Cases reported "Thyroiditis, Autoimmune"

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1/10. myxedema coma of both primary and secondary origin, with non-classic presentation and extremely elevated creatine kinase.

    myxedema coma is a rare, often fatal endocrine emergency that concerns elderly patients with long-standing primary hypothyroidism; myxedema coma of central origin is exceedingly rare. Here, we report a 37-year-old woman in whom classical symptoms of hypothyroidism had been absent. Six years earlier, she had severe obstetric hemorrhage and, shortly after, two subsequent episodes of pericardial effusion. On the day of admission, pericardiocentesis was performed for the third episode of pericardial effusion. Because of the subsequent grave arrhythmias and unconsciousness, she was transferred to our ICU. Prior to the endocrine consultation, a silent myocardial infarction had been suspected, based on the extremely high serum levels of creatine kinase (CK) and isoenzyme CK-MB. However, based on thyroid sonography, pituitary computed tomography, elevated titers of antithyroid antibodies and pituitary stimulation tests, the final diagnosis was myxedema coma of dual origin: an atrophic variant of Hashimoto's thyroiditis and post-necrotic pituitary atrophy (Sheehan syndrome). Substitutive therapy caused a prompt clinical amelioration and normalization of CK levels. Our patient is the first case of myxedema coma of double etiology, and illustrates how its presentation deviates markedly from the one endocrinologists and physicians at ICU are prepared to encounter. In addition, cardiac problems as those of our patient should not discourage from substitutive treatment (using L-thyroxine and the gastrointestinal route of absorption), if the age is relatively low.
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keywords = grave
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2/10. Onset of autoimmune hepatitis during intravenous steroid therapy for thyroid-associated ophthalmopathy in a patient with Hashimoto's thyroiditis: case report.

    A 43-year-old woman with Hashimoto's thyroiditis (HT), euthyroid on levothyroxine since 1999, developed thyroid-associated ophthalmopathy (TAO) in February 2002. She had involvement of the eye muscles, as shown by computed tomography (CT) scan. She was started on methylprednisolone pulse therapy 7.5 mg/kg of body weight, (one cycle every 2 weeks, each cycle comprising two infusions on alternate days), with rapid improvement of soft tissue inflammation and of eye motility, as confirmed by the reduction of clinical activity score (CAS) and eye muscles size on CT scan. At the end of treatment the patient showed a marked and rapid increase of serum aminotransferases (up to 1200 U/L). She had negative hepatitis a, B, and C viruses serology, but circulating antinuclear antibodies. A liver biopsy, performed at 4 weeks after the discontinuation of intravenous steroids, led to the diagnosis of autoimmune hepatitis (AIH). The patient was treated with oral steroids with a rapid reduction of serum aminotransferases concentrations. To our knowledge, there have been only two reports of liver dysfunction after intravenous steroids for TAO, but the etiology of such hepatitis had not been established. AIH may develop in patients with multiple autoimmunity and may not become overt until immune rebound occurs (i.e. after cessation of or between immunosuppressive treatment cycles). steroids are the first line of treatment for AIH, hence their use would not be contraindicated when patients with TAO have chronic hepatitis, provided that the modalities of treatment are appropriate.
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ranking = 958.63591740543
keywords = ophthalmopathy
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3/10. Graves' ophthalmopathy, ocular myasthenia gravis and Hashimoto's thyroiditis.

    A case of Graves' ophthalmopathy, ocular myasthenia gravis (MG) and Hashimoto's thyroiditis is presented, an association that has not been previously reported. A 22-year-old woman presented with exophthalmos and a normal-sized thyroid. Four years later, shortly after delivery of her second child, ocular MG developed. Twenty years after her initial symptoms, Hashimoto's thyroiditis and mild hypothyroidism were diagnosed. Treatment of the latter brought about marked improvement of the ophthalmoplegia. The differential diagnosis of ophthalmoplegia is discussed, and the importance of recognizing and treating hypothyroidism in MG is emphasized. Since Hashimoto's thyroiditis as well as MG have an abnormality of T-lymphocyte regulatory function, and the autoimmune process is directed in both diseases against cell membrane receptors, they can be considered as pathogenetically related. The reported case exemplifies this association.
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ranking = 958.63591740543
keywords = ophthalmopathy
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4/10. Hodgkin's disease and hyperthyroidism.

    In recent years we have had the occasion to observe hyperthyroidism in 6 patients with Hodgkin's disease. All patients had received Mantlefield irradiation and were disease-free when hyperthyroidism appeared. hyperthyroidism allows three different pictures to be distinguished: 1 case report of Graves' disease without ophthalmopathy, 1 case report of Hashimoto's thyroiditis corresponding to a particular form called hashitoxicosis, and 4 case reports of atypical silent thyroiditis. Reports concerning case studies of postirradiation Graves' disease or Hashimoto's thyroiditis during Hodgkin's disease are only to be found exceptionally. Atypical silent thyroiditis was recently individualized, but no postirradiation case studies have been reported. It is suggested that these 6 cases represent a radiation-induced immune thyroid disease: physiopathology and predisposing factors are discussed.
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ranking = 191.72718348109
keywords = ophthalmopathy
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5/10. Ophthalmopathy after neck irradiation therapy for Hodgkin's disease.

    Ophthalmopathy associated with autoimmune thyroid disease (Graves' ophthalmopathy) may occur years after irradiation of the neck for nonthyroid malignant disease. Two patients developed this complication 2 and 18 years after irradiation treatment of Hodgkin's disease: one with hypothyroidism associated with Hashimoto's thyroiditis and the other with hyperthyroidism. Careful long-term observation of thyroid function following neck irradiation is recommended in view of this unusual complication and the frequent occurrence of hypothyroidism.
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ranking = 191.72718348109
keywords = ophthalmopathy
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6/10. diplopia in autoimmune thyroid disease.

    diplopia without obvious exophthalmos, caused by infiltrative endocrine ophthalmopathy, developed in 12 patients with clinical and laboratory confirmation of autoimmune thyroid disease. In eight patients, the diplopia alone prompted medical attention, which led to the diagnosis of autoimmune thyroid disease. A hypotropia secondary to restrictive tightening of the inferior rectus muscle, producing vertical diplopia, was the most common manifestation of the disorder. The ocular muscle imbalance in autoimmune thyroid disease is caused by mechanical orbital restriction of the extraocular muscle, not by an innervational defect. Evidence of orbital restriction of the eye muscles can establish the diagnosis, regardless of the patient's thyroid function.
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ranking = 191.72718348109
keywords = ophthalmopathy
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7/10. Simultaneous occurrence of Graves' disease with endocrine ophthalmopathy. thyroiditis and thyroid carcinoma.

    The simultaneous occurrence of Graves' disease with ophthalmopathy lymphocytic and subacute de Quervains' thyroiditis has been observed in two male patients suffering from follicular-type thyroid carcinoma. In one of them Sjogren syndrome and a mild form of diabetes were also diagnosed. It is assumed, on the basis of indirect evidence, that the humoral and cellular lesions determined by genetic factors and influenced by prolonged thyrostatic and steroid treatment are jointly responsible for tumour genesis.
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ranking = 958.63591740543
keywords = ophthalmopathy
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8/10. Evidence for autoimmune mechanisms in the evolution of invasive fibrous thyroiditis (Riedel's struma).

    The etiology of Riedel's invasive fibrous thyroiditis, a rare disorder confused in the past with the more common fibrous variant of Hashimoto's disease, has remained obscure. However, the presence of mononuclear cells in the fibrosclerotic process and the detection of autoantibodies directed against thyroid-specific antigens in a large proportion of patients with invasive fibrous thyroiditis favor an autoimmune pathogenesis of invasive fibrous thyroiditis. Further, an association between invasive fibrous thyroiditis and Hashimoto's thyroiditis has been suggested. Here we report the first two patients in whom invasive fibrous thyroiditis evolved from antecedent Graves' disease, documented by the presence of thyroid dysfunction, bilateral ophthalmopathy, and thyrotropin receptor stimulating autoantibodies. The diagnosis of invasive fibrous thyroiditis was established in both instances on the basis of the established histopathological criteria. The presence of extensive mononuclear cell infiltration within the invasive fibrosclerotic process in these two patients, the close relationship between thyroid-specific autoantibodies, inflammatory parameters, and disease activity, and the response to glucocorticoid therapy all suggest the existence of a link between Graves' disease and invasive fibrous thyroiditis. These findings support the notion of autoimmune mechanisms playing a role in the pathogenesis of Riedel's invasive fibrous thyroiditis.
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ranking = 191.72718348109
keywords = ophthalmopathy
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9/10. Concomitant Graves' disease and Hashimoto's thyroiditis, presenting as primary hypothyroidism.

    hypothyroidism in patients with Graves' disease is usually the result of ablative treatment. We describe a 58 year old man with Graves' ophthalmopathy and pre-tibial myxoedema, who presented with spontaneous primary hypothyroidism. Circulating TSH receptor antibody activity was increased, while thyroid microsomal antibody was detectable in titres greater than one in one hundred thousand. It is likely that the TSH receptor antibody of Graves' disease was ineffective in stimulating hyperthyroidism because of concomitant thyroid destruction due to Hashimoto's disease. Alternatively, primary hypothyroidism could have resulted from the effects of a circulating TSH receptor blocking antibody.
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ranking = 191.72718348109
keywords = ophthalmopathy
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10/10. Antitriiodothyronine antibody in patient with Hashimoto's thyroiditis.

    We described a 44-year-old female patient with a history of goiter for 2 months. physical examination revealed a diffusely enlarged thyroid gland weighing 40 g firm to hard in consistency. She was clinically euthyroid and had neither ophthalmopathy nor dermopathy. serum thyroid hormone levels revealed total T4 (RIA) of 4.8 micrograms/dL (normal, 4-11 micrograms/dL), total T3 (RIA) of above 600 ng/dL (70-175 ng/dL), and TSH (IRMA) of 54 mU/L (0.3-6 mU/L). Antithyroglobulin and antiperoxidase antibody titers were 1:5,120 and 1:409,260, respectively. Because of the discrepancy between the patient's clinical status and laboratory values, assay for thyroid hormone autoantibodies (THAA) was done and subsequently demonstrated antitriiodothyronine antibody with percentage of precipitation by polyethylene of 98.4 per cent (normal range, 3.06 /- 8.58%). In conclusion, THAA should be suspected in patients whose clinical status is incoherent with the thyroid function test.
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ranking = 191.72718348109
keywords = ophthalmopathy
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