SUN-549 Erratic Medication-Related Malabsorption of L-T4 Associated with Highly Elevated TSH Levels in a Patient with Renal Tubular Acidosis, Thyrotroph Hyperplasia, and Hashimoto's Thyroiditis

Background: Hypokalemic periodic paralysis (HypoKPP) is characterized by transient episodes of flaccid muscle weakness. We describe the case of a teenaged boy with HypoKPP and hyperthyroidism due to Hashimoto's thyroiditis with initial manifestation of renal tubular acidosis. This combination is rare and little described previously in men. Case presentation: A 17-year-old boy was admitted after three days of muscular weakness and paresthesia in the lower limbs with an ascending evolution, leading to prostration. Decreased strength was found in the lower limbs without a defined sensory level, reduced patellar and ankle reflexes. Positive antithyroid antibodies were found. He received hydration treatment, IV potassium and levothyroxine, with which there was a clinical improvement. Other examinations led to the diagnosis of type 1 renal tubular acidosis. Conclusion: HypoKPP is a rare disorder characterized by acute episodes of muscle weakness. Type 1 renal tubular acidosis can occur as a consequence of thyroiditis, which is explained by the loss of potassium. This combination is unusually rare, and has not been described before in men. The etiopathogenesis of the disease as well as a dynamic explanation of what happened with the patient are discussed in this report.

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Unusual Presentation of Polyautoimmunity and Renal Tubular Acidosis in an Adolescent With Hashimoto's Thyroiditis and Central Pontine Myelinolysis

Frontiers in Endocrinology ◽

10.3389/fendo.2020.548877 ◽

2020 ◽

Vol 11 ◽

Author(s):

Nora Bruns ◽

Ilja Finkelberg ◽

Ibrahim Al-Attrach ◽

Peter F. Hoyer ◽

Rainer Büscher

Keyword(s):

Renal Tubular Acidosis ◽

Hashimoto’S Thyroiditis ◽

Central Pontine Myelinolysis ◽

Unusual Presentation ◽

Hashimoto's Thyroiditis ◽

Pontine Myelinolysis ◽

Renal Tubular ◽

Central Pontine

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From Bartter’s syndrome to renal tubular acidosis in a patient with Hashimoto’s thyroiditis: A case report

Clinical Nephrology ◽

10.5414/cn109820 ◽

2020 ◽

Vol 94 (3) ◽

pp. 150-154

Author(s):

Sai Wang ◽

Bingzi Dong ◽

Cui Wang ◽

Jingru Lu ◽

Leping Shao

Keyword(s):

Case Report ◽

Renal Tubular Acidosis ◽

Hashimoto’S Thyroiditis ◽

Hashimoto's Thyroiditis ◽

Bartter’S Syndrome ◽

Bartter's Syndrome ◽

Renal Tubular

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SAT-497 Conversion of Hashimoto’s Thyroiditis to Grave’s Disease: A Case Report

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1447 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Tayba S Wahedi ◽

Najah Younes Douba

Keyword(s):

Thyroid Function ◽

Hashimoto’S Thyroiditis ◽

Hashimoto's Thyroiditis ◽

Thyroid Peroxidase ◽

Autoimmune Thyroid ◽

Grave’S Disease ◽

Thyroid Uptake ◽

Common Causes ◽

Grave's Disease ◽

Tsh Levels

Abstract Introduction: Hashimoto’s thyroiditis and Grave’s disease are common causes for autoimmune thyroid disease. Conversion from Grave’s disease to hypothyroidism have been previously reported in literature. But development of Grave’s disease after a long standing hypothyroidism rarely occurs.Case report: a 22 -year-old Saudi pregnant female patient, was diagnosed with subclinical hypothyroidism with positive anti -thyroid peroxidase antibodies (Anti-TPO) in 2009. She was started on thyroxin and eventually became euthyroid with normal TSH levels till 2016. During subsequent follow-ups, patient was increasingly complaining of palpitations, weight loss and fine tremors. Thyroid function revealed increasingly suppressed TSH levels and over-replacement was suspected. Thyroxin dose was then gradually reduced and finally stopped for few months. Yet her symptoms persisted. Repeated thyroid function showed suppressed TSH level and elevated T4, T3 levels in keeping with overt hyperthyroidism. Thyroid scan further confirmed the diagnosis with diffuse thyroid uptake suggestive of Grave’s disease.Patient was started on medical treatment initially, then successfully treated with radioactive ablation.Conclusion: Although it rarely occurs, possibility of conversion from hypothyroidism to hyperthyroidism should always be kept in mind while treating hypothyroid patients with persistent clinical or biochemical evidence of hyperthyroidism despite dose reduction.References:[1] McLachlan SM. Rapoport B. Thyrotropin-blocking autoantibodies and thyroid-stimulating autoantibodies: Potential mechanisms involved in the pendulum swinging from hypothyroidism to hyperthyroidism or vice versa. Thyroid. 2013;23(1):14-24.[2] Ohye H, Nishihara E, Sasaki I, et al. Four cases of Graves’ disease which developed after painful Hashimoto’s thyroiditis. Intern Med. 2006;45(6):385-9.

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Hashimoto's thyroiditis is associated with papillary thyroid carcinoma: role of TSH and of treatment with l-thyroxine

Endocrine Related Cancer ◽

10.1530/erc-11-0028 ◽

2011 ◽

Vol 18 (4) ◽

pp. 429-437 ◽

Cited By ~ 88

Author(s):

E Fiore ◽

T Rago ◽

F Latrofa ◽

M A Provenzale ◽

P Piaggi ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Hashimoto’S Thyroiditis ◽

High Titer ◽

Nodular Goiter ◽

Hashimoto's Thyroiditis ◽

Papillary Thyroid ◽

Significant Difference ◽

Serum Tsh ◽

Tsh Levels

The possible association between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) is a still debated issue. We analyzed the frequency of PTC, TSH levels and thyroid autoantibodies (TAb) in 13 738 patients (9824 untreated and 3914 under l-thyroxine, l-T4). Patients with nodular-HT (n=1593) had high titer of TAb and/or hypothyroidism. Patients with nodular goiter (NG) were subdivided in TAb−NG (n=8812) with undetectable TAb and TAb+NG (n=3395) with positive TAb. Among untreated patients, those with nodular-HT showed higher frequency of PTC (9.4%) compared with both TAb−NG (6.4%; P=0.002) and TAb+NG (6.5%; P=0.009) and presented also higher serum TSH (median 1.30 vs 0.71 μU/ml, P<0.001 and 0.70 μU/ml, P<0.001 respectively). Independently of clinical diagnosis, patients with high titer of TAb showed a higher frequency of PTC (9.3%) compared to patients with low titer (6.8%, P<0.001) or negative TAb (6.3%, P<0.001) and presented also higher serum TSH (median 1.16 vs 0.75 μU/ml, P<0.001 and 0.72 μU/ml, P<0.001 respectively). PTC frequency was strongly related with serum TSH (odds ratio (OR)=1.111), slightly related with anti-thyroglobulin antibodies (OR=1.001), and unrelated with anti-thyroperoxidase antibodies. In the l-T4-treated group, when only patients with serum TSH levels below the median value (0.90 μU/ml) were considered, no significant difference in PTC frequency was found between nodular-HT, TAb−NG and TAb+NG. In conclusion, the frequency of PTC is significantly higher in nodular-HT than in NG and is associated with increased levels of serum TSH. Treatment with l-T4 reduces TSH levels and decreases the occurrence of clinically detectable PTC.

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The role of thyroid stimulating hormone in the timing of thyroxin supplement after thyroid operations

Muthanna Medical Journal ◽

10.52113/1/2410-4590/2021-44-53 ◽

2021 ◽

Vol 8 (2) ◽

pp. 44-53

Author(s):

Basil A. S. Al-Khayyat ◽

Anmar Jumaa Ghali ◽

Berq J. Hadi Al-Yasseri

Keyword(s):

Hashimoto’S Thyroiditis ◽

Thyroid Nodules ◽

Thyroid Stimulating Hormone ◽

Suppressive Therapy ◽

Hashimoto's Thyroiditis ◽

Histopathological Results ◽

Serum Tsh ◽

Tsh Levels ◽

Stimulating Hormone

Thyroid Stimulating Hormone (TSH) levels can be measured accurately down to a very low serum concentration with an immunoassay. When the serum TSH level is in the normal range, measuring the T3 and T4 levels is redundant. The objective of this study is to study the relation of TSH levels postoperatively in thyroid surgeries with the timing for thyroxin treatment as a supplemental and suppressive therapy. A prospective cohort study was done on 84 patients underwent thyroid operations in Al-Yarmouk Teaching Hospital from March 2010 through November 2012. Patients underwent different thyroid operations (lobectomy, subtotal thyroidectomy and total thyroidectomy) for different thyroid pathology. Later, they were followed up by TSH assay in periods of 2, 4, 6 and 12 months postoperatively. Variables were compared by using the analysis of variance, ANOVA test. P – values equal or less than 0.05 and 0.01 were considered to be statistically significant and highly significant, respectively. The mean age of patients was 43.30 ± 10.19 years. The females made the vast majority of study sample (85.7%). Patients were divided into six groups: simple colloid goiters (17 patients), multinodular goiters (32 patients), solitary thyroid nodules (11 patients), Hashimoto’s thyroiditis (8 patients), Graves’ disease (8 patients) and papillary and follicular carcinomas (8 patients). The study revealed that all patients with malignant thyroid nodules (i.e. those with total thyroidectomies) and the vast majority of patients with Hashimoto’s thyroiditis were in definite need for thyroxin treatment post-operatively. Other patients were variable in their need and timing of treatment according to the histopathological results and the type of operations. In conclusion; measurement of TSH level postoperatively is a good indicator for need of thyroxin treatment and for dose adjustment with the help of pathological results and the type of surgery.

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CASE REPORT - ACUPUNCTURE TREATMENT IN MALE PATIENT WITH HASHIMOTO THYROIDITIS

International Journal of Research -GRANTHAALAYAH ◽

10.29121/granthaalayah.v7.i9.2019.612 ◽

2019 ◽

Vol 7 (9) ◽

pp. 288-291

Author(s):

Blagica Arsovska ◽

Jihe Zhu ◽

Kristina Kozovska

Keyword(s):

Hashimoto’S Thyroiditis ◽

Acupuncture Treatment ◽

Treated Patient ◽

Hashimoto Thyroiditis ◽

High Serum ◽

Hashimoto's Thyroiditis ◽

Thyroid Autoantibodies ◽

Normal Range ◽

Chronic Autoimmune Thyroiditis ◽

Tsh Levels

Hashimoto's thyroiditis is associated with the presence of anti-thyroid autoantibodies (anti-TPO). High serum antibodies are found in the active phases of chronic autoimmune thyroiditis. In many medical cases with Hashimoto’s thyroiditis it is possible to have high levels of anti-TPO antibodies and fT4, fT3 and TSH levels to be within the normal range. Most doctors believe that Hashimoto's thyroiditis is an incurable form of thyroid deficiency. With the TCM treatment the patient’s strength and vitality can be improved, the Qi flow can be harmonized, nourished and strengthened and the body’s system can be repaired and recharged so the patient may go into remission. The treated patient is 44 year old man, diagnosed with Hashimoto’s thyroiditis caused by stress. The patient has done 40 acupuncture treatments within 21 months, once a week. The patient wasn’t taking any additional hormonal medications. The parameters for fT4, fT3 and TSH were showing normal levels and the anti-TPO levels were increased. Before the treatment the anti-TPO antibodies amount was 252.4 IU/ml and after the treatment 4.07 IU/ml (normal <80 IU/ml). Treated points are: BL15 (XinShu), BL20 (PiShu), BL23 (ShenShu), DU4 (MingMen), DU14 (DaZhui), DU20 (BaiHui), ST9 (RenYing), LI4 (HeGu), KI3 (TaiXi), GB20 (FengChi), RN4 (QuanYuan), RN6 (QiHai), LR2 (TaiChong), SP9 (YinLingQuan), SP6 (SanYinJiao), ST36 (ZuSanLi) and Ashi points located on the neck (front and back).

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