scholarly journals Palpitations and Fatigue Post COVID: A Harbinger of Silent Thyroiditis!

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A946-A946
Author(s):  
Marvyn Allen G Chan ◽  
Bisrat T Teweldemedhin ◽  
Josemaria M Demigillo ◽  
Ma Pamella G Demigillo ◽  
Patrick Benjamin ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Neck Pain ◽  
Subacute Thyroiditis ◽  
Low Grade ◽  
Free T4 ◽  
Anterior Neck ◽  
Silent Thyroiditis ◽  
Organ Systems ◽  
Work Up

Abstract Background: Subacute thyroiditis is a self-limiting condition brought about by an inflammatory reaction often linked to a recent viral infection. SARS-COV2 (COVID-19), an RNA coronavirus that started a global pandemic in December 2019 has been linked mostly to severe acute respiratory distress syndrome. However, there have been increasing reports of its effect on other organ systems. We present a case of a 32-year-old female recovering from COVID-19, only to develop silent thyroiditis afterwards. Clinical Case: A 32-year-old female with anxiety disorder but otherwise in excellent health was diagnosed with COVID-19 via nasal swab RT-PCR after experiencing low grade fever and cough. She quarantined at home and was on her way to recovery when, a few weeks later, she began to experience increasing bouts of chest pain with no relation to activity, intermittent headaches and lower extremity edema. This prompted her to visit the emergency department. Work-up done at that time was unremarkable and her symptoms were attributed mostly to anxiety. She was advised to follow-up as an outpatient with a cardiologist. One month later, due to the persistence of her fatigue, low exercise tolerance and tremors, she decided to seek consult with a cardiologist. An electrocardiogram done during that visit showed normal sinus rhythm with poor-R wave progression and early repolarization changes. Both the echocardiogram and 24-hour Holter monitoring, which were subsequently done, were unremarkable. Blood work-up, however, revealed a significantly low thyroid stimulating hormone (TSH) level of 0.17 mU/L, for which she was referred to an endocrinologist. A month later, she sought consult with an endocrinologist. Thyroid gland was non-tender on palpation. Repeat blood work-up showed an elevated TSH level (23.50 mU/L) with a low Free T4 (0.42 ng/dL) and an elevated thyroid peroxidase antibody (TPO-Ab) level (900 mU/mL), indicative of subacute thyroiditis, but without associated neck pain. Thyroid sonography done showed diffusely heterogeneous thyroid lobes with no evidence of a dominant mass or nodule. A decision was made to start her on low dose levothyroxine. Two months into treatment, she underwent repeat thyroid hormone levels. Normal TSH and normal free T4 were observed. However, TPO-Ab was still elevated. It was decided to continue her therapy for one more month before gradually tapering her levothyroxine dose. She was told to follow-up in a month for further monitoring. Conclusion: Subacute thyroiditis associated with COVID-19 infection has become a more common occurrence as more cases of COVID-19 are noted worldwide. Our patient followed the usual course of subacute thyroiditis, initially presenting with a thyrotoxicosis phase which typically lasts 4-10 weeks, then subsequently developing hypothyroidism, inadvertently needing thyroid hormone replacement. What made this case more intriguing was that she did not have severe anterior neck pain, the classic clinical presentation of subacute thyroiditis. While there is a very strong association between COVID-19 and respiratory failure, there is paucity of evidence linking COVID-19 to dysfunction of other body systems. This case of thyroiditis presenting post COVID-19 illness, buttresses the versatility of COVID-19. Physicians should keep this in mind when evaluating a COVID-19 survivor who continue to present with persistent tachycardia or palpitations with or without anterior neck pain even after a month or two from infection. Routine follow-up TSH assay on COVID-19 survivors may be a valuable consideration.

scholarly journals Low-Dose Prednisone Therapy is Efficacious in Treating Painful Subacute Thyroiditis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A940-A940
Author(s):  
Mohamed K M Shakir ◽  
Robert D Leimbach ◽  
Rinsha P V Sherin ◽  
Michael I Orestes ◽  
Vinh Q Mai ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Neck Pain ◽  
Low Dose ◽  
Subacute Thyroiditis ◽  
Thyroid Disorder ◽  
Free T4 ◽  
Anterior Neck ◽  
Prednisone Therapy ◽  
Thyroid Scan ◽  
Dose Prednisone

Abstract Subacute thyroiditis (SAT) usually presents with neck pain, radiating to ears and is often associated with hyperthyroidism. Currently the available treatment involves administration of NSAID or in more symptomatic patients prednisone 40mg daily tapered over 6 weeks or longer. We report successful treatment of 3 patients (Pts) with SAT with low-dose prednisone therapy (20mg/day) (LDP20) initially and tapered over 4 weeks. Patient 1: A 32-year-old female presented with severe neck pain radiating to both ears and low- grade fever of 2-weeks duration. Two weeks prior, patient had cold-like symptoms lasting for 3 days. Physical examination: HR 110bpm, tremors of fingers noted, tenderness of the anterior neck present, thyroid 30-gms in size. Labs: ESR 92 mm/hr, CRP 3.2 mg/dL, TSH <0.005 uIU/mL, free T4 2.71 ng/dL, total T3 168 ng/mL. Thyroid scan and uptake showed a 24-hrs uptake <1%, thyroid gland not visualized, consistent with SAT. Patient was treated with atenolol and LDP20 tapered over 4 weeks. Pain significantly improved after 2 days of treatment. Six weeks later TSH was 0.9 uIU/mL with a free T4 1.4 ng/dL and ESR 8 mm/hr. Patient 2: A 19-year-old female presented with left-ear pain, anterior neck pain, fever, and extreme fatigue. PE: HR 111bpm, heat shield present, tender-to-palpation thyroid, brisk DTR. Lab: CBC normal, ESR 98 mm/hr, CRP 9.9 mg/dL, TSH <0.01 uIU/mL, free T4 3.8 ng/dL, total T3 210 ng/mL. Thyroid scan and uptake: uptake <1%, no thyroid gland visualized and SAT was diagnosed. Patient was started on LDP20 and atenolol. Four days following prednisone therapy her symptoms completely resolved and prednisone was tapered off over 4 weeks. Thyroid functions were normal by the seventh week. Patient 3: A 38-year-old male presented with fever, fatigue, severe neck pain, palpitation and a weight loss of 8 pounds. PE: HR 120 bpm, thyroid severely tender on palpation, brisk DTR. Lab: normal CBC, ESR 128 mm/hr, CRP 11.9 mg/dL, TSH <0.001 uIU/mL, free T4 4.2 ng/dL, total T3 201 ng/mL. Thyroid scan: thyroid gland not visualized and uptake was < 1%. SAT was diagnosed and patient was treated with propranolol and LDP20. After 5 days the dose of prednisone was reduced to 15mg/day and the prednisone was tapered over five weeks. Patient had resolution of symptoms in 70 hours and remained asymptomatic for the next 12 months of follow-up. Thyroid function normalized by the eighth week. Conclusion: SAT is a painful disabling thyroid disorder apparently caused by a viral infection; and NSAID or high-dose steroid treatment remains the standard of care. We have treated 3 Pts with relatively lower doses of prednisone than previously recommended and attained remission successfully. Thus side effects can be avoided with lower prednisone dose.

scholarly journals POST-CORONAVIRUS DISEASE 2019 DE QUERVAIN’S THYROIDITIS – A CASE REPORT AND LITERATURE REVIEW

2021 ◽  
pp. 4-6
Author(s):  
MOHAMAD SAFWAN ◽  
VIJAYAN KN ◽  
NAJEEB ◽  
JITHU TG
Keyword(s):  
Neck Pain ◽  
Beta Blockers ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
C Reactive Protein ◽  
Free T4 ◽  
Persistent Fever ◽  
Reactive Protein ◽  
Technetium Uptake

De Quervain’s thyroiditis, also known as subacute thyroiditis (SAT), is a self-limiting inflammatory thyroid disease typically occurring a few weeks after a respiratory viral infection. A 29-year-old female with no comorbidities presented with persistent fever, neck pain, and swelling of 10 days duration. She also had tremors, fatigue, and palpitation. A careful enquiry revealed that she had been diagnosed with coronavirus disease 2019 (COVID-19) infection 6 weeks ago and had recovered uneventfully with conservative management. Her laboratories showed leukocytosis, elevated erythrocyte sedimentation rate, and C-reactive protein. Thyroid function tests (TFTs) yielded low thyroid-stimulating hormone, and high T3 and free T4. Ultrasonography neck was suggestive of thyroiditis. Thyroid scintigraphy demonstrated very low technetium uptake which confirmed SAT. Her symptoms ameliorated with nonsteroidal anti-inflammatory drug and beta-blockers and her TFTs improved during follow-up. We report this as emerging sequelae of COVID-19 infection. A persistent fever and neck pain following recent COVID-19 infection should alert clinician toward the possibility of de Quervain’s thyroiditis following severe acute respiratory syndrome coronavirus 2.

scholarly journals Clinical characteristics of patients with subacute thyroidits and factors affecting development hypothyroidism after subacute thyroiditis

2022 ◽  
Author(s):  
İNAN ANAFOROĞLU ◽  
Murat Topbas
Keyword(s):  
Neck Pain ◽  
Medical Records ◽  
Clinical Characteristics ◽  
Subacute Thyroiditis ◽  
Upper Respiratory Tract ◽  
Inclusion Criteria ◽  
Imaging Studies ◽  
Factors Affecting ◽  
Upper Respiratory

IntroductionSubacute thyroiditis (SAT) is typically a self-limiting, inflammatory disease. Patients can experience hypothyroidism during or after an episode. We examined the clinical characteristics based on laboratory and imaging studies in patients with SAT and possible factors contributing to the development of permanent hypothyroidism after SAT.Material and methodsWe retrospectively examined medical records of patients diagnosed with SAT at one medical facility in Turkey. Patients known to have previous thyroid disease, those with <6 months of follow-up after resolution of SAT, and those who lacked sufficient data for analysis were excluded. Of the 283 patients identified 119 met all inclusion criteria. We extracted data on demographics, laboratory tests, neck pain and other symptoms, ultrasonography findings, medication use, and SAT recurrence. We examined the relationships between these variables and development of permanent hypothyroidism.ResultsThe patients were 42 years old on average, and 78% were women. Most patients (70%) described flu-like symptoms before neck pain started; accordingly, 57% had initially visited a specialty other than endocrinology before SAT was diagnosed, and 28% had received antibiotics for misdiagnosed upper respiratory tract infection. In all, 10 patients (8.4%) developed permanent hypothyroidism after SAT. These patients had received steroids significantly longer than did those without permanent hypothyroidism (mean 17.7 vs. 8.9 weeks; P = .021). Development of hypothyroidism was significantly lower among patients with thyrotoxicosis.ConclusionsThe diagnosis of SAT can be challenging. Patients who require longer-term steroids after SAT and who have recurrent SAT should be closely monitored for development of hypothyroidism.

scholarly journals Evaluation of the Adequacy of Levothyroxine Replacement Therapy in Patients with Central Hypothyroidism1

1999 ◽  
Vol 84 (3) ◽  
pp. 924-929 ◽  
Author(s):  
Elisabetta Ferretti ◽  
Luca Persani ◽  
Marie-Lise Jaffrain-Rea ◽  
Salvatore Giambona ◽  
Guido Tamburrano ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Replacement Therapy ◽  
Interleukin 2 ◽  
Hormone Action ◽  
Normal Range ◽  
Free T4 ◽  
Central Hypothyroidism ◽  
Thyroid Hormone Action ◽  
Daily Dose

As there are few data on the evaluation of the adequacy of levothyroxine (l-T4) therapy in patients with central hypothyroidism (CH), a prospective study was performed to assess the accuracy of various parameters in the follow-up of 37 CH patients. Total and free thyroid hormones, TSH, and a series of clinical and biochemical indexes of peripheral thyroid hormone action have been evaluated off and on l-T4 therapy. Samples were taken before the daily administration of l-T4. In all patients off therapy, clinical hypothyroidism and low levels of free T4 (FT4) were observed, whereas values of FT3, total T4, and total T3 were below the normal range in 73%, 57%, and 19% of cases, respectively. Most of the indexes of thyroid hormone action were significantly modified after l-T4 withdrawal and exhibited significant correlation with free thyroid hormone levels. During l-T4 replacement therapy, 32 patients had circulating levels of FT4 and FT3 and indexes within the normal range with a mean l-T4 daily dose of 1.5 ± 0.3 μg/kg BW. Despite normal serum FT4, 3 patients had borderline high values of FT3 and a clear elevation of serum-soluble interleukin-2 receptor concentrations, suggesting overtreatment. Low or borderline low FT4/FT3 levels indicated undertreatment in 2 patients. The clinical parameters lack the required specificity for the diagnosis or follow-up of CH patients. The l-T4 daily dose should be established, taking into account the weight, the age, and the presence of other hormone deficiencies or pharmacological treatment of CH patients. In conclusion, our results indicate that the diagnosis of CH is reached at best by measuring TSH and FT4 concentrations. In the evaluation of the adequacy of l-T4 replacement therapy, both FT4 and FT3 serum levels together with some biochemical indexes of thyroid hormone action are all necessary to a more accurate disclosure of over- or undertreated patients.

scholarly journals Peripherally Embolizing Aortic Thrombus: The Work-Up, Management, and Outcome of Primary Aortic Thrombus

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Ramy Mando ◽  
Robert Gemayel ◽  
Ashish Chaddha ◽  
Julian J. Barbat ◽  
Elvis Cami
Keyword(s):  
Filling Defect ◽  
Sudden Onset ◽  
Low Grade ◽  
Unique Case ◽  
Descending Aorta ◽  
Aortic Thrombus ◽  
Risk Patients ◽  
History Of ◽  
Work Up

Background. Primary aortic thrombus is an uncommon entity and not frequently reported in the literature. Herein, we discuss the presentation and management of a patient with a primary thoracic mural thrombus. Case Summary. A 46-year-old female with past medical history of tobacco dependence presented for low-grade fever and sudden onset, severe right upper quadrant abdominal pain with associated nausea and vomiting. Computed tomography (CT) revealed an intraluminal polypoid filling defect arising from the isthmus of the aorta projecting into the proximal descending aorta and findings consistent with infarction of the spleen and right kidney. Infectious, autoimmune, hematologic, and oncologic work-up were all unyielding. The patient was started on heparin and later transitioned to apixaban 5 mg twice a day and 81 mg of aspirin daily. She was also counseled regarding smoking cessation. Two months follow-up CT revealed resolution of the thrombus. Patient had no further thromboembolic complications. Discussion. We present a unique case of primary aortic thrombus. To our knowledge, this is the first reported case managed successfully with a NOAC. This diagnosis is one of exclusion and through work-up should be completed. Our aim is to raise awareness of this condition and successful management with apixaban in low-risk patients.

scholarly journals SUBACUTE THYROIDITIS IN A PATIENT WITH CORONAVIRUS DISEASE 2019

2020 ◽  
Vol 6 (6) ◽  
pp. e361-e364
Author(s):  
Mari Des J. San Juan ◽  
Mary Queen V. Florencio ◽  
Mark Henry Joven
Keyword(s):  
Neck Pain ◽  
Thyroid Function ◽  
Reference Range ◽  
Thyroid Stimulating Hormone ◽  
Subacute Thyroiditis ◽  
Thyroid Function Tests ◽  
Anterior Neck ◽  
Neck Ultrasound ◽  
Function Tests ◽  
Stimulating Hormone

Objective: Subacute thyroiditis (SAT) is an inflammatory disorder of the thyroid gland that causes destructive thyrotoxicosis and is attributed to a viral or post-viral response. SARS-CoV-2 is a novel coronavirus that caused a global pandemic in 2020. We present a case that suggests that there may be a relationship between SAT and corona-virus disease 2019 (COVID-19). Methods: We describe the clinical findings, thyroid function tests, and neck ultrasound of a patient presenting with anterior neck pain. Results: A 47-year-old, Filipino female presented with anterior neck pain associated with neck tenderness and goiter. She did not have fever or respiratory symptoms but had right lower lobe pneumonia on chest radiograph. Thyroid function tests were consistent with subclinical hyperthyroidism with thyroid-stimulating hormone of 0.05 μIU/mL (reference range is 0.47 to 4.68 μIU/mL), free thyroxine of 1.68 pg/mL (reference range is 0.78 to 2.19 pg/mL), and total triiodothyronine of 1.4 ng/mL (reference range is 0.97 to 1.69 ng/mL). Anti-thyroid peroxidase, anti-thyroglobulin, and thyroid-stimulating hormone receptor antibodies were negative. Neck ultrasound showed heterogenous thyroid tissues with normal vascularity. Reverse transcription-polymerase chain reaction for SARS-CoV-2 using nasopharyngeal and oropharyngeal swabs were positive. The patient was diagnosed as having SAT and was treated with mefenamic acid, which was later switched to celecoxib. Ceftriaxone and hydroxychloroquine were started for COVID-19 pneumonia. Complete resolution of symptoms and primary hypothyroidism occurred after 2 months. Conclusion: SAT may be a presenting symptom or a sequela of COVID-19. Histopathology studies and definitive documentation of the virus in thyroid tissues may be required to confirm the relationship between SAT and COVID-19.

scholarly journals Biopsy Confirmed Subacute Thyroiditis Associated With COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A922-A922
Author(s):  
Francisco Javier López Maldonado ◽  
Rene Arturo Cota Arreola
Keyword(s):  
Neck Pain ◽  
Plasma Cells ◽  
Color Doppler ◽  
Previous History ◽  
Granulomatous Inflammation ◽  
Subacute Thyroiditis ◽  
Anterior Neck ◽  
Increased Risk ◽  
Right Lobe ◽  
The Right

Abstract Subacute thyroiditis is a transient inflammatory disease of the thyroid associated with anterior neck pain, and systemic symptoms. The diagnosis is generally reserved for a specific type of thyroiditis characterized by granulomatous inflammation and the presence of giant cells. We hereby present a case of a woman with a COVID-19 diagnosis, and a compatible biopsy result for subacute thyroiditis. On 06/03/2020, a 28 year old woman with previous history of ankylosing spondylitis managed with certolizumab pegmol, presented with fatigue, headache, odynophagia, and fever (38.1°C). 2 days later an oropharyngeal swab (PCR) for SARS-CoV-2 turned out positive. On the 4th day the fever spiked to 39°C with added malaise. Acetaminophen 1 gr PO TID was prescribed. The patient denied dyspnea, and thorax CT-Scan was normal. Complete remission was achieved in 3 weeks. On 08/01/20 she returned to work after a negative swab test. On 08/04/20, she presented with fever (38.7°C), malaise, distal tremors, anorexia, tachycardia, myalgias, arthralgias, and fatigue. 2 days later anterior neck pain that radiated to the jaw, and diffuse goiter was noticed. A thyroid function panel reported Total T4: 24 µg/dL (4.5-12.5), fT4 5.2 ng/dl (0.8-1.8), TSH: 0.001 mUI/L (0.37-4.7), thyroglobulin 135 ng/ml (3-42). TPO-Ab &lt;35 IU/mL and TgAb &lt;20 IU/mL. A neck US showed increased volume in the right lobe with multiple hypoechoic regions on both lobes, and diminished vascularization at color Doppler. I-131 scan showed no uptake. A biopsy of the right lobe reported fibrosis with inflammatory infiltrate composed of lymphocytes, plasma cells, histiocytes, and scarce neutrophils. Some cells with epithelioid appearance and a multinucleated giant cell were also found. Residual thyroid follicles showed colloid depletion and degenerative changes to the epithelium, which was consistent with a diagnosis of subacute thyroiditis. Treatment was initiated with prednisone 10 mg PO QD, propranolol 20 mg PO BID for 2 weeks, and acetaminophen 1 gr PO TID PRN. Fever and pain were intermittent for 6 weeks, but the rest of the symptoms subsided within 2 weeks. On 11/15/20, the patient attended a check-up with lab results that were consistent with hypothyroidism, negative IgM, and positive IgG SARS-CoV-2. Replacement therapy with levothyroxine 88 mcg per day was initiated. This case, which confirms the diagnosis of subacute thyroiditis via biopsy, among the others reported worldwide suggests that there’s an increased risk for women for subacute thyroiditis associated with COVID-19. Further research is needed to confirm risk factors for the development of the disease.

scholarly journals SAT-464 A Case of Impending Thyroid Storm in a Patient with Subacute Thyroiditis Following an Influenza Vaccine

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Simona Stefan ◽  
Whitlatch B Hillary
Keyword(s):  
Family History ◽  
Influenza Vaccine ◽  
Beta Blockers ◽  
Subacute Thyroiditis ◽  
Laboratory Evaluation ◽  
Thyroid Storm ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Anterior Neck ◽  
Pain Symptoms

Abstract Introduction: Thyroid storm is a rare, potentially fatal condition, affecting 1% of individuals with thyrotoxicosis. Although it can theoretically be seen in any cause of thyrotoxicosis, the most likely underlying etiology is Graves’ disease. The rarity of thyroid storm due to thyroiditis makes the diagnosis challenging as the clinical and biochemical features overlap Grave’s disease. Here we describe a rare case of severe thyrotoxicosis in a woman due to subacute thyroiditis that developed after receiving an influenza vaccine. Case report: A 30 year-old Caucasian female with no known past medical history presented to the ED with worsening sore throat, odynophagia and anterior neck pain. Symptoms began 4 weeks ago prior to presentation, 1 day after receiving an influenza vaccine. Other symptoms included loss of appetite, chills, fever, fatigue, malaise, abdominal pain, diarrhea, palpitations, heat intolerance and 5lbs weight loss. She was treated by her primary care provider for suspected pharyngitis with a course of corticosteroids and antibiotics. Two weeks later, given worsening symptoms, was referred to the emergency room. On exam, she appeared anxious and was tachycardic (124 beats per minute) and tachypneic (28 breaths per minute). She had no lid lag, stare, thyromegaly or thyroid bruit. However, there was significant tenderness on palpation of the anterior neck. Laboratory evaluation was notable for TSH &lt;0.01 uIU/mL (0.39 - 4.0.8), free T4 5.19 ng/dL (0.58 - 1.64), free T3 10 pg/ml (2.53-3.87), ESR 95 mm/hr (0-20) and CRP 9.339 mg/dl (0.0-0.9) consistent with thyrotoxicosis. Given Burh-Wartofsky score of 45, there was a concern for impending thyroid storm. She received hydrocortisone, methimazole and beta blockers and was admitted to the intensive care unit. She responded dramatically to treatment and was discharged within 24 hours on prednisone and metoprolol. The 24-hour radioactive iodine uptake (RAIU) was 2.7% 2 weeks post admission, consistent with a diagnosis of subacute thyroiditis. TSI was negative. Family history was negative for autoimmune disease. She continued on beta blockers with a steroid taper for 8 weeks. Thyroid function tests and inflammatory markers normalized within 3 months. Conclusion: Aside from the described patient, only three other cases of thyrotoxic crisis due to subacute thyroiditis have been reported in the literature. This case underscores the importance of thoroughly investigating the etiology of severe thyrotoxcosis, given the management and prognosis varies depending on underlying cause. Thyroiditis should be considering in the differential diagnosis of thyroid storm in patients who do not have a personal or family history of autoimmunity and present with neck tenderness in the setting of a precipitating event. Subacute thyroiditis is very uncommon after influenza vaccine, there have been 4 reported cases.

Hashimotothyreoïditis bij kinderen en adolescenten: klinische, hormonale en echografische kenmerken bij de diagnosestelling

2021 ◽  
Author(s):  
G. MASSA ◽  
B. HOESSELS ◽  
H. GWOREK ◽  
R. ZEEVAERT
Keyword(s):  
Thyroid Gland ◽  
Children And Adolescents ◽  
Growth Retardation ◽  
Clinical Manifestations ◽  
Thyroid Peroxidase ◽  
Free T4 ◽  
Thyroglobulin Antibodies ◽  
Work Up

Hashimoto’s thyroiditis in children and adolescents: clinical, hormonal and ultrasound features at diagnosis The clinical, biochemical and sonographic features of 51 children and adolescents (45 girls) being diagnosed with hashimotothyroiditis (HT) were studied. HT was diagnosed based on the presence of thyroid peroxidase and/or thyroglobulin antibodies, together with thyroid ultrasound compatible with thyroiditis or manifest hypothyroidism characterized by decreased free T4 and increased TSH levels. The median age of the patients was 12.8 years (range: 5.9 and 16.5 years). At the time of diagnosis, 18 patients (35.3%) were euthyroid, 16 (31.3%) subclinically hypothyroid, 13 (25.5%) hypothyroid, and 4 (7.8%) hyperthyroid. The reasons for referral were an enlargement of the thyroid gland (39.2%), symptoms suggestive of hypothyroidism (35.3%) or an accidental finding on work-up for an unrelated problem (25.4%). The most common clinical manifestations were a goiter (60.8%), fatigue (60.8%), weight gain (25.0%), constipation (11.8%), hair loss (11.8%) and growth retardation (5,9%). A goiter was most common in the euthyroid children. Growth retardation was only observed in three hypothyroid children. On ultrasound an enlarged thyroid gland was diagnosed in 80.0% of the patients. Associated coeliac disease was diagnosed in four patients; one patient developed type 1 diabetes mellitus during the follow-up period and one patient developed Hashimoto’s encephalopathy.

scholarly journals SAT-158 New Data on High Prevalence and Time of Occurrence of New Onset Hypothyroidism Associated with Mitotane Therapy in a Cohort of Adrenocortical Cancer

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jonathan Poirier ◽  
André Lacroix ◽  
Harold J Olney ◽  
Isabelle Bourdeau
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Function ◽  
Adrenocortical Cancer ◽  
Free T4 ◽  
Central Hypothyroidism ◽  
Number Of Patients ◽  
Secondary Hypothyroidism ◽  
Second Year ◽  
New Onset

Abstract Context. Mitotane is a steroidogenesis inhibitor and an adrenocorticolytic drug used to treat adrenocortical cancer (ACC). Central hypothyroidism is recognized in mitotane-treated patients and recent data suggested that mitotane could have an inhibitory effect on TSH-secreting cells in the pituitary gland. Moreover, mitotane may lead to induction of thyroid hormone metabolism. Clinical data on hypothyroidism related to mitotane such as prevalence and time of occurrence was described in a limited number of patients. Objective. To better characterize clinically secondary hypothyroidism in patients with ACC treated with mitotane therapy. Methods. We reviewed retrospectively paper charts and electronic records from patients with histologically confirmed diagnosis of ACC evaluated at our center from 1995-2019. We analysed the pattern of TSH and thyroid function, but also mitotane timing and levels at baseline and during treatment of patients under mitotane therapy. Thyroid hormone assessment including TSH, FT4 and FT3 was performed at least every 3 months during follow-up. Results. Our cohort of 104 patients with ACC includes 84 patients that received mitotane therapy. Among them, thyroid function data was incomplete for 39 cases. Complete data was retrieved from 45 patients. Ten out of 45 (22.2%) patients were already known for primary hypothyroidism and were receiving L-T4 replacement before the initiation of mitotane. Two of 45 (4.4%) patients maintained a normal thyroid function during complete follow up (4.5 years) and 33/45 (73.3%) had new onset hypothyroidism requiring levothyroxine treatment. Of these 33 patients, 22 were females and 11 were males, ranging from 22-74 yo with a median of 46 yo. The number of patients with ENSAT stage I, II, III and IV of disease were 1, 8, 11 and 13 respectively. Thyroid profiles were compatible with central hypothyroidism (low T4 with low or inappropriately normal TSH) in 22/33 patients (66.7%). Interestingly, 6/33 patients (18.2%) developed a TSH elevation with a normal lower-limit or low T4 level. The timeline distribution of the occurrence of hypothyroidism was 21.2% (n:7) at &lt;3 months, 15.2% (n:5) between 3-6 months, 21.2% (n:7) between 6-9 months and 15.2% (n:5) between 9-12 months. 9.1% (n:3) occurred within the second year of treatment (between 12-24 months). However, in 5/33 (15.2%) cases, the exact time of new hypothyroidism onset was undetermined. Conclusion. Mitotane therapy is frequently associated with new onset hypothyroidism with a prevalence of 73% in our cohort of exposed patients and is most likely of central etiology. 72.7% of cases occur in the first year of treatment while 9.1% occur in the second year. This study supports the importance of monitoring thyroid function (including a free T4 level) during the complete course of mitotane therapy.

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