Rare Presentation Of Hypothyroidism Research Articles

Myxedema Coma: A rare presentation of hypothyroidism

Myxedema Coma: A rare presentation of hypothyroidism

Pituitary Macroadenoma: A Rare Presentation of Hypothyroidism

Hypothyroidism is a common endocrine disease which occurs when the levels of Thyroid hormones produced by the Thyroid gland are decreased. Here we present a case of a 19-year-old female, who presented with symptoms of hyperprolactinemia, weight gain, unilateral blurring of eyes and headache. Examination findings of the patient were significant for presence of Acanthosis Nigricans and Hirsutism. Rest of the systemic examination was normal. Laboratory investigations revealed Hyperprolactinemia, Hypothyroid profile and dyslipidemia. MRI brain and pituitary done showed findings consistent with Pituitary macroadenoma. Patient was treated along the lines of hypothyroidism with Thyroxine. Follow-up after 3 months showed improvement of her symptoms and disappearance of lesion of MRI scan. This case was a rare presentation of Hypothyroidism. Such unusual and uncommon presentations should be reported and studied in detail to prevent misdiagnosis and provide the correct treatment to the patients.

Myxedema psychosis: A protocol for a systematic review and a pooled analysis.

Background:Myxedema psychosis (MP) is a rare presentation of hypothyroidism. Although known for >70 years, a significant lack of systematic literature describing this condition exists. This limits the clinician's ability to identify and manage this entity properly. Hence, we aimed to systematically review the literature and summarize the presentation, diagnosis, management, and outcomes of this rare entity.Methods:Systematic review following PRISMA guidance. We will perform a comprehensive search of PubMed, Medline, Embase, Google Scholar (first 300 hits), and Cochrane databases for published observational studies, case series, and case reports. We will use descriptive statistics to provide summary estimates of demographics, common presenting features, laboratory test results, imaging findings, treatment administered, and outcomes. Moreover, continuous variables will be compared by the Wilcoxon Mann Whitney test, whereas categorical variables will be assessed by the χ2 test. Bivariate and multivariate regression will be performed to assess risk factors associated with poor outcome. A scoping review revealed that a meta-analysis might not be feasible owing to the paucity of systematic studies describing the condition.Results:This is the first systematic review examining this rare entity. Thus, the result of which will be significant. We hope that this review will help in identifying relevant predictive clinical or laboratory characteristics. Additionally, it identifies the best treatment strategies. The findings of this review will help increase our knowledge of this condition so as to recognize this condition promptly. Also, it will assist in differentiating MP from masqueraders, such as Hashimoto encephalopathy (HE). The results of this review will be published in a peer-reviewed journal.Conclusion:This is the first systematic review exploring MP demographics, diagnosis treatment, and outcomes. The information gathered by this review will be necessary for patients, clinicians, researchers, and guideline makers.PROSPERO registration number:CRD42020160310

Myxedema Psychosis: Neuropsychiatric Manifestations and Rhabdomyolysis Unmasking Hypothyroidism

Background. 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. Case Presentation. 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. Discussion and Conclusion. 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.

Postoperative Myxedema Coma: A Rare Presentation of Hypothyroidism

Myxedema coma is a rare life-threatening form of severe hypothyroidism with physiological decompensation. It occurs as a result of long-standing, undiagnosed, or undertreated hypothyroidism and is usually precipitated by an acute event similar to infection, cerebrovascular accident, myocardial infarction, trauma, cold exposure, surgery, or drug therapy. Patients with myxedema coma are generally severely ill with hypothermia and depressed mental status. It is a medical emergency with a high mortality rate. If the diagnosis is suspected, immediate management is necessary before confirming the diagnosis. Patients with myxedema coma should be treated in an intensive care unit with continuous cardiac monitoring. Initial steps in management include airway management, thyroid hormone replacement, glucocorticoid therapy, and supportive measures. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread availability of thyroid-stimulating hormone assays. The following presentation is a case of postoperative myxedema coma that was successfully managed with multidisciplinary effort. The patient has had a complete recovery.

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.

Hypothyroidism as the cause of reversible dilated cardiomyopathy: A case report

Introduction. The causes of dilated cardiomyopathy can be divided into ischemic and nonischemic. Although the importance of thyroid hormones for proper functioning of the cardiovascular system is well known, dilated cardiomyopathy is a rare presentation of hypothyroidism. Case Report. This is a case report of a 38-year-old man admitted to the Intensive Cardiac Care Unit with signs and symptoms of advanced heart failure. Dilated cardiomyopathy was established by echocardiography, while blood test showed highly elevated levels of thyroid stimulating hormone and decreased levels of free triiodothyronine and free thyroxine. The ejection fraction was significantly improved with levothyroxine replacement therapy. Conclusion. Hypothyroidism should always be considered as the cause of dilated cardiomyopathy. Thyroid hormone tests should be performed in all patients with dilated cardiomyopathy.

Spontaneous Ovarian Hyperstimulation Syndrome in Pregnancy: A Rare Presentation of Hypothyroidism

Spontaneous Ovarian Hyperstimulation Syndrome in Pregnancy: A Rare Presentation of Hypothyroidism

A Case of Hoffman Syndrome Masquerading as Pituitary Tumour

Hoffman syndrome, a rare presentation of hypothyroidism, is characterized by pseudo-hypertrophy and stiffness of muscles, myxoedematous features. Long standing hypothyroidism can cause pituitary hyperplasia which is difficult to distinguish with pituitary adenoma even with contrast MRI. We describe a case of a 48 years old male presenting as ‘Hoffman syndrome’ with reactive pituitary hyperplasia that mimicked a pituitary macroadenoma. After 20 days of thyroid hormone therapy, the patient had improvement of the muscular cramps. After 03 months of active therapy a repeat MRI was done which showed regression of size of the mass. In a case of primary hypothyroidism with a solid mass lesion of the pituitary gland, pituitary hyperplasia secondary to hypothyroidism rather than pituitary adenoma should be excluded to avoid unnecessary surgical intervention which has its own complications.

A 7 years old girl with abdominal lump and per-vaginal bleeding - A rare presentation of Hypothyroidism

Hypothyroidism is a common endocrine disorder resulting from decreased secretion of thyroid hormone. The diagnosis of hypothyroidism is suggested from the clinical and laboratory findings. Its occurrence in childhood is rare. Here we present a case report on this disease with rare presentation of abdominal lump and pervaginal bleeding in childhood. A 7 years old girl admitted in tertiary level hospital with abdominal lump and irregular per vaginal bleeding. Abdominal swelling was gradually increasing in size &amp; associated with lower abdominal pain for last 5 months. On examination the girl was moderately anaemic, mildly oedematous, distended lower abdomen and a mass in left iliac region. Her thyroid function test, serum FSH, serum LH, serum Prolactin was done and high FSH, LH, Prolactin levels were found. USG of lower abdomen revealed bulky uterus and bilateral ovarian cysts. MRI of Brain showed feature of pituitary microadenoma. Finally the patient was diagnosed as primary hypothyroidism and bilateral follicular ovarian cyst with pituitary adenoma developed as its consequence. The case is reported for clinical awareness &amp; to share our experience.&#x0D; CBMJ 2014 July: Vol. 03 No. 02 P: 41-44

A Case Report of Reversible Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM) is mostly an idiopathic disease with a progressive and irreversible course. It carries poor prognosis and outcome. Rarely, a reversible metabolic etiology that is amenable to specific therapy is identified. Alteration in thyroid status can lead to changes in systolic and diastolic function of left ventricle. Heart is sensitive to thyroid hormone changes, and cardiac disorders are commonly associated with both hyper and hypothyroidism. Diastolic dysfunction is the most common abnormality reported in hypothyroidism. In systolic function, prolonged systolic time interval or normal cardiac function has been reported by most workers. DCM is a rare presentation of hypothyroidism. Here, we report a case of 40-year-old female diagnosed with DCM due to hypothyroidism

Hypothyroidism presenting as dilated cardiomyopathy

Alteration in thyroid status can lead to changes in systolic and diastolic function of left ventricle. Heart is very sensitive to thyroid hormone changes and cardiac disorders are commonly associated with both hyper and hypothyroidism. Diastolic dysfunction is the most common abnormality reported in hypothyroidism. In systolic function, prolonged systolic time interval or normal cardiac function has been reported by most workers. Dilated cardiomyopathy is a very rare presentation of hypothyroidism.

Acute Renal Failure: A Rare Presentation of Hypothyroidism

Thyroid hormones affect the function of almost every body organ, and thyroid dysfunction produces a wide range of metabolic disturbances. Severe hypothyroidism is associated with significant effects on the kidney. The pathophysiology is thought to be multifactorial, while the exact mechanism remains unclear. Hypothyroidism as a cause of renal impairment is usually overlooked, leading to unnecessary diagnostic procedures. We describe two patients with acute renal failure due to severe hypothyroidism in whom thyroid hormone substitution therapy led to a significant improvement in renal function.