Cases reported "Myxedema"

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1/40. Factors associated with mortality of myxedema coma: report of eight cases and literature survey.

    High-dose thyroid hormone replacement has been recommended for treatment of myxedema coma (MC) while questions of safety of the therapy and of efficacy of low-dose thyroid hormone replacement have not been systematically addressed. We treated 8 patients with MC in a period of 18 years, the first 3 with high-dose intravenous injections of levotriiodothyronine (LT3) and the other 5 patients with a smaller amount of either LT3 or levothyroxine (LT4). Two of the first 3 patients died of pneumonia and the other 5 recovered despite pulmonary abnormalities at the outset. To find factors associated with fatal outcome after treatment, the medline database was searched for MC cases with data of thyroid hormone replacement and outcome within 1 month of therapy. Clinical data for our 5 patients and 82 cases from the medline search were pooled and factors associated with mortality were sought among age, gender, presence of cardiac or pulmonary complications, and doses of thyroid hormone by multiple logistic regression analysis. It revealed that greater age, cardiac complications, and high-dose thyroid hormone replacement (LT4 > or = 500 microg/d or LT3 > or = 75 microg/d) were significantly associated with a fatal outcome within 1 month of treatment. Elderly MC patients can be treated with low-dose hormone replacement. A bolus of 500 microg LT4, especially by mouth or via nasogastric tube, appears to be tolerated by younger patients (< 55 years) without cardiac complication. The conclusion remains to be confirmed in more patients.
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2/40. ascites due to hypothyroidism in a patient with alcoholic cirrhosis.

    myxedema is the cause of ascites in less than 1% of new-onset ascites cases, where as only 4% of patients with hypothyroidism present ascites. When ascites is the first manifestation of thyroid insufficiency, there is usually a delay in diagnosis. We report here a case of myxedema ascites occurring in a patient with alcoholic cirrhosis, that was first thought to be the cause of the ascites, and review the features of 48 cases previously reported. Some clinic and analytical findings that have been commonly reported, are the long duration of the ascites before diagnosis, the prompt response (with resolution of ascites) to thyroid replacement treatment, a high total protein concentration in ascites fluid, white moderate white blood cell counts and a lymphocyte predominance. serum-ascites albumin gradient has been postulated to be high in myxedema ascites, but we believe this has been studied in too few cases thus far, to be conclusive.
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3/40. myxedema accompanied by huge portal-systemic shunt without portal hypertension.

    A 43-year-old woman with a huge portal-systemic shunt accompanied by myxedema showed slow speech and behavior. Several imaging studies revealed a bold portal-systemic shunt from the splenic vein to the left renal vein. In addition, hypothyroidism caused by chronic thyroiditis was diagnosed, and synthesized thyroxine replacement was effective for the symptoms. However, the serum ammonia and indocyanin green retention remained in the abnormal range, nevertheless the portal vein pressure was normal and findings of liver cirrohsis were not recognized histologically. Surgical shunt closure was performed, resulting in normalized serum ammonia levels and serum branched chain amino acids /aromatic amino acids ratio, and improvement of the ammonia tolerance test.
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4/40. Sinus arrest following diuretic therapy in a patient with myxedema and hypertension.

    A 65-year-old female patient suffering from hypertension and myxedema due to chronic thyroiditis developed anginal attacks under trichlormethiazide therapy. The ECG revealed a SA block with reciprocal beats and aberrant ventricular conduction in a form of bigeminy. Upon substitution of desiccated thyroid for the antihypertensive drug, the anginal attacks subsided, the conduction disturbances disappeared and the blood pressure returned to normal without hypotensive treatment. This observation suggests that replacement therapy should precede diuretics in hypertensive patients with myxedema.
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5/40. myxedema ascites in the posttransplant setting: case report.

    ascites is a rare but important complication of hypothyroidism. Because of the rarity of the disease and the inconsistency of symptoms associated with hypothyroidism, patients often go undiagnosed for months. Institution of thyroid replacement hormone results in rapid and complete resolution of ascites. Here we present a case of myxedema ascites that presented in a 52-year-old man 4 months after allogeneic bone marrow transplant (BMT). Diagnoses initially considered in the differential included the common post-BMT complications, namely, hepatic veno-occlusive disease, graft vs. host disease, and infection. However, posttransplant patients are also at risk for illnesses unrelated to their underlying diagnosis or transplant procedure, including hypothyroidism. This case illustrates the importance of considering a broad differential diagnosis in posttransplant patients, especially those in whom the clinical course is atypical.
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6/40. myxedema associated with cardiac tamponade.

    pericardial effusion is frequently found in patients diagnosed with hypothyroidism, yet it is rarely associated with cardiac tamponade. This report presents an atypical case concerning a 60-year-old Taiwanese female, with a history of thyroidectomy surgery due to thyroid cancer, who was later diagnosed with myxedema and cardiac tamponade. Treatment included an immediate pericardiocentesis followed by thyroxine hormone replacement therapy. Postoperative and recovery phases progressed favorably, and the patient's prognosis is good.
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keywords = replacement therapy, replacement
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7/40. Spontaneous bacterial peritonitis in a patient with myxedema ascites.

    ascites is uncommon in patients with hypothyroidism. Herein we describe an 84-year-old female patient with myxedema ascites that resolved completely with thyroid replacement medication. Bacteriological studies of the ascitic fluid revealed gram-negative rods which eventually proved to be klebsiella pneumoniae treated successfully with antibiotics. Our review of the literature failed to reveal a previous case of myxedema ascites with concomitant subclinical spontaneous bacterial peritonitis.
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8/40. An unusual case of myxedema megacolon with features of ischemic and pseudomembranous colitis.

    myxedema megacolon is rare; usually, it manifests with abdominal distention, flatulence, and constipation. Herein we describe a 72-year-old man who had intermittent diarrhea, bloating, and abdominal pain for more than a year. Cultures of stool specimens for clostridium difficile enterotoxin were variably positive and negative. Colonoscopic biopsy specimens were thought to be consistent with chronic ischemia. thyroid function tests showed severe hypothyroidism; the patient's symptoms resolved with thyroid hormone replacement. We hypothesize that gross dilatation of the colon, attributed to myxedema, was followed by intestinal ischemia and complicated by recurrent episodes of pseudomembranous colitis. A review of the relevant literature is provided. This unusual manifestation of myxedema should be considered in the differential diagnosis when a patient has diarrhea, bloating, and abdominal pain.
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9/40. The many faces of hypothyroidism: a review of two inpatient populations.

    Unusual presentations of acute hypothyroidism often go unrecognized and delay the onset of effective therapy. We reviewed admissions of two different patient populations at the University of Louisville Hospital and the veterans Affairs Medical Center to evaluate the extent and profiles of such patients admitted for acute care. We found that although these hospitals differed in gender and age profiles, similarities existed for their admissions and delay in diagnosis for hypothyroidism. These similarities were related to unusual clinical presentation including myxedematous states, which were not usually recognized, and psychiatric conditions that were also commonly complicated by hypothyroidism. In all cases, the history, physical examinations, and thyroid-stimulating hormone test were essential in recognizing acute hypothyroidism so as to institute effective therapy with thyroid replacement early in the course of the disorder.
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10/40. Gross ascites as a first manifestation of primary hypothyroidism due to post-treatment of radioiodine therapy for Graves' disease.

    We report herein a case with myxedema (primary hypothyroidism) associated with marked ascites that was found during the course of examination for a suspected decompensated state of liver cirrhosis or malignant disease. Aspirated ascitic fluid was found to have the characteristics of the exudate. Thyroid hormone replacement resulted in rapid clinical improvement with resolution of the ascites. This case is an unusual association of hypothyroidism as a cause of ascites. In all the cases with ascites of unknown etiology, the differential diagnosis requires consideration of myxedema.
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