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

PURPOSE: Thyroid cancer is a rare disease in pediatric population, but its incidence rate is increasing. The aim of this report is to present a single institution experience of pediatric thyroid cancer and to identify clinical features, predisposing factors, and postoperative course of pediatric thyroid cancer. METHODS: We retrospectively reviewed 35 pediatric patients who underwent operation due to thyroid cancer at Seoul National University Children's Hospital between May 1997 and January 2017. The median follow-up period was 70 months (range, 5–238 months). RESULTS: The mean age at operation was 12.0±5.91 years and 27 patients were female. The underlying conditions in patients included history of chemoradiotherapy for previous other malignancies (n=4), hypothyroidism (n=3), history of chemotherapy (n=2), family history of thyroid cancer (n=1) and history of radiation therapy (n=1). The initial symptoms were palpable neck mass (n=21) and incidental findings (n=11). Total thyroidectomy (n=30) or unilateral lobectomy (n=5) were performed. There were 15 postoperative complications including transient hypocalcemia in 14 patients and Horner's syndrome in 1 patient. The most common pathologic cell type was papillary thyroid cancer (n=29). Extrathyroid extension and lymph node invasion were found in 25 patients and 27 patients, respectively. Thirteen patients showed multifocality. During follow-up period, 5 patients underwent additional operation because of tumor recurrence in lymph nodes. Lung metastasis was detected in 3 patients at the time of diagnosis and in 3 patients during follow-up period. The mortality rate was zero and mean disease-free survival was 83.7±47.9 months. CONCLUSION: Pediatric thyroid cancer has lower mortality rate and recurrence rate as seen in this study despite the advanced stage at diagnosis. A thorough follow-up of patients with an underlying condition such as history of chemoradiotherapy and understanding new pediatric guideline can be helpful to maximize patients' survival and prognosis.
Causality ; Chemoradiotherapy ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Horner Syndrome ; Humans ; Hypocalcemia ; Hypothyroidism ; Incidence ; Incidental Findings ; Lung ; Lymph Nodes ; Mortality ; Neck ; Neoplasm Metastasis ; Pediatrics ; Postoperative Complications ; Prognosis ; Rare Diseases ; Recurrence ; Retrospective Studies ; Seoul ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

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

Amiodarone is a di-iodated benzofuran derivative that is commonly used to treat patients with various cardiac arrhythmias. It is associated with side effects that involve the liver, thyroid, and other organs. Approximately 1-3% of patients treated with amiodarone suffer from symptomatic liver disease. Thyroid dysfunction occurs in 10% of patients treated with amiodarone. A 65-year-old woman with coronary heart disease and atrial fibrillation was administered with amiodarone. She developed nausea, vomiting, dyspepsia, and sweating within 9 months of amiodarone administration (200 mg orally once a day). Results of the laboratory finding showed increased hepatic enzymes, and low thyroid hormone levels. A liver biopsy showed irregular arrangement of hepatocytes and diffuse micro- and macrovesicular fatty changes. Electron microscopy findings showed pleomorphic mitochondria with crystalloid inclusions and membrane-bound lysosomal structures. The liver and thyroid functions returned to normal, after the amiodarone was stopped. We describe an unusual case in which amiodarone induced hepatitis and hypothyroidism simultaneously. Physicians should take a close look to the adverse event when using amiodarone which can cause adverse effects in multiple organs.
Aged ; Amiodarone/*adverse effects/therapeutic use ; Arrhythmias, Cardiac/drug therapy ; Drug-Induced Liver Injury/*complications/pathology/*radiography ; Female ; Fibrosis/pathology ; Humans ; Hypothyroidism/*chemically induced/*complications ; Microscopy, Electron ; Mitochondria/drug effects/metabolism ; Tomography, X-Ray Computed ; Treatment Outcome

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

OBJECTIVETo study the changes in hormone levels and the therapy of pituitary hyperplasia secondary to primary hypothyroidism in children.

METHODSThe clinical data of 8 children with pituitary hyperplasia secondary to primary hypothyroidism (5 girls and 3 boys) at ages of 5 to 9 years were studied retrospectively. All of the children had a short stature. They were followed up 1 to 6 years.

RESULTSThe thyroid hormone levels decreased and the serum thyroid stimulating hormone (TSH) and prolactin (PRL) levels increased in the 8 children. After 2 to 6 months thyroxine replacement therapy, the levels of free triiodothyronine (FT3), free thyroxine (FT4) and serum TSH and PRL returned to normal, and the pituitary enlargement regressed to normal in the 8 children. Of them, 6 children's height growth rate increased significantly from 3.1+/-0.5 cm per year to 11.6+/-1.7 cm per year (p<0.01). The other 2 cases had low growth rate and then received additional recombinant human growth hormone (rhGH) therapy. Their height growth rate increased by 11 cm per year. Pituitary hyperplasia did not recur in the 8 children during the follow-up.

CONCLUSIONSThe thyroid function and pituitary examinations are necessary for children with a short stature. Thyroxine substitution therapy appears to be effective for primary hypothyroidism secondary to pituitary hyperplasia. rhGH replacement therapy after regression of the pituitary enlargement can result in a satisfactory height growth in children with low thyroid hormone levels and growth hormone deficiency.

Body Height ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Human Growth Hormone ; therapeutic use ; Humans ; Hyperplasia ; Hypothyroidism ; complications ; drug therapy ; Magnetic Resonance Imaging ; Male ; Pituitary Gland ; pathology ; Thyrotropin ; blood ; 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

OBJECTIVETo explore the clinical features of respiratory failure secondary to hypothyroidism.

METHODWe retrospectively analyzed the clinical data of 4 patients with respiratory failure secondary to hypothyroidism.

RESULTSRespiratory failure secondary to hypothyroidism usually happened in the aged patients, presenting as myxedema, disturbance of consciousness, anemia, and hyponatrium. Respiratory symptoms were rare. Type II respiratory failure might occur as disease progressed. The clinical presentation of hypothyroidism was atypical and easily neglected. The hypoxia and hypercapnia ameliorated after thyroid hormone therapy.

CONCLUSIONHypothyroidism is a rare reason of respiratory failure. The prognosis is good after hormone therapy and mechanical ventilation.

Aged ; Aged, 80 and over ; Female ; Humans ; Hypothyroidism ; complications ; drug therapy ; therapy ; Male ; Middle Aged ; Respiratory Insufficiency ; drug therapy ; etiology ; therapy ; Thyroid Hormones ; therapeutic use

This paper summarises the current evidence on neuro-developmental deficits in the early (< 1 month of age) treated congenital hypothyroid and the influencing factors. A literature search revealed only few citations that compared outcome with matched controls. In all but one, the median age of treatment onset was >2 weeks. Mean Global IQ scores are about 10 points lower and remain identifiable in adulthood. Verbal and performance scores are usually similar. Deficits persisting into adolescence and adulthood involve the visuomotor, memory, attention and posture domains. Lower academic performance is common in the early years. Prenatal factors associated with a worse prognosis are aetiology (dysgenesis), low birth weight, associated complications and severity of hypothyroidism. Postnatal factors are age at onset of treatment (>1 month), lower thyroxine dose at onset (<8 mcg/kg/day), late normalisation of thyroid function (>2 weeks after treatment), and a lower socio economic family status. The author proposes the evaluation of a multi centre cohort with a median age of treatment onset <1 week, TSH normalisation by <3 weeks with treatment thyroxine levels maintained in the 3rd quartile for age. The outcome of this cohort should indicate if current targets in management need to be revised.
Adolescent ; Adult ; Child ; Child, Preschool ; Congenital Hypothyroidism ; complications ; drug therapy ; Developmental Disabilities ; etiology ; Humans ; Infant, Newborn ; Nervous System Diseases ; etiology ; Thyroxine ; administration & dosage