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Caron P, Imbert P, Dekeister C, Grunenwald S. Concurrent pretibial myxedema and thyroid eye disease following mRNA COVID-19 vaccine in a patient with history of Graves' disease. Ann Endocrinol (Paris) 2024; 85:100-103. [PMID: 37866430 DOI: 10.1016/j.ando.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
A 70-year-old female had a history of thyroid surgery for benign nodules and Graves' disease. Following mRNA COVID-19 vaccination, she presented Graves' orbitopathy and pretibial myxedema. Symptoms of thyroid eye disease and thyroid dermopathy improved after 500-mg methylprednisolone infusions.
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Affiliation(s)
- Philippe Caron
- Consultation multidisciplinaire des orbitopathies, Service d'endocrinologie et maladies métaboliques, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
| | - Philippe Imbert
- Consultation multidisciplinaire des orbitopathies, Service d'endocrinologie et maladies métaboliques, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Céline Dekeister
- Consultation multidisciplinaire des orbitopathies, Service d'endocrinologie et maladies métaboliques, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Solange Grunenwald
- Consultation multidisciplinaire des orbitopathies, Service d'endocrinologie et maladies métaboliques, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
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Patel RT, Grider DJ, Ramey N. Novel teprotumumab treatment of severe thyroid dermopathy; ototoxicity as an adverse side effect. Dermatol Online J 2023; 29. [PMID: 37040908 DOI: 10.5070/d329160211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Abstract
Pretibial myxedema, more generally thyroid dermopathy, results from mucopolysaccharide accumulation in the dermis, typically between the knee and dorsal foot. Thyroid dermopathy presents in Graves disease, but can occur in Hashimoto thyroiditis, primary hypothyroidism, and euthyroid patients. Treatment of thyroid eye disease with teprotumumab is established in the literature, with few case reports also showing improvement in pretibial myxedema. Reported is a 76-year-old man with thyroid eye disease and pretibial myxedema treated with teprotumumab; improvement was demonstrated in both conditions. He developed "muffled" hearing as an adverse effect, a complication not widely published in the dermatology literature. At 18 months post-treatment, his symptoms are stable without recurrence, but hypoacusis persists. Given the long-term efficacy and side-effects, dermatologists should recognize the potential benefits and risks of using teprotumumab for thyroid dermopathy. A baseline audiogram may be considered prior to therapy. Additionally, longitudinal data is needed to document the benefits and risks of this novel therapy.
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Smulders Y. [A man with a low voice]. Ned Tijdschr Geneeskd 2022; 166:D6841. [PMID: 36300445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A 57-year old man with several non-specific complaints is found to have severe hypothyroidism. Only then he realizes that his voice may have changed. A recording of his voice during and after full recovery illustrates the profound effects that vocal cord myxedema may have of a patient's voice.
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Affiliation(s)
- Yvo Smulders
- Amsterdam UMC, afd. Interne Geneeskunde, Amsterdam
- Contact: Yvo Smulders
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Crea B, Elia F, Cavalot G. A pretibial skin lesion in a patient with type 1 diabetes mellitus. Eur J Intern Med 2022; 98:109-110. [PMID: 35027265 DOI: 10.1016/j.ejim.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/01/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Bruna Crea
- School of Internal Medicine, University of Turin, Turin, Italy.
| | - Fabrizio Elia
- Emergency Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Giulia Cavalot
- Emergency Medicine, San Giovanni Bosco Hospital, Turin, Italy
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Affiliation(s)
- Shin-Ya Kawashiri
- Departments of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Remi Sumiyoshi
- Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsushi Kawakami
- Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Affiliation(s)
- Takafumi Taguchi
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Japan
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Trimarchi F, Martino E, Bartalena L. The clinical enigma of the "Flea catcher" by Georges de La Tour: a pregnant sinner with pre-eclampsia or a hypothyroid girl? J Endocrinol Invest 2019; 42:995-996. [PMID: 30730039 DOI: 10.1007/s40618-019-01017-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 11/27/2022]
Affiliation(s)
- F Trimarchi
- Accademia Peloritana dei Pericolanti at the University of Messina, Messina, Italy.
| | | | - L Bartalena
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Munir A. Myxedema Coma. J Ayub Med Coll Abbottabad 2018; 30:119-120. [PMID: 29504346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Myxedema may be the first presentation of patients with undiagnosed hypothyroidism. Definitive management is with thyroid hormone but supportive measures, identification and treatment of precipitating factors in an appropriately safe environment are vital. There is no consensus about preferred thyroid hormone regimen. Corticosteroid therapy is given until adrenal insufficiency has been excluded. We present here a case of seventy-four years old woman of myxodema coma.
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Affiliation(s)
- Atif Munir
- Diabetes and Endocrinology, University Hospital of Hartlepool, UK
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WEGELIUS O. Accumulation of Connective Tissue Ground Substance in the Heart of the Dwarf Mouse. Acta Medica Scandinavica 2009; 175:SUPPL 412:229+. [PMID: 14159186 DOI: 10.1111/j.0954-6820.1964.tb04654.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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SCHEINBERG P, STEAD EA, BRANNON ES, WARREN JV. Correlative observations on cerebral metabolism and cardiac output in myxedema. J Clin Invest 2004; 29:1139-46. [PMID: 14774460 PMCID: PMC436156 DOI: 10.1172/jci102351] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Contempré B, de Escobar GM, Denef JF, Dumont JE, Many MC. Thiocyanate induces cell necrosis and fibrosis in selenium- and iodine-deficient rat thyroids: a potential experimental model for myxedematous endemic cretinism in central Africa. Endocrinology 2004; 145:994-1002. [PMID: 14500569 DOI: 10.1210/en.2003-0886] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Thyroid destruction leading to endemic myxoedematous cretinism is highly prevalent in central Africa, where iodine (I) and selenium (SE) deficiencies as well as thiocyanate (SCN) overload are combined. All three factors have been studied experimentally in the etiology of the disease, but they have never been studied in combination. In a model using rats, we have previously shown that combining I and SE deficiencies increases the sensitivity of the thyroid to necrosis after iodide overload, an event unlikely to occur in the African situation. To develop a model that would more closely fit with the epidemiological findings, we have determined whether an SCN overload would also result in thyroid necrosis as does the I overload. The combination of the three factors increased by 3.5 times the amount of necrotic cells, from 5.5 +/- 0.3% in the I-SE+ thyroids to 18.9 +/- 1.6% in the I-SE-SCN-overloaded ones. Methimazole administration prevented the SCN-induced necrosis. SE- thyroids evolved to fibrosis, whereas SE+ thyroids did not. TGFbeta was prominent in macrophages present in SE- glands. Thyroid destruction in central Africa might therefore originate from the interaction of three factors: I and SE deficiencies by increasing H(2)O(2) accumulation, SE deficiency by decreasing cell defense and promoting fibrosis, and SCN overload by triggering follicular cell necrosis.
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Affiliation(s)
- Bernard Contempré
- Institute of Interdisciplinary Research, Free University of Brussels, B-1200 Brussels, Belgium
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Abstract
The basal oxygen consumption and heart rate of the myxedematous rabbit has been studied following the intravenous injection of 200–400 µg of triiodothyronine. The heart rate increased in 1–3 hours after injection which was invariably before the onset of the rise in oxygen consumption at 3.5–14 hours after injection.
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Affiliation(s)
- F Rongioletti
- Department of Dermatology, University of Genoa, Italy
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