scholarly journals Severe primary hypothyroidism in an apparently asymptomatic 19-year-old woman: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Rania Dannan ◽  
Sulaiman Hajji ◽  
Khaled Aljenaee
Keyword(s):  
Incidental Finding ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Conflicting Evidence ◽  
Thyroid Function Testing ◽  
History Of ◽  
Asymptomatic Individuals ◽  
High Index Of Suspicion

Abstract Background Hypothyroidism is diagnosed on the basis of laboratory tests because of the lack of specificity of the typical clinical manifestations. There is conflicting evidence on screening for hypothyroidism. Case presentation We report a case of an apparently healthy 19-year-old Kuwaiti woman referred to our clinic with an incidental finding of extremely high thyroid-stimulating hormone (TSH), tested at the patient’s insistence as she had a strong family history of hypothyroidism. Despite no stated complaints, the patient presented typical symptoms and signs of hypothyroidism on evaluation. Thyroid function testing was repeated by using different assays, with similar results; ultrasound imaging of the thyroid showed a typical picture of thyroiditis. Treatment with levothyroxine alleviated symptoms and the patient later became biochemically euthyroid on treatment. Conclusion There is controversy regarding screening asymptomatic individuals for hypothyroidism; therefore, it is important to maintain a high index of suspicion when presented with mild signs and symptoms of hypothyroidism especially with certain ethnic groups, as they may be free of the classical symptoms of disease.

scholarly journals A study of serum thyroid stimulating hormone levels, and its correlation with clinical features and delayed diagnosis of hypothyroidism in central India

2019 ◽  
Vol 7 (1) ◽  
pp. 176
Author(s):  
Dharmendra Jhavar ◽  
Umesh Kumar Chandra ◽  
Shivshankar Badole ◽  
Anurag Rahekar ◽  
Sumit Vishwakarma
Keyword(s):  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Central India ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
P Value ◽  
Overt Hypothyroidism ◽  
Delay In Diagnosis ◽  
High Level ◽  
High Index Of Suspicion

Background: The clinical manifestations of hypothyroidism are variable, depending upon its cause, duration and severity. The spectrum extends from subclinical to overt hypothyroidism to myxedema coma. A high degree of suspicion is thus required in order to appreciate the clinical manifestation of the disorder to reach a diagnosis. Purpose of this study was to correlate serum TSH level with severity of clinical manifestations and evaluate possible cause of delay in the diagnosis.Methods: A cross section observational and descriptive study for the assessment of severity of primary hypothyroidism at presentation and evaluation of the causes of delay in diagnosis in 86 patients was done from December 2012 to November 2013 in the Department of Medicine, MGM Medical College, Indore, MP, India.Results: Illiterate patients had significantly (p value 0.002) higher TSH values at presentation. 34.8% of patients presented as severe hypothyroidism with TSH value >100 mIU/L. Delay of as much as 7 years was noted. Majority of patients had a delay of around 1 to 3 years in diagnosis. Only 4.6% patients were diagnosed without any delay due to high level of suspicion at presentation.Conclusions: Due to non-specific symptomatology of hypothyroidism diagnosis is often delayed. Therefore, high index of suspicion is required at the physician’s level and test of thyroid function is available at subsided cost therefore it should be offered to all such patients.

Patient with systemic emboli in the setting of Klebsiella oxytoca tricuspid valve endocarditis and patent foramen ovale treated with NobleStitch and AngioVac

2021 ◽  
Vol 14 (8) ◽  
pp. e243370
Author(s):  
John Leso ◽  
Majd Al-Ahmad ◽  
Drinnon O Hand
Keyword(s):  
Tricuspid Valve ◽  
Patent Foramen Ovale ◽  
Klebsiella Oxytoca ◽  
Signs And Symptoms ◽  
Foramen Ovale ◽  
Surgical Debulking ◽  
History Of ◽  
Infectious Disease Specialists ◽  
High Index Of Suspicion ◽  
Pfo Closure

A 34-year-old man with a medical history of injection drug use presented with 2 weeks of weakness, nausea, vomiting and septic shock secondary to infective endocarditis of a native tricuspid valve. On admission, CT chest demonstrated multiple cavitary lesions as well as numerous small infarcts seen on MRI brain concerning for systemic septic emboli. Subsequent transthoracic echo with bubble study revealed a large patent foramen ovale (PFO). The patient later received surgical debulking of his tricuspid valve vegetation with AngioVac. Subsequently, PFO closure was performed with a NobleStitch device. The case presented here demonstrates the importance of having a high index of suspicion with right-sided endocarditis and the development of other systemic signs and symptoms. It also underscores the necessity of a multidisciplinary team of cardiologists, surgeons, infectious disease specialists and intensivists in the treatment of these complicated patients.

Bouveret syndrome: a rare form of gallstone ileus

2021 ◽  
Vol 14 (2) ◽  
pp. e238126
Author(s):  
Don Haering ◽  
Mattie Murphy ◽  
John Craig ◽  
Gavin A Falk
Keyword(s):  
Clinical Evidence ◽  
Incidental Finding ◽  
Gallstone Ileus ◽  
Definitive Treatment ◽  
Abdominal Radiograph ◽  
Quadrant Pain ◽  
Abdominal Ct Scan ◽  
History Of ◽  
Bouveret Syndrome ◽  
High Index Of Suspicion

A 57-year-old woman presented with a 5-day history of worsening right upper quadrant pain, bilious emesis and approximately 20 pounds of weight loss. The patient was afebrile, without jaundice and had mild tenderness in her right upper quadrant. She noted an incidental finding of asymptomatic cholelithiasis on imaging 4 years earlier. An abdominal radiograph revealed pneumobilia and a large ectopic calculus. An abdominal CT scan confirmed pneumobilia, a large concretion completely obstructing the third portion of the duodenum and a soft tissue communication between the gallbladder and proximal duodenum. She was brought to the operating room for definitive treatment and had the obstructing gallstone removed via a transverse duodenotomy. Bouveret syndrome is a rare cause of small bowel obstruction that requires a high index of suspicion for diagnosis. It should be considered in older patients with clinical evidence of gastric or duodenal obstruction, particularly with a history of cholelithiasis.

scholarly journals The Natural History of Retinal Vascular Changes from Infancy to Adulthood in Wyburn-Mason Syndrome

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 598
Author(s):  
Kristina Horkovicova ◽  
Ivajlo Popov ◽  
Dana Tomcikova ◽  
Veronika Popova ◽  
Vladimir Krasnik
Keyword(s):  
Arteriovenous Malformations ◽  
Incidental Finding ◽  
Vitreous Hemorrhage ◽  
Signs And Symptoms ◽  
Clinical Findings ◽  
Vascular Changes ◽  
Ocular Symptoms ◽  
Neurocutaneous Disorder ◽  
History Of ◽  
Ocular Signs

Wyburn-Mason syndrome is a rare, non-hereditary congenital neurocutaneous disorder leading to arteriovenous malformations. Malformations are characterized by an artery that is directly connected to veins without a capillary system and forms a fragile mass of abnormal vessels. It can be found in the midbrain, in the eyes, orbit, and rarely in cutaneous nevi. Neurological and ocular symptoms are the most common. Ocular signs and symptoms include abnormally dilatated vessels of conjunctiva, nystagmus, strabismus, vitreous hemorrhage, vein occlusions, retinal detachment, etc. Neurological symptoms may include headaches, paralysis, epistaxis, hydrocephalus, and hemiparesis. Imaging modalities such as MRI/CT angiography, optical coherence angiography, and fluorescein angiography are the most important for the identification of arteriovenous malformations. In our case report, we present an eight-month-old girl with an incidental finding of retinal angiomatosis on the left eye and was subsequently diagnosed with Wyburn-Mason syndrome. We compare the findings from the first visit to her clinical findings 20 years later.

scholarly journals A Case of Hypocalcemia Secondary to Infection With SARS-CoV-2 Virus

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A171-A172
Author(s):  
Abdul Mannan Khan ◽  
James Lightell ◽  
Corey Majors
Keyword(s):  
New York ◽  
Respiratory Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Calcium Dependent ◽  
Electrolyte Disturbances ◽  
History Of ◽  
Diagnosed Diabetes ◽  
Newly Diagnosed Diabetes

Abstract Background: A Case of Hypocalcemia Secondary to Infection with SARS-CoV-2 Virus. Clinical Case: A 40 year-old obese male presented to the emergency department with a five day history of nausea, vomiting, shortness of breath, and nonproductive cough. Symptoms progressed culminating in a single episode of pre-syncope leading to his seeking medical care. Positive testing for the presence of SARS-CoV-2 as well as findings from computed tomography of the patient’s chest led to a diagnosis of COVID-19 and the patient’s admission to a COVID-19 ward, where treatment with dexamethasone, doxycycline, and 2 L oxygen via nasal cannula began. Blood testing on admission revealed profound hypocalcemia (6.2 mg/dL total and 3.5 mg/dL ionized) as well as newly diagnosed diabetes mellitus type 2 (T2DM) (HbA1c 13.0% on admission). Further electrolyte disturbances noted were consistent with his history of vomiting and untreated T2DM. Thyroid stimulating hormone and thyroxine levels showed primary hypothyroidism, but the patient’s parathyroid hormone level (16.5 pg/mL) was inappropriately normal. No other causes for hypocalcemia were identified. The patient’s hypocalcemia was treated with intravenous calcium gluconate and rose consistently through day six of hospitalization. Calcium fell sharply between day six and seven (7.6 mg/dL to 7.3 mg/dL) coinciding with worsening respiratory symptoms and requiring a doubling of oxygen dose from 2 to 4 L with subsequent improvement in hypocalcemia once underlying pulmonary function improved. Discussion: SARS-CoV-2 infection presenting with hypocalcemia has been well documented without definitive explanation [1]. Further, while the precise mechanism of SARS-CoV-2 virion export is unclear, the patient’s worsening hypocalcemia, respiratory symptoms, and concurrent presumable increased viral load suggests this is caused by a calcium-dependent exocytotic process [2]. 1: Marazuela, M., Giustina, A. & Puig-Domingo, M. Endocrine and metabolic aspects of the COVID-19 pandemic. Rev Endocr Metab Disord 21, 495–507 (2020). https://link.springer.com/article/10.1007/s11154-020-09569-22: Fehr A.R., Perlman S. (2015) Coronaviruses: An Overview of Their Replication and Pathogenesis. In: Maier H., Bickerton E., Britton P. (eds) Coronaviruses. Methods in Molecular Biology, vol 1282. Humana Press, New York, NY. https://link.springer.com/protocol/10.1007%2F978-1-4939-2438-7_1.

scholarly journals Hypothyroidism: current state of the problem

2020 ◽  
pp. 96-107
Author(s):  
E. V. Biryukova ◽  
D. V. Kileynikov ◽  
I. V. Solovyeva
Keyword(s):  
Kinase Inhibitors ◽  
Clinical Manifestations ◽  
Final Diagnosis ◽  
Thyroid Stimulating Hormone ◽  
Pathological Process ◽  
Primary Hypothyroidism ◽  
The Body ◽  
Hormone Deficiency ◽  
Side Reactions ◽  
Secondary Hypothyroidism

The article presents the issues of epidemiology, classification, and clinic of hypothyroidism. The frequency of hypothyroidism increases significantly with age. The most common form is primary hypothyroidism, caused by a pathological process in the thyroid gland itself. Secondary hypothyroidism or tertiary hypothyroidism is caused by insufficient secretion of thyroid- stimulating hormone (TSH), or thyrotropin-releasing hormone. The article deals with the main causes of primary and secondary hypothyroidism. The most common cause of primary hypothyroidism is autoimmune thyroiditis, which can develop both separately and simultaneously with other autoimmune diseases, as part of polyglandular syndrome. Special attention should be paid to the change of thyroid status as a result of adverse side reactions when using a range of drugs. The questions about the mechanisms of thyroid insufficiency development as a result of unfavorable side reactions when using a number of drugs (lithium preparations, iodine-containing compounds, tyrosine kinase inhibitors, etc.) have been raised. Undiagnosed hypothyroidism is a risk factor for the progression of already existing cardiovascular diseases. The severity of clinical manifestations is determined by the severity of thyroid hormone deficiency. There are no significant clinical differences between the pronounced forms of primary and secondary hypothyroidism. Depending on the degree of lesion, secondary hypothyroidism may be complicated by other manifestations of hypothalamic-pituitary disorders, as well as the latter may include a decrease in the secretion of antidiuretic hormone at a certain stage of their development. Diagnostic difficulties are discussed, as hypothyroidism disrupts the functioning of most organs and systems of the body (musculoskeletal, cardiovascular, urinary, gastrointestinal, central and peripheral nervous systems) and can be masked by various diseases. The final diagnosis of hypothyroidism is clarified by a number of laboratory and instrumental studies. Substitution therapy with levothyroxine is used to treat hypothyroidism of any etiology.

A Rare Nonmalignant Mass of the Pancreas: Case Report and Review of Pancreatic Sarcoidosis

2010 ◽  
Vol 76 (1) ◽  
pp. 79-84
Author(s):  
Martin Wijkstrom ◽  
Rabih I. Bechara ◽  
Juan M. Sarmiento
Keyword(s):  
Signs And Symptoms ◽  
Whipple Procedure ◽  
Unknown Etiology ◽  
Benign Condition ◽  
Pancreatic Malignancy ◽  
First Case ◽  
Pancreatic Involvement ◽  
Positron Emission ◽  
History Of ◽  
High Index Of Suspicion

Sarcoidosis is a systemic granulomatous disease of unknown etiology affecting patients from all genetic backgrounds. Pancreatic involvement is rare; the first case was described on autopsy in 1937. We present a case of pancreatic sarcoidosis without a history of the disease presenting as biliary obstruction mimicking pancreatic malignancy. We also review the literature with respect to management and outcomes of similar cases. The patient described here presented with all the signs and symptoms of a pancreatic malignancy, which was confirmed on a CT scan; the positron emission tomography scan and the CA 19-9 level were also confirmatory of the suspected diagnosis. In this setting, if the mass looks resectable, a Whipple procedure would be the next logical step. However, such strategy would be aggressive management for a benign condition that could be palliated with diverting rather than resective procedures without changing the outlook of the disease. We suggest keeping a high index of suspicion in patients with a history of the disease if demographic concordance exists.

scholarly journals Colonic pseudo-obstruction in a patient with Sheehan’s syndrome

2019 ◽  
Vol 12 (8) ◽  
pp. e228936
Author(s):  
Navneet Kaur ◽  
Ulrich Schubart ◽  
Adel Mandl
Keyword(s):  
Exploratory Laparotomy ◽  
Sigmoid Resection ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Thyroid Function Tests ◽  
Sheehan’S Syndrome ◽  
Central Hypothyroidism ◽  
End Colostomy ◽  
History Of ◽  
Sheehan's Syndrome

A 56-year-old woman with a history of hypothyroidism and chronic constipation presented with an acute abdomen due to colonic pseudo-obstruction. Thyroid function tests were consistent with central hypothyroidism prompting intravenous administration of stress-dose glucocorticoids and levothyroxine. The patient then underwent emergency exploratory laparotomy with sigmoid resection and end-colostomy. The postoperative endocrine evaluation revealed that the patient had panhypopituitarism due to Sheehan’s syndrome (SS). The diagnosis had been missed by physicians who had been treating her for several years for presumed primary hypothyroidism with a low dose of levothyroxine, aimed at normalising a minimally elevated thyroid-stimulating hormone (TSH) level. This is the second reported case of SS presenting with colonic pseudo-obstruction and it illustrates the potential danger of relying on measurement of TSH alone in the evaluation and treatment of thyroid dysfunction.

Update of hypothyroidism and its management in Unani medicine

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Md. Anzar Alam ◽  
Mohd Aleemuddin Quamri ◽  
Ghulamuddin Sofi ◽  
Shabnam Ansari
Keyword(s):  
Thyroid Hormone ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Clinical History ◽  
Developed Countries ◽  
Modern Medicine ◽  
Thyroid Stimulating Hormone ◽  
Clinical Syndrome ◽  
Hormone Deficiency ◽  
Unani Medicine

AbstractHypothyroidism is a clinical syndrome caused by thyroid hormone deficiency due to reduced production, deranged distribution, or lack of effects of thyroid hormone. The prevalence of hypothyroidism in developed countries is around 4–5%, whereas it is about 11% in India, only 2% in the UK, and 4·6% in the USA. It is more common in women than in men. Hypothyroidism has multiple etiologies and manifestations. The most common clinical manifestations are weight gain, loss of hair, cold intolerance, lethargy, constipation, dry skin, and change in voice. The signs and symptoms of hypothyroidism differ with age, gender, severity of condition, and some other factors. The diagnosis is based on clinical history, physical examination and serum level of FT3, FT4, and thyroid-stimulating hormone, imaging studies, procedures, and histological findings. The treatment of choice for hypothyroidism is levothyroxine, however; in this review article, we have discussed the epidemiology, etiology, clinical sign and symptoms, diagnosis, complications, and management of hypothyroidism in modern medicine and a comparative treatment by the Unani system of medicine (USM). In the USM, the main emphasis of the principle of treatment (Usool-e-Ilaj) is to correct the abnormal constitution (Su-e-Mizaj) and alter the six prerequisites for existence (Asbab-e-Sitta Zarooriya) to restore normal health. It is a packaged treatment, that is, different components of treatment are given as a package form which includes different drugs, dosages form, and regimens.

scholarly journals Right Cerebellar Tuberculosis with Cranial Nerve Palsy in Pulmonary Tuberculosis Patient

2021 ◽  
Vol 7 (2) ◽  
pp. 65
Author(s):  
I Komang Rusgi Yandi ◽  
Isnin Anang Marhana
Keyword(s):  
Young Adult ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Tuberculosis Patient ◽  
Public Health Issue ◽  
High Morbidity ◽  
Radiological Findings ◽  
Blurred Vision ◽  
History Of

Introduction: Tuberculosis (TB) is a major public health issue. The most devastating clinical manifestations of TB is Central nervous system (CNS) TB. CNS TB is found approximately in 1% of all patients with active TB, and cerebellar TB is rarely reported. CNS TB can present as meningitis, arachnoiditis, tuberculomas, or the uncommon forms of tuberculous subdural empyema and brain abscess.Case: A 23-year-old patient was reported in October 2018 with signs and symptoms of 2-month history of vertigo, headache, vomiting, weakness, fever, blurred vision, lingual palsy, dysmetria, and decrease of consciousness. The patient had a few months of history of cough, contact with a TB patient, his father, and loss of body weight. On admission, the patient had fever (38.50 C) and Glasgow coma score of 13.Discussion:  CNS TB can occur in an immunocompromised patient with malnutrition, whether a child or young adult. The patient in this case had risk factors because he is a young adult and had contact with a patient of TB, his father. Based on epidemiology, clinical signs and symptoms, radiological findings, and the result of AFB-stained sputum, the patient was diagnosed with right cerebellar TB and PTB.Conclusion: The high morbidity and mortality characteristics of CNS TB are very important to note, thus the prompt diagnosis and therapy should be done. The specific therapy of ATD combined with surgery seems to provide a good result. The clinical and radiological findings were used as the evaluation of the medication.

Sign in / Sign up

Export Citation Format

Share Document