Recurrent Galactorrhoea: A consequence of unheeded primary hypothyroidism

2021 ◽  
Vol 4 (1) ◽  
pp. 54-59
Author(s):  
Olutomiwa Omokore ◽  
Nwachukwu Nwachukwu ◽  
Oreoluwa Fuwape ◽  
Adetomilayo Arijeniwa ◽  
Abiola Adekoya ◽  
...  
Keyword(s):  
Hormone Replacement ◽  
Elevated Serum ◽  
Signs And Symptoms ◽  
Symptomatic Improvement ◽  
Thyroid Stimulating Hormone ◽  
Pharmacological Therapy ◽  
Primary Hypothyroidism ◽  
Serum Prolactin ◽  
Low Mood ◽  
Hormonal Assay

Background: Primary hypothyroidism can lead to hyperprolactinemia through several mechanisms in both men and women, manifesting as galactorrhoea, loss of libido, and infertility in both sexes, as oligomenorrhea/amenorrhea in women, and as gynecomastia and erectile dysfunction in men. Case presentation: Here presented is a 28-year-old Nigerian woman with a history of recurrent bilateral painless galactorrhoea of 12 years’ duration and persistent low mood. Physical examination was unremarkable. The hormonal assay revealed elevated thyroid-stimulating hormone, elevated serum prolactin, low thyroxine, and low triiodothyronine levels. Magnetic resonance imaging of the brain revealed normal findings. A diagnosis of hyperprolactinemia secondary to primary hypothyroidism was made. Pharmacological therapy began with thyroid hormone replacement therapy and a dopamine agonist: 75 micrograms of levothyroxine daily and 0.5 micrograms of cabergoline twice weekly for 8 weeks. After 8 weeks of pharmacological therapy, hormonal assay revealed values within the reference range with significant symptomatic improvement evidenced by cessation of galactorrhoea and low mood. Conclusion: Primary hypothyroidism has been proven to be one of the numerous causes of hyperprolactinemia and it could be unheeded in a patient who does not present with the typical signs and symptoms of primary hypothyroidism.

SERUM PROLACTIN IN PATIENTS WITH "FUNCTIONLESS" CHROMOPHOBE ADENOMAS BEFORE AND AFTER THERAPY

1977 ◽  
Vol 84 (3) ◽  
pp. 449-460 ◽  
Author(s):  
N. A. Samaan ◽  
M. E. Leavens ◽  
J. H. Jesse
Keyword(s):  
Hormone Replacement ◽  
Pituitary Surgery ◽  
Pituitary Tumour ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
High Serum ◽  
Primary Hypothyroidism ◽  
Pituitary Function ◽  
Serum Prolactin ◽  
Before And After

ABSTRACT The immunoreactive serum human prolactin (PRL) level was measured before and after intravenous administration of 500 μg of thyrotrophinreleasing hormone (TRH) in 11 patients with "functionless" chromophobe adenomas before and after surgery and after radiotherapy in 6 of these patients. The results were compared to other pituitary function tests. Two of the patients studied had recurrent disease after previous pituitary surgery and radiotherapy. Five patients had pituitary surgery through the transfrontal route, while 6 had adenoma removal via the transnasal transsphenoidal route. Before surgery, the serum PRL concentration was abnormally high in 4 patients, before and after TRH administration. It was normal in 6 and subnormal in 1 patient who had had previous therapy. Two of the patients studied showed high serum thyroid-stimulating hormone (TSH) levels in the presence of low serum T3 and T4 suggesting primary hypothyroidism with a secondary TSH-producing pituitary tumour. After surgery all patients showed a significant decrease of the serum PRL level. This contrasts with more variable results in the measurements of other pituitary hormones. Post-operative radiotherapy produced no significant additional change in serum PRL levels in 5 of the 6 patients measured 6 months to 4 years after radiotherapy. Five of the 6 patients who had adenoma removed via the transsphenoidal route required no cortisol replacement and 4 remained euthyroid, whereas all 5 patients after transfrontal surgery required both cortisol and thyroid hormone replacement. These results indicate: (1) that measurement of serum PRL levels at basal and after TRH administration in patients with "functionless" chromophobe adenomas before and after treatment may be the best index for evaluating the effect of therapy; (2) that adenoma removal may be followed by preservation of normal pituitary function, but this is more likely to occur if the transsphenoidal approach is used; and (3) that primary thyroid insufficiency may be associated with a pituitary adenoma.

Van Wyk-Grumbach syndrome with hemangioma in an infant

2018 ◽  
Vol 31 (9) ◽  
pp. 1057-1060
Author(s):  
Moumita Biswas ◽  
Malay Kumar Sinha ◽  
Mrinal Kanti Das ◽  
Sumantra Sarkar
Keyword(s):  
Thyroid Hormone ◽  
Congenital Hypothyroidism ◽  
Hormone Replacement ◽  
Signs And Symptoms ◽  
Bone Age ◽  
Infantile Hemangioma ◽  
Thyroid Stimulating Hormone ◽  
High Serum ◽  
Primary Hypothyroidism ◽  
Thyroid Hormone Replacement

Abstract Background Van Wyk-Grumbach syndrome (VWGS) is characterized by juvenile primary hypothyroidism, delayed bone age and isosexual incomplete precocious puberty with reversal to the prepubertal state following thyroid hormone replacement. Case presentation In this case, an 18-month-old girl presented with premature menarche since 9 months of age, delayed bone age and enlarged bilateral multicystic ovaries along with a superficial infantile hemangioma over the upper anterior chest. VWGS was diagnosed based on the clinical features. High serum thyroid stimulating hormone and low free thyroxine with the absence of any carpal bones in the wrist X-ray were suggestive of congenital hypothyroidism. Interestingly, the coexisting hemangioma could also play a role in the etiology of the hypothyroidism through “consumptive hypothyroidism”. Thyroid hormone replacement resulted in the complete resolution of signs and symptoms. Conclusions Untreated congenital hypothyroidism of short duration, onset of symptoms in infancy and association of an infantile hemangioma in VWGS were the unique features in our case.

Hypothyroidism following Treatment for Head and Neck Cancer

1981 ◽  
Vol 90 (5) ◽  
pp. 449-453 ◽  
Author(s):  
Donald P. Vrabec ◽  
Timothy J. Heffron
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Thyroid Function ◽  
Elevated Serum ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Overt Hypothyroidism ◽  
Patient Will ◽  
Effects Of Radiation ◽  
Tsh Levels

One hundred ninety-six head and neck patients were studied to determine the effects of radiation therapy and surgery on thyroid function. Serum thyroid-stimulating hormone (TSH) levels were obtained as a screening test for primary hypothyroidism. Elevated TSH levels were found in 57 of the 196 patients (29.1%). The highest incidence of abnormal TSH values (66%) occurred in the group treated with combination radiation therapy and surgery, including partial thyroidectomy. TSH levels rose early in the posttreatment period with 60% of the abnormal values occurring within the first three posttreatment years. Posttreatment thyroid dysfunction was twice as common in women (48.6%) as in men (25.4%). When serum thyroxine levels by radioimmunoassay (T4RIA) were correlated with the elevated serum TSH levels, a similar pattern was seen with 65% of the patients in Group 3 having a decreased T4RIA level indicating overt hypothyroidism. Pretreatment levels of thyroid function including thyroid antibody studies should be established for all patients. Serial TSH levels should be done every three months during the first three posttreatment years and semiannually thereafter as long as the patient will return for follow-up care. All patients treated with combination radiation therapy and surgery who develop elevated TSH levels should be treated with thyroid replacement therapy. Patients receiving radiation therapy alone should receive replacement thyroid therapy if they develop a depressed T4RIA value or a pattern of gradually increasing TSH levels.

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.

Autoimmune Hypothyroidism Coexisting with a Pituitary Adenoma Secreting Thyroid-Stimulating Hormone, Prolactin and α-Subunit

2001 ◽  
Vol 38 (5) ◽  
pp. 566-571 ◽  
Author(s):  
Jyothi M Idiculla ◽  
Geoff Beckett ◽  
Patrick F X Statham ◽  
James W Ironside ◽  
Stephen L Atkin ◽  
...  
Keyword(s):  
Anterior Pituitary ◽  
Elevated Serum ◽  
Pituitary Tumour ◽  
Thyroid Stimulating Hormone ◽  
Serum Prolactin ◽  
Residual Tumour ◽  
Mri Scan ◽  
Α Subunit ◽  
Autoimmune Hypothyroidism ◽  
Stimulating Hormone

A 44-year-old woman presented to her GP with excessive tiredness. She had positive thyroid microsomal and thyroglobulin autoantibodies and was found to have an elevated serum thyroid-stimulating hormone (TSH) concentration of 8.37 (normal = 0·15–3·5) mU/L and a low normal total thyroxine (T4) of 86 (reference range 60–145) nmol/L. She was rendered symptom free on a dose of 150μg of thyroxine per day. However, her TSH failed to return to normal, and following a further increase in her thyroxine dose she was referred to the endocrine clinic for further assessment. Her TSH at this stage was 14mU/L, free T4 (fT4) 28 (normal = 10–27) pmol/L and free T3 (fT3) 10 (normal = 4·3–7·6) pmol/L. She denied any problems with adherence to her medication. Her serum prolactin was elevated at 861 (normal = 60–390) mU/L. A pituitary tumour was suspected and an MRI scan showed a macroadenoma of the right lobe of the pituitary, extending into the suprasellar cistern. The tumour was resected trans-sphenoidally. Electron microscopy showed a dual population of neoplastic cells compatible with a thyrotroph cell and prolactin-secreting adenoma. Immunocytochemistry and cell culture studies confirmed the secretion of TSH, prolactin and α-subunit. Postoperative combined anterior pituitary function tests did not demonstrate any deficiency of anterior pituitary hormones. A repeat MRI scan showed no significant residual tumour; however, her serum TSH and prolactin levels remained high and she was given a course of pituitary irradiation. This case illustrates the difficulty of diagnosing a TSHoma when it coexists with autoimmune hypothyroidism. We believe the combination of pathologies reported here is unique.

scholarly journals Severe Prolonged Hypothyroidism

2015 ◽  
Vol 2 ◽  
pp. 2333794X1557467
Author(s):  
Yonatan Yeshayahu ◽  
Shirly Frizinsky ◽  
Raz Somech ◽  
Gal Dubnov-Raz
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Magnetic Resonance Imaging ◽  
Signs And Symptoms ◽  
Psychomotor Retardation ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Resonance Imaging ◽  
Pituitary Mass ◽  
Visual Field Examination

Background. Hashimoto’s thyroiditis usually presents with nonspecific systemic symptoms. The purpose of our study was to characterize the various properties of severe ongoing hypothyroidism and the rate of normalization following treatment. Methods. An adolescent girl with severe primary hypothyroidism was studied. Clinical evaluation, laboratory testing, brain magnetic resonance imaging, resting metabolic rate (RMR) testing, electroencephalogram, and visual field examination were performed at baseline and following treatment with levothyroxine. Results. At baseline, a significant psychomotor retardation was observed, serum thyroid-stimulating hormone concentration was 1088.4 mIU/mL. Magnetic resonance imaging showed a large intrasellar mass. Electroencephalogram was abnormal, and RMR was significantly reduced. Restoration of neurocognitive function and normalization of RMR, electroencephalogram, and laboratory tests occurred rapidly, alongside vanishing of the pituitary mass within 4 weeks of treatment. Conclusions. The various signs and symptoms of severe prolonged hypothyroidism may resolve rapidly with treatment, including the disappearance of a large pituitary mass.

scholarly journals Cardiac tamponade due to primary hypothyroidism: acute management and approach to prevent recurrence—a case report

2020 ◽  
Vol 4 (3) ◽  
pp. 1-5
Author(s):  
Vikas Reddy Maddali ◽  
Srikar Miryala ◽  
Yagna Sreekanth Bellamkonda ◽  
Praveen Nagula
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Venous Pressure ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Thyroid Stimulating Hormone ◽  
Cellular Level ◽  
Primary Hypothyroidism ◽  
The Body ◽  
Dysmorphic Features

Abstract Background Hypothyroidism is a common endocrine disorder resulting from deficiency of thyroid hormone, with iodine deficiency remains the foremost cause. It is more common in women with increasing incidence in the elderly. The manifestations of hypothyroidism results from the hypometabolism in the body at cellular level and affects all organs. Although there can be an incidental diagnosis of the disorder, the presentation with cardiac signs and symptoms is rare. We report a case of primary hypothyroidism with dysmorphic features manifesting as massive pericardial effusion with cardiac tamponade at presentation. Case summary A female aged 20 years presented with lethargy, constipation, and dyspnoea of 6 months duration. On examination, she was short-statured and had dysmorphic features with hypotension, raised jugular venous pressure (JVP), muffled heart sounds, and thyroid stimulating hormone >100 uIU/mL. Chest X-ray showed cardiomegaly and 2DEcho confirmed cardiac tamponade for which emergency pericardiocentesis was done. Discussion Cardiovascular manifestations in hypothyroidism are dyspnoea and decreased exercise tolerance. Bradycardia, diastolic hypertension, cardiomegaly, and non-pitting or pitting peripheral oedema may be seen on physical examination. Mild pericardial effusion is common and generally asymptomatic. Massive pericardial effusion being manifested at presentation primarily as a sign of hypothyroidism is rare. A few cases have been mentioned in the literature in India and western population. Rarely, hypothyroidism presents with massive pericardial effusion resulting in cardiac tamponade as in our case.

scholarly journals DUOX2 variants are a frequent cause of congenital primary hypothyroidism in Thai patients

2020 ◽  
Vol 9 (11) ◽  
pp. 1121-1134
Author(s):  
Kinnaree Sorapipatcharoen ◽  
Thipwimol Tim-Aroon ◽  
Pat Mahachoklertwattana ◽  
Wasun Chantratita ◽  
Nareenart Iemwimangsa ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Gene List ◽  
Signs And Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Potential Candidate ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Thyroid Dyshormonogenesis ◽  
Design And Methods

Objective To identify the genetic etiologies of congenital primary hypothyroidism (CH) in Thai patients. Design and methods CH patients were enrolled. Clinical characteristics including age, signs and symptoms of CH, pedigree, family history, screened thyroid-stimulating hormone results, thyroid function tests, thyroid imaging, clinical course and treatment of CH were collected. Clinical exome sequencing by next-generation sequencing was performed. In-house gene list which covered 62 potential candidate genes related to CH and thyroid disorders was developed for targeted sequencing. Sanger sequencing was performed to validate the candidate variants. Thyroid function tests were determined in the heterozygous parents who carried the same DUOX2 or DUOXA2 variants as their offsprings. Results There were 118 patients (63 males) included. Mean (SD) age at enrollment was 12.4 (7.9) years. Forty-five of 118 patients (38%) had disease-causing variants. Of 45 variants, 7 genes were involved (DUOX2, DUOXA2, TG, TPO, SLC5A5, PAX8 and TSHR). DUOX2, a gene causing thyroid dyshormonogenesis, was the most common defective gene (25/45, 56%). The most common DUOX2 variant found in this study was c.1588A>T. TG and TPO variants were less common. Fourteen novel variants were found. Thyroid function tests of most parents with heterozygous state of DUOX2 and DUOXA2 variants were normal. Conclusions DUOX2 variants were most common among Thai CH patients, while TG and TPO variants were less common. The c.1588A>T in DUOX2 gene was highly frequent in this population.

scholarly journals Levothyroxine pseudo-malabsorption: testing and treatment in the outpatient setting

2018 ◽  
Vol 9 (7) ◽  
pp. 217-222 ◽  
Author(s):  
Grzegorz M. Rdzak ◽  
Laura M. Whitman ◽  
Silvio E. Inzucchi
Keyword(s):  
Hormone Replacement ◽  
Clinical Problem ◽  
Outpatient Setting ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Inadequate Response ◽  
Individual Support ◽  
Common Clinical Problem ◽  
Persistent Elevation ◽  
Rule Out

Persistent elevation of thyroid stimulating hormone (TSH) is a common clinical problem in outpatient clinics treating patients with primary hypothyroidism. One challenge to practitioners involves predicaments where patients have an inadequate response to a seemingly appropriate dose of levothyroxine (L-T4). A patient’s self-assessed compliance to hormone replacement therapy or verification refill history at the patient’s pharmacy might not be a reliable form of confirmation of non-adherence to the drug by the patient, which has been referred to as “L-T4 pseudo-malabsorption.” A fast and inexpensive tool to rule out true LT4 malabsorption and thereby properly diagnosing and ultimately successfully treat LT4 pseudo-malabsorption is available in the outpatient setting. This allows clinicians to identify which patients for individual support in adhering to their prescribed therapy and may also reduce unnecessary referrals for sub-specialty care by endocrinologists.

scholarly journals Isolated Adrenocorticotropic Hormone Deficiency Accompanied by Impaired Cognitive Function: A Case Report

2021 ◽  
Author(s):  
ATSUKO IKENOUCHI ◽  
Issei Seki ◽  
Naomichi Okamoto ◽  
Yuki Konishi ◽  
Reiji Yoshimura
Keyword(s):  
Cognitive Functions ◽  
Adrenocorticotropic Hormone ◽  
Psychiatric Symptoms ◽  
Hormone Replacement ◽  
Adjustment Disorder ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Hormone Deficiency ◽  
Physical Treatment

Abstract Background: Isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) is an adrenal insufficiency caused by a decrease in ACTH alone among the anterior pituitary hormones. IAD is often overlooked because it causes nonspecific symptoms. We report a case of IAD diagnosed after the appearance of mild cognitive impairment (MCI).Case presentation: Our department was consulted on a case of a 46-year-old man for whom dementia was suspected because he was speaking incoherently, wiped his nose with his hands and showed mild brain atrophy on MRI. He was previously diagnosed with some psychiatric diseases, such as narcolepsy and adjustment disorder. He could not continue working due to somnolence, general fatigue and appetite loss. At the examination, he had difficulty concentrating and sustaining attention, exhibited restlessness, and scored 25 points on the Mini Mental State Examination-Japanese (MMSE-J); MCI was observed. Blood tests showed decreased ACTH, cortisol and free thyroxine and increased thyroid-stimulating hormone levels. He received further evaluation, and he was diagnosed with IAD and primary hypothyroidism. Hydrocortisone (15 mg) was started, after which his physical problems and his difficulty concentrating disappeared. His MMSE-J score also increased to 30. His cognitive functions completely recovered. He returned to work and continued to work stably.Conclusion: This patient was diagnosed with IAD and treated with adrenocortical hormone replacement therapy. His cognitive functions recovered, his physical and mental disorders were alleviated, and he returned to society. It is important not to miss neurological and psychiatric symptoms that can be cured by physical treatment.

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