2.Multidisciplinary Treatment for Severe Secondary Raynaud's Phenomenon: A Case Report.
Leng CUI-BO ; Lin GUAN-JUN ; Cao HONG ; Liu ZI-JIA
Chinese Medical Sciences Journal 2022;37(4):353-358
Raynaud's phenomenon is a symptom complex manifested as intermittent fingertip ischemia caused by cold or other sympathetic drivers. Secondary Raynaud's phenomenon is often more severe and could even lead to finger ulceration, making it particularly complicated to treat. We describe a case of severe Raynaud's phenomenon secondary to subclinical hypothyroidism lasting for more than 6 hours in a 65-year-old woman. The patient was also diagnosed with hypothyroidism, epilepsy, and secondary soft tissue infection of the right middle and ring fingers. After careful multidisciplinary consultation and discussion, the patient received vasodilation, anticoagulation, thyroxine supplementation, stellate ganglion block, hyperbaric oxygen therapy and debridement. The patient responded well to the medication, avoiding amputation or obviously dysfunction. Multidisciplinary team gathering the doctors from different departments proposes appropriate strategies for patients with severe Raynaud's phenomenon and could improve the prognosis and satisfaction of patient effectively.
Female
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Humans
;
Aged
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Hypothyroidism/complications*
;
Raynaud Disease/diagnosis*
3.Diagnosis and treatment of intra-abdominal infection complicated with hypothyroidism.
Gang HAN ; Xiaofang QIAO ; Zhiming MA
Chinese Journal of Gastrointestinal Surgery 2018;21(12):1356-1360
Intra-abdominal infection complicated with hypothyroidism is very common. It mostly featured decreased T3, with or without decreased T4, and without elevated thyroid stimulating hormone(TSH). This particular type of hypothyroidism was called "low T3 syndrome" or "thyroid illness syndrome", and is called "non-thyroid illness syndrome" increasingly in recent years. Its pathogenesis has not been fully understood, and probably is associated with abnormality of hypothalamic-pituitary-thyroid axis, disorder of peripheral thyroid hormone metabolism, change in thyroid hormone binding protein, regulation of triiodothyronine receptors, effect of cytokines, and lack of trace element selenium. Intra-abdominal infection complicated with hypothyroidism should be differentiated from primary hypothyroidism, which may be one cause of mental depression, insufficient anabolism, and poor tissue healing. Therefore, the changes of T3 and T4 levels should be actively monitored in patients with severe or prolonged intra-abdominal infection. Whether treatment is needed for intra-abdominal infection complicated with hypothyroidism remains controversial. T3 replacement therapy may improve prognosis. When low T3 syndrome presents as a disease-mediated hypothyroidism, we recommend the use of levothyroxine(L-T4) or liothyronine (L-T3) treatment to improve the prognosis of critical patients. Enteral nutrition can improve hypothyroidism and has good efficacy for enterocutaneous fistula patients with intra-abdominal infection.
Humans
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Hypothyroidism
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complications
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drug therapy
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Intraabdominal Infections
;
complications
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diagnosis
;
therapy
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Thyroxine
;
therapeutic use
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Triiodothyronine
;
therapeutic use
5.Magnetic resonance imaging findings of pituitary hyperplasia due to primary hypothyroidism.
Wei-hong ZHANG ; Hui-juan ZHU ; Xue-wei ZHANG ; Xiao-lan LIAN ; Wei-xin DAI ; Feng FENG ; Xiao-ping XING ; Zheng-yu JIN
Acta Academiae Medicinae Sinicae 2012;34(5):468-473
OBJECTIVETo explore the clinical and magnetic resonance imaging (MRI) findings of pituitary hyperplasia due to primary hypothyroidism.
METHODThe clinical presentations, laboratory examinations, and MRI findings of 11 patients with pituitary hyperplasia secondary to primary hypothyroidism diagnosed at our hospitals from the beginning of 2008 to the end of 2011 were retrospectively reviewed.
RESULTSThe clinical manifestations in 11 patients included growth arrest(7/8), mental retardation (6/8), cold intolerance and fatigue(6/11), slightly increased body weight (6/11), galactorrhea (3/11), paramenia (8/9), precocious puberty companying vaginal bleeding (2/2),and blurry vision (3/11). Laboratory investigations revealed grossly increased thyroid stimulating hormone, decreased thyroxine, and slightly elevated prolactin levels in all cases. Thyroid antibody was positive in six cases. On MRI, pituitary mass were detected a large intrasellar with/without suprasellar extension in all patients,showing the characteristic of symmetric enlargement. Spherical shape was viewed in 5 cases,with the height of (12.22 ± 3.12)mm. In the other 6 cases, the pituitary mass with the shape of calabash extended superiorly to suprasellar area, with a height of(18.95 ± 2.23)mm. The signal of pituitary mass was isointense to grey matter both on T1 weighted imaging and T2 weighted imaging. Bright short T1 signal in posterior lobe of pituitary was visible. Pituitary stalk was detected only in 4 cases from MRI without dislocation, while the width of pituitary stalk was within the normal limit.
CONCLUSIONSPituitary hyperplasia should be considered when homogenous enlargement of the pituitary gland is found on MRI. The integration of MRI findings, clinical manifestations, and laboratory findings is helpful for the proper identification of the primary endocrine disease and thus avoid misdiagnosis.
Adolescent ; Adult ; Child ; Female ; Humans ; Hyperplasia ; complications ; diagnosis ; Hypothyroidism ; complications ; diagnosis ; Magnetic Resonance Imaging ; Male ; Pituitary Gland ; pathology ; Retrospective Studies ; Young Adult
6.Assessment of left ventricular global systolic function using real-time three-dimensional speckle-tracking echocardiography in patients with hypothyroidism.
Qiu XIE ; Hui LI ; Chen LI ; Wenjuan BAI ; Chunmei LI ; Ying PENG ; Li RAO
Journal of Biomedical Engineering 2014;31(1):58-63
The present study aimed to investigate the impact of hypothyroidism on left ventricular systolic function using real-time three-dimensional speckle tracking imaging (RT3D-STI). Thirty hypothyroidism patients and forty healthy volunteers were recruited and received RT3DSTI measurement of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS). A comparison of differences between the hypothyroidism patients and those in the healthy group was carried out and we obtained the results as followings. The values of GLS were (-18.93 +/- 3.89) vs. (-21.44 +/- 1.99), with P < 0.01, GRS were (51.13 +/- 11.95) vs. (56.10 +/- 5.76), with P < 0.0; and GAS were (-31.63 +/- 5.38) vs. (-34.40 +/- 2.32), with P < 0.01, i.e. they were lower in hypothyroidism group than those in the health group. While GCS were (-17.75 +/- 1.92) vs. 17.03 +/- 3.45), with P > 0.05, which were not significantly different between the two groups. In linear regres sion, GLS showed significant correlation with both TSH (b = -0.69, P < 0.01) and FT3 (b = 0.71, P < 0.01). Meanwhile, the GRS (b = 2.98, P < 0.05) and GAS (b = 3.11, P < 0.05) linearly correlated with FT3 level. In conclusion, the present study shows that the global longitudinal and radial moves of left ventricular are weaker in patients with hypothyroidism than healthy controls. And the impairment of left ventricular function would aggravate as FSH rises or FT3 declines.
Case-Control Studies
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Echocardiography, Three-Dimensional
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Heart Ventricles
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physiopathology
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Humans
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Hypothyroidism
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complications
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Imaging, Three-Dimensional
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Reproducibility of Results
;
Systole
;
Ventricular Dysfunction, Left
;
complications
;
diagnosis
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Ventricular Function, Left
7.Hypopituitarism Presenting as Adrenal Insufficiency and Hypothyroidism in a Patient with Wilson's Disease: a Case Report.
Hae Won LEE ; Jin Du KANG ; Chang Woo YEO ; Sung Woon YOON ; Kwang Jae LEE ; Mun Ki CHOI
Journal of Korean Medical Science 2016;31(8):1345-1348
Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.
Adrenal Insufficiency/diagnosis/etiology
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Adult
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Brain/diagnostic imaging
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Depression/etiology
;
Female
;
Hepatolenticular Degeneration/*complications
;
Humans
;
Hypopituitarism/complications/*diagnosis/drug therapy
;
Hypothyroidism/diagnosis/etiology
;
Liver Cirrhosis/complications/diagnostic imaging
;
Magnetic Resonance Imaging
;
Steroids/therapeutic use
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Thyrotropin-Releasing Hormone/therapeutic use
8.Hypopituitarism Presenting as Adrenal Insufficiency and Hypothyroidism in a Patient with Wilson's Disease: a Case Report.
Hae Won LEE ; Jin Du KANG ; Chang Woo YEO ; Sung Woon YOON ; Kwang Jae LEE ; Mun Ki CHOI
Journal of Korean Medical Science 2016;31(8):1345-1348
Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.
Adrenal Insufficiency/diagnosis/etiology
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Adult
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Brain/diagnostic imaging
;
Depression/etiology
;
Female
;
Hepatolenticular Degeneration/*complications
;
Humans
;
Hypopituitarism/complications/*diagnosis/drug therapy
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Hypothyroidism/diagnosis/etiology
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Liver Cirrhosis/complications/diagnostic imaging
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Magnetic Resonance Imaging
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Steroids/therapeutic use
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Thyrotropin-Releasing Hormone/therapeutic use
9.Myxedema Ascites: Case Report and Literature Review.
Jeong Seon JI ; Hiun Suk CHAE ; Young Seok CHO ; Hyung Keun KIM ; Sung Soo KIM ; Chang Wook KIM ; Chang Don LEE ; Bo In LEE ; Hwang CHOI ; Kang Moon LEE ; Hye Kyung LEE ; Kyu Yong CHOI
Journal of Korean Medical Science 2006;21(4):761-764
Myxedema ascites caused by hypothyroidism is rare, so its diagnosis is often delayed and patients frequently receive unnecessary procedures such as liver biopsies and exploratory laparotomies. We report a 71-yr-old man with clinical ascites that was the first manifestation of hypothyroidism, and which resolved completely in response to thyroid hormone replacement therapy. To our knowledge, this is the first report of myxedema ascites in Korea. A review of the literature revealed 51 well-documented cases of myxedema ascites. Analyses of ascites from patients in this condition usually show high protein (>2.5 g/dL) and low white blood cell counts, with a high proportion of lymphocytes. A consistent feature is the good response to thyroid hormone replacement therapy, which has always led to resolution of the ascites. Myxedema ascites is thus rare but easy to treat; it should be borne in mind, especially if the ascites fluid has a high protein content.
Treatment Outcome
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Thyroid Hormones/deficiency/therapeutic use
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Myxedema/*etiology/pathology
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Male
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Hypothyroidism/*complications/diagnosis/drug therapy
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Humans
;
Hormone Replacement Therapy
;
Diagnosis, Differential
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Ascites/*etiology/pathology
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Aged
10.A Case of Sheehan's Syndrome that Manifested as Bilateral Ptosis.
Journal of Korean Medical Science 2011;26(4):580-582
Hypothyroidism can cause a variety of signs and symptoms of the neuromuscular system. However, ptosis in a patient with hypothyroidism is very rare. We report here on a case of central hypothyroidism that was due to Sheehan's syndrome and it manifested as bilateral ptosis in a 51-yr-old woman. She complained of exertional dyspnea and weakness. About 25-yr ago, she had a history of severe postpartum vaginal bleeding. The laboratory studies demonstrated hypopituitarism with secondary hypothyroidism. The ptosis was improved by replacement of thyroid hormone. Hypothyroidism should be considered in the differential diagnosis of patients who manifest with ptosis and that prompt replacement of hormone can lead to a complete recovery.
Blepharoptosis/complications/*diagnosis/drug therapy
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Electromyography
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Female
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Glucocorticoids/therapeutic use
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Humans
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Hypopituitarism/complications/*diagnosis/drug therapy
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Hypothyroidism/complications
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Magnetic Resonance Imaging
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Middle Aged
;
Muscular Diseases/etiology
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Neuromuscular Junction/physiopathology
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Prednisolone/therapeutic use
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Thyroxine/therapeutic use