Unusual Manifestations Associated with Primary Hypothyroidism: Experience from A Tertiary Care Health Center
Keywords:primary hypothyroidism, Van Wyk-Grumbach syndrome, Kocher-Debre-Semelaigne syndrome
Hypothyroidism is a commonly diagnosed endocrine disorder. Typical signs and symptoms of hypothyroidism include lethargy, cold intolerance, hoarseness, dry skin, constipation, delayed relaxation phase of deep tendon reflexes, and bradycardia. However, some patients may present with unusual signs and symptoms of hypothyroidism which can result in diagnostic confusion.
Besides the usual clinical manifestations of primary hypothyroidism, some signs are very unusual and not commonly recorded. The treating physician may not be familiar with them. Hence, timely identification of these unusual presentations is very important for early intervention and treatment.
Unnikrishnan AG, Kalra S, Sahay RK, Bantwal G, John M, Tewari N. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian J Endocr Metab. 2013;17(4):647-52. PMID: 23961480. PMCID: PMC3743364. https://doi.org/10.4103/2230-8210.113755.
Gutch M, Philip R, Philip R, Toms A, Saran S, Gupta K K. Skeletal manifestations of juvenile hypothyroidism and the impact of treatment on skeletal system. Indian J Endocr Metab. 2013;17(7):181-3. https://doi.org/10.4103/2230-8210.119565.
El-Shafie KT. Clinical presentation of hypothyroidism. J Family Community Med. 2003;10(1):55-8. PMID: 23011981. PMCID: PMC3425758.
Bhattacharjee A, Shakya S, Gutch M, Rao PK. Unusual Hormonal Overlap Syndrome: Van Wyk-Grumbach Syndrome. JIRMPS. 2016; 9:54-7.
Razi SM, Gupta AK, Gupta DC, Gutch M, Gupta KK, Usman SI. Van Wyk-Grumbach Syndrome with Kocher-Debré-Sémélaigne Syndrome: Case Report of a Rare Association. Eur Thyroid J. 2017;6:47-51. https://doi.org/10.1159/000448993.
Shu J, Xing L, Zhang L, Fang S, Huang H. Ignored adult primary hypothyroidism presenting chiefly with persistent ovarian cysts: A need for increased awareness. Reprod Biol Endocrinol. 2011;9:119. PMID: 21861901. PMCID: PMC3184057. https://doi.org/10.1186/1477-7827-9-119.
Philip R, Saran S, Gutch M, Gupta KK. An unusual case of precocious puberty and macroorchidism. Thyroid Res Pract. 2013;10(1):29-31. https://doi.org/10.4103/0973-0354.105845.
Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31(5):702-55. PMID: 20573783. https://doi.org/10.1210/er.2009-0041.
Eckstein AK, Lösch C, Glowacka D, Schott M, Mann K, et al. Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetric Graves ophthalmopathy. Br J Ophthalmol. 2009;93(8):1052–6. PMID: 19221109. https://doi.org/10.1136/bjo.2007.137265.
Radheshyam P, Prasad A, Bhadra R, Basu A. Massive pericardial effusion as the only manifestation of primary hypothyroidism. J Cardiovasc Dis Res. 2013;4(4):248-50. PMCID: PMC3953684. https://doi.org/10.1016/j.jcdr.2014.01.001.
Shastry RM, Shastry CC. Primary hypothyroidism with pericardial tamponade. Indian J Pediatr. 2007;74:580-1.
Gutch M, Bhattacharjee A, Kumar S, Shakya S. Uncommon manifestation of primary hypothyroidism: Constrictive pericarditis. IJMRPS. 2016;3(3):11-4.
Omran A, Peng J, Shrestha B, Ashhab MU, Yin F. Male child with Van Wyk-Grumbach's syndrome and other complications of long-standing primary hypothyroidism: A case report. Case Rep Pediatr. 2012; 2012:352751. PMID: 23133775. PMCID: PMC3485864. https://doi.org/10.1155/2012/352751.
Rastogi A, Bhadada SK, Bhansali A. An unusual presentation of a usual disorder: Van Wyk-Grumbach syndrome. Indian Endocrinol Metab. 2011;15(Suppl 2):141–3. PMCID: PMC3169870. https://doi.org/10.4103/2230-8210.83356.
Philip R, Saran S, Gutch M, Gupta K. An unusual presentation of Hashimoto's encephalopathy. Indian J Endocr Metab. 2014;18(1):113-5. PMCID: PMC3968716. https://doi.org/10.4103/2230-8210.126589.
Takahashi S, Mitamura R, Itoh Y, Suzuki N, Okuno A. Hashimoto encephalopathy: Etiologic considerations. Pediatr Neurol. 1994;11(4):328-31. https://doi.org/10.1016/0887-8994(94)90011-6.
Agrawal A, Diwan SK. Pituitary hyperplasia resulting from primary hypothyroidism. Asian J Neurosurg. 2011;6(2):99-100. https://doi.org/10.4103/1793-5482.92171.
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