; recent experiences have implicated respiratory failure in its genesis. Serial studies in this patient suggested that impaired function of the chest bellows was subsidiary, and temporary depression of respiratory center responsiveness was paramount in the genesis of respiratory acidosis and coma. A favorable outcome depends on early recognition and vigorous management of the respiratory acidosis.