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 ; Hypothyroidism ; complications ; drug therapy ; Intraabdominal Infections ; complications ; diagnosis ; therapy ; Thyroxine ; therapeutic use ; Triiodothyronine ; therapeutic use

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 ; Thyroid Hormones/deficiency/therapeutic use ; Myxedema/*etiology/pathology ; Male ; Hypothyroidism/*complications/diagnosis/drug therapy ; Humans ; Hormone Replacement Therapy ; Diagnosis, Differential ; Ascites/*etiology/pathology ; Aged

Some patients have ascites without having liver disease, so it is important to analyze the cause of these ascites. Tuberculous peritonitis is an infectious disease characterized by lymphocyte-dominant exudative ascites. In contrast, myxedema ascites is a very rare disease characterized by a high serum/ascites albumin gradient (SAAG) with hypothyroidism. We herein report a case involving a 48-year-old woman with both diseases simultaneously. She was hospitalized because of massive ascites, generalized edema, and a puffy face. Hypothyroidism was confirmed by thyroid function tests. Her ascitic fluid had a high SAAG; no other specific findings were identified by cytology, culture, or computed tomography. Three months after initiating drug therapy for the hypothyroidism, the patient's systemic edema improved but the ascites recurred. Accordingly, diagnostic laparoscopy was performed, and tuberculous peritonitis was confirmed. As seen in this case, when myxedema ascites is associated with tuberculous peritonitis, an accurate diagnosis may be challenging.
Ascites* ; Ascitic Fluid ; Communicable Diseases ; Diagnosis ; Drug Therapy ; Edema ; Female ; Humans ; Hypothyroidism ; Laparoscopy ; Liver Diseases ; Middle Aged ; Myxedema* ; Peritonitis, Tuberculous* ; Rare Diseases ; Thyroid Function Tests

PURPOSE: This study is aimed to find out the incidence of late endocrine complications in children who were treated for childhood cancer. METHODS: We reviewed the medical records of 60 patients who was treated for childhood cancer and evaluated various pituitary hormonal functions after completion of treatment from July 1985 to September 2004 at Kyungpook National University Hospital. RESULTS: Forty-four boys (73.3%) and sixteen girls (26.7%) were involved in the study and their ages ranged from 2 months to 14 years. Twenty-four patients were treated with chemotherapy with cranial irradiation and thirty-six were treated with chemotherapy only. The diagnoses included ALL (n=27, 45.0%), AML (n=2, 3.3%), malignant lymphoma (n=13, 21.7%), brain tumor (n=5, 8.3%), MDS (n=1, 1.7%), and other solid tumor (n=12, 20.2%). Forty-four (73.3%) out of the 60 patients had an additional endocrine abnormality. Growth hormone deficiency (GHD) was identified in 44 children (73.3%). Incidence of GHD was significantly higher among those who had received cranial irradiation (91.6% vs. 61.1%) (P=0.009) but this kind of difference was not found in ALL 27 patients (93.7% vs. 72.7%) (P=0.131). Only one patient was diagnosed as primary hypothyroidism, two patients were diagnosed as primary hypogonadism, and these three patients showed growth hormone deficiency. No patient had abnormalities of ACTH and cortisol. CONCLUSION: We thought that late endocrine complications were very common in childhood cancer survivors. Accordingly, we recommended that we should focus on endocrine abnormalities while treating and following up the patients.
Adrenocorticotropic Hormone ; Brain Neoplasms ; Child ; Cranial Irradiation ; Diagnosis ; Drug Therapy ; Female ; Growth Hormone ; Gyeongsangbuk-do ; Humans ; Hydrocortisone ; Hypogonadism ; Hypothyroidism ; Incidence ; Lymphoma ; Medical Records ; Survivors*

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 ; Electromyography ; Female ; Glucocorticoids/therapeutic use ; Humans ; Hypopituitarism/complications/*diagnosis/drug therapy ; Hypothyroidism/complications ; Magnetic Resonance Imaging ; Middle Aged ; Muscular Diseases/etiology ; Neuromuscular Junction/physiopathology ; Prednisolone/therapeutic use ; Thyroxine/therapeutic use

Myxedema coma is the extreme form of untreated hypothyroidism. In reality, few patients present comatose with severe myxedema. We describe a patient with myxedema coma which was initially misdiagnosed as a brain stem infarct. She presented to the hospital with alteration of the mental status, generalized edema, hypothermia, hypoventilation, and hypotension. Initially her brain stem reflexes were absent. After respiratory and circulatory support, her neurologic status was not improved soon. The diagnosis of myxedema coma was often missed or delayed due to various clinical findings and concomitant medical condition and precipitating factors. It is more difficult to diagnose when a patient has no medical history of hypothyroidism. A high index of clinical suspicion can make a timely diagnosis and initiate appropriate treatment. We report this case to alert clinicians considering diagnosis of myxedema coma in patients with severe decompensated metabolic state including mental change.
Aged ; Brain Stem Infarctions/diagnosis/radiography ; Diagnosis, Differential ; Diagnostic Errors ; Echocardiography ; Female ; Humans ; Hypothyroidism/complications/drug therapy ; Myxedema/*diagnosis/etiology/radiography ; Republic of Korea ; Thyroxine/therapeutic use ; Tomography, X-Ray Computed

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 ; Adult ; Brain/diagnostic imaging ; 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 ; Thyrotropin-Releasing Hormone/therapeutic use

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 ; Adult ; Brain/diagnostic imaging ; 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 ; Thyrotropin-Releasing Hormone/therapeutic use

OBJECTIVES: To evaluate the association between fracture risk and levothyroxine use in elderly women with hypothyroidism, according to previous osteoporosis history. METHODS: We conducted a cohort study from the Korean Health Insurance Review and Assessment Service claims database from January 2005 to June 2006. The study population comprised women aged > or =65 years who had been diagnosed with hypothyroidism and prescribed levothyroxine monotherapy. We excluded patients who met any of the following criteria: previous fracture history, hyperthyroidism, thyroid cancer, or pituitary disorder; low levothyroxine adherence; or a follow-up period <90 days. We categorized the daily levothyroxine doses into 4 groups: < or =50 microg/d, 51 to 100 microg/d, 101 to 150 microg/d, and >150 microg/d. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with the Cox proportional hazard model, and subgroup analyses were performed according to the osteoporosis history and osteoporosis-specific drug prescription status. RESULTS: Among 11 155 cohort participants, 35.6% had previous histories of osteoporosis. The adjusted HR of fracture for the >150 microg/d group, compared with the 51 to 100 microg/d group, was 1.56 (95% CI, 1.03 to 2.37) in osteoporosis subgroup. In the highly probable osteoporosis subgroup, restricted to patients who were concurrently prescribed osteoporosis-specific drugs, the adjusted HR of fracture for the >150 microg/d group, compared with the 51 to 100 microg/d group, was 1.93 (95% CI, 1.14 to 3.26). CONCLUSIONS: While further studies are needed, physicians should be concerned about potential levothyroxine overtreatment in elderly osteoporosis patients.
Aged ; Aged, 80 and over ; Cohort Studies ; Databases, Factual ; Female ; Fractures, Bone/*prevention & control ; Humans ; Hypothyroidism/diagnosis/drug therapy ; Insurance Claim Review ; Medication Adherence ; Osteoporosis/*pathology ; Proportional Hazards Models ; Risk Assessment ; Thyroxine/*therapeutic use ; Time Factors

PURPOSE: Medulloblastoma is the most common malignant brain tumor in childhood. The standard treatments are composed of tumor resection, irradiation and chemotherapy. In this study, we analysed the outcome of high risk medulloblastoma patients who were treated with surgical resection followed by craniospinal irradiation and chemotherapy utilizing cisplatin, vincristine, cyclophosphamide and etoposide. METHODS: We conducted a retrospective analysis of medical record of twenty-five patients with high risk medulloblastoma, treated from January 1998 to April 2004 in the Department of Pediatrics, Neurosurgery and Radiation Oncology at Asan Medical Center. RESULTS: The median age at diagnosis was 9 years and 10 month. The 2-year overall survival rate was 80%, and 2-year progression-free survival rate was 71%. Degree of surgical resections or residual tumor did not show statistically significant differences of survival rate, but there was difference depending on metastasis staging. The side effects of chemotherapy were grade IV hematologic toxicity (n=20), SIADH (n=2), and severe paralytic ileus (n=1). The long-term sequelae were endocrinopathy (n=6) that include growth failure, precocious puberty and hypothyroidism. Neurological complications such as mild mental retardation and ataxia occurred in seven patients. There was no treatment-related mortality. Four patients died of tumor progression. CONCLUSION: Patients with high risk medulloblastoma treated with surgical resection followed by radiation and chemotherapy as described here show satisfactory outcome. In this high risk group, metastasis staging correlated with outcome but the degree of surgical resection and presence or absence of residual tumor at primary site did not correlate with outcome.
Ataxia ; Brain Neoplasms ; Child ; Chungcheongnam-do ; Cisplatin ; Craniospinal Irradiation ; Cyclophosphamide ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Etoposide ; Humans ; Hypothyroidism ; Inappropriate ADH Syndrome ; Intellectual Disability ; Intestinal Pseudo-Obstruction ; Medical Records ; Medulloblastoma* ; Mortality ; Neoplasm Metastasis ; Neoplasm, Residual ; Neurosurgery ; Pediatrics ; Puberty, Precocious ; Radiation Oncology ; Retrospective Studies ; Survival Rate ; Vincristine