Erythema elevatum diutinum and hypothyroidism: coincidence or causal relationship?

AbstractErythema elevatum diutinum is a rare chronic leukocytoclastic vasculitis of unknown etiology. It is believed to be due to deposition of immune complexes in the vessels. Clinically it is manifested as erythematous violaceous papules and nodules, isolated or confluent with hardened consistency, symmetrical, usually located on the extensor surface of the extremities, particularly over the joints. Diagnosis is based on clinical and histological findings. We report the case of a woman, 71 years old, with erythematous violaceous nodules on the hands, elbows, back and legs, beginning two years ago, with pain and itching. Histopathological analysis revealed leukocytoclastic vasculitis, confirming the clinical suspicion. Laboratory tests revealed hypothyroidism. We report the case because of its rarity, with subsequent review of the literature.

Ectopic Thyroid Tissue Co-Existing with a Eutopic Thyroid.

Ectopic thyroid tissue, a developmental defect of thyroid gland, is met with rarity in day to day clinical practice. The diagnosis of ectopic thyroid demands a meticulous clinical examination and use of different imaging modalities. We are here reporting a case which presented as an anterior neck swelling, moving with deglutition, and also on and off dysphagia. After necessary investigations she underwent surgery and then the diagnosis of ectopic thyroid was made which was later confirmed with biopsy report which was suggestive of lymphocytic thyroiditis.

Light and electron microscopic study of thyroid follicular cells in adult albino rats following green tea administration

Green tea [GT] is one of the most popular beverages with high daily consumption worldwide. It has a rich content of polyphenols, among which catechins predominate. Its extracts are widely used as ingredients in dietary supplements, beverages, and functional foods, which may lead to a higher consumption of GT polyphenols by the general population. Recently, a relationship between GT administration and disruption of thyroid homeostasis was suggested. The goal of the study was to clarify the impact of GT administration on the histological structure of thyroid follicular cells of adult albino rats. Thirty adult male albino rats [140-160 g] were categorized into three equal groups: group I served as the control group; groups II and III received 1.25 and 5.0 g% GT extract orally at a dose of 10 ml/kg body weight, respectively, every day for 30 days. At the end of the experiment, blood samples were collected from all animals for estimation of serum triiodothyronine [T[3]], thyroxine [T[4]], and thyroid stimulating hormone. Rats were then euthanized and the thyroid glands were harvested for histological examination of thyroid follicular cells by light and transmission electron microscopy. The follicular epithelial height and colloid area of thyroid follicles were morphometrically evaluated and statistically analyzed. GT in small concentrations [in group II] did not induce any significant change in hormonal, histological, and histomorphometric assessments as compared with the control group. However, some follicular cells exhibited mildly dilated rough endoplasmic reticulum and multiple lysosomes. In contrast, GT administration in group III induced hypothyroidism as evidenced by significant reduction in serum T[3] and T[4] levels along with substantial increase in thyroid stimulating hormone level compared with controls. Histologically, many follicles displayed signs of hyperactivity as evidenced by focal hypertrophy and hyperplasia of the follicular cells along with colloid depletion. Ultrastructurally, dilated rough endoplasmic reticulum and disrupted mitochondria were encountered. Some severely degenerated follicular cells were revealed as well. Histomorphometrically, there was a significant increase in the mean follicular epithelial height, whereas the colloid area was significantly lowered as compared with the respective controls. The study clearly indicates that GT in large concentrations has the potential to disrupt thyroid follicular cell structure and function

Propylthiouracil-induced hypothyroidism delays apoptosis during the first wave of spermatogenesis

Mammalian germ cell apoptosis plays a key role in controlling the correct number of germ cells supported by Sertoli cells during the first wave of spermatogenesis in mammalian puberty. However, little is known about hormonal factors that could influence the rate of germ cell apoptosis during puberty or adulthood. In this work we evaluate germ cell apoptosis under hypothyroidism induced by goitrogen propylthiouracil (PTU) during the first wave of spermatogenesis. Neonatally administered PTU promoted a delay in the differentiation of Sertoli cells as evaluated by the expression of clusterin using immunohistochemistry and RT-PCR. Clusterin had different expression levels in control and PTU-treated animals, but under both conditions the highest levels were found in 35-day-old rats. In addition, clusterin displayed a cytoplasmic localization in control testes, but appeared located in the nucleus in PTU-treated animals. The wave of apoptosis (determined by caspase activity and quantification of apoptotic cells) characteristic of the first round of spermatogenesis was delayed by at least 10 days in these animals. The expression levels of proapoptotic genes like BAX or BAD were different between control and PTU-treated rats; although in both groups the highest level was found at the same age (days). Thus our results indicate that the characteristic pubertal apoptotic wave during rat spermatogenesis is delayed in neonatal hypothyroid rats.

Ovarian tumors with elevated ca-125 levels and severe juvenile hypothyroidism: A need for increased awareness.

A 15-yr-old girl presented with bilateral gross ovarian tumors, clinical features of long-standing unrecognized hypothyroidism and markedly elevated CA-125 levels. Ovarian resection was avoided, as the presentation was consistent with the Van Wyk and Grumbach syndrome; and the patient was treated with replacement of thyroid hormone. Regression of the ovarian tumors occurred 6 months after initiation of the treatment. The authors emphasise the need for increased awareness and screening for hypothyroidism in patients with ovarian tumors, in order to prevent inadvertent operative interventions.

Central hypothyroidism.

A 15-mth-old male child of consanguineous parents, presented with classical features of congenital hypothyroidism. Serum total thyroxine (T4), total triiodothyronine (T3) and TSH were low. There was no evidence of deficiency of other pituitary hormones. Magnetic resonance imaging of the pituitary was normal. TSHB gene sequencing revealed a homozygous missense mutation due to single base substitution G?A at codon 85 resulting in change from Glycine to Arginine. This mutation in TSHB gene has been reported earlier in three cases with similar phenotype from Japan.

effect of transient and persistent neonatal hypothyroidism on the adult albino rat testis [light and electron microscope study]

thyroid hormone is known to play a critical role in the development and growth of the testis. So, this study was designed to compare between the effect of transient and persistent neonatal hypothyroidism on the testis of adult rats. Thirty newborn rats [1 day old] were classified equally into control group and two experimental groups. In experimental group I, the transient hypothyroidism was induced in neonates by giving their lactating mothers 0.05%, 6-propyl-2 thiouracil [PTU] through drinking water for 30 days after birth then the treatment was withdrawal for 60 days. In experimental group II, the persistent hypothyroidism was induced by giving the neonates 0.05% PTU through their mother's milk until weaning then directly through drinking water for 90 days after birth. After 90 days postpartum, all animals were anesthetized and their testes were dissected out and processed for light and electron microscope examination. In experimental group I, the testes of transient hypothyroid rats appeared with large seminiferous tubules [ST] that the length of their diameters and the height of their lining epithelium were significantly increased as compared to those of control rats. They were lined by many Sertoli cells, primary spermatocytes, secondary spermatocytes, early spermatides and late spermatids. The interstitial spaces contained some Leydig cells and few fluid. In experimental group II, the testes of persistent hypothyroid rats appeared with small ST that the length of their diameters and the height of their lining epithelium were significantly decreased as compared to those of control rats. They were lined by thin disorganized germinal epithelium containing many Sertoli cells and few germ cells. Many sloughed degenerating cells and large multinucleated giant cells were seen in the lumen of ST. The interstitial spaces contained many connective tissue cells, congested blood vessels, excessive collagen fibers and abundant fluid. Electron microscope examination revealed Sertoli cells which were surrounded by wide spaces due to loss of germ cells. They contained distorted mitochondria, nuclei with peripheral heterochromatin condensation. They appeared with free processes due to loss of tight junction between them. the present study revealed that the neonatal transient hypothyroidism enhanced the growth of the testes. They contained large seminiferous tubules with many germ cells. While, the persistent hypothyroidism induced testicular atrophy with degeneration of germ cells. So, estimation of thyroid hormone level is recommended in all neonates immediately after birth for early diagnosis and treatment of thyroid hormone deficiency to prevent serious adverse effect of hypothyroidism on the testis

Complicaciones de la cirugía tiroidea / Postoperative complications of thyroidectomy

En este artículo se revisan las complicaciones de la cirugía tiroidea con especial énfasis en la lesión de nervio recurrente, hipoparatiroidismo transitorio y permanente, sangrado post operatorio y la lesión de nervio laringeo superior. Se mencionan los factores de riesgo que predisponen a complicaciones quirúrgicas insistiendo en la necesidad de una técnica operatoria cuidadosa que extreme los cuidados en la hemostasia, realice una exacta localización y preservación de los nervios recurrentes y una correcta identificación del mayor número posible de glándulas paratiroides ejerciendo una manipulación depurada y cuidadosa de estas estructuras. El uso de drenajes en el lecho operatorio de la tiroidectomía es controvertido, razón por la cual se comentan los pro y contras del uso rutinario. Se concluye que la experiencia del cirujano y una técnica quirúrgica meticulosa son los factores más determinantes de la morbilidad de esta cirugía.

Crecimiento y estado nutricional de niños venezolanos con síndrome de down / Growth and nutritional status in venezuelan children with down`s syndrome

Evaluar el crecimiento, estado nutricional y enfermedades asociadas en niños con Síndrome de Down que asistieron a la consulta de Nutrición, Crecimiento y Desarrollo del "Hospital de Niños J.M de Los Ríos" durante los años 2003 al 2005. Estudio descriptivo, transversal y retrospectivo en pacientes con Síndrome de Down. Se registro: edad, género, peso, talla, perímetro cefálico, circunferencia media del brazo izquierdo y pliegues cutáneos tricipital y subescapular. Se revisaron enfermedades asociadas y número de hospitalizaciones. Para el diagnóstico nutricional y de crecimiento se utilizaron como referencias el Estudio Transversal de Caracas (ETC), el Nacional Center Health Statistics (NCHS) y las Gráficas de Cronk, con sus respectivos puntos de corte. Se incluyeron 41 pacientes, 26 de género femenino y 15 de género masculino, con edades entre 15 días y 15 años de edad, se evidenció talla baja en el 83 por ciento y desnutrición en 88 por ciento al utilizar como referencias el NCHS. Con gráficas específicas para Síndrome de Down se determinó talla baja en 32 por ciento y desnutrición en 85 por ciento. 69 por ciento de los niños con talla baja tenían cardiopatías congénitas y 15 por ciento hipotiroidismo. La talla en los niños con Síndrome de Down evaluados se relacionó significativamente con desnutrición. El uso de guías de supervición de salud y gráficas de crecimiento específicas para Síndrome de Down, son herramientas útiles para vigilar la nutrición, el crecimiento y brindar atención integral a estos niños.

To evaluate growth, nutritional condition and associate diseases in children with Down’s syndrome who attend an out patient clinic of Nutrition, Growth and Development of the “Hospital de Niños J.M de Los Ríos” during 2003 to 2005. A descriptive, cross-sectional and retrospective study was performed. It was registered: Age, heigth, weight, cephalic perimeter, left arm average circumference, tricipital and subescapular skin fold. Associate diseases and number of hospitalizations were reviewed. For growth and nutritional diagnosis were used as references the Cross-sectional Study Caracas (ETC), Nacional Center Health Statistics (NCHS) and the Graphs of Cronk, with respective cut points. 41 patients were included, 26 females and 15 males, with ages between the 15 days and 15 years old. There was short stature in 83% of the children and malnutrition in 88% when comparing them with NCHS charts. With Down’s syndrome specific growth charts, there was short stature in 32% of the children and this one was associated to malnutrition in 85%, congenital heart defect in 69% and hypothyroidism in 15%. Short statures in children with Down syndrome evaluated were related significantly to malnutrition. Health supervision guides and Down syndrome specific growth charts are useful tools to watch the nutrition, growth and to offer integral attention to these children.

Carbimazole-induced hypothyroidism causes the adrenal atrophy in 10 days' prenatally treated albino rats

To investigate the effects of carbimazole-induced hypothyroidism, and simultaneous administration of thyroxine [thyroid hormone analogue] on the adrenal glands of 10 days' prenatally treated albino rats. A comparative study. Department of Anatomy, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC], Karachi, from 15th July 2001 to 31st August 2001. Ten days old albino rats of either gender, which were delivered by their respective mothers which were originally obtained from Charles River Breeding Laboratories, Brooklyn, Massachusetts, USA, and were cross bred, housed and maintained on the balanced diet in the Animal House of BMSI, JPMC, Karachi. Eighteen prenatally treated albino rats of 10 days old were used in the experiment and divided into three groups: X, Y and Z, comprising 06 animals in each group, i.e. from carbimazole treated mothers [X], carbimazole plus thyroxine treated mothers [Y], and controlled mothers [Z]. At the end of 10th postnatal day all the animals were sacrificed, their adrenal glands were removed, fixed, sectioned, and stained with H and E. The adrenal histology with relation to its width of cortex, zones and number of cells in different zones of cortex were studied. Carbimazole-induced hypothyroidism causes the adrenal atrophy in the adrenals of 10 days' prenatally treated albino rats by decreasing the total width of cortex and its zones especially zona fasciculata. Carbimazole-induced hypothyroidism by carbimazole causes the shrinkage of adrenal cortex in 10 days prenatally treated albino rats

Efeito da associação hipotireoidismo-castração no osso e nas paratireóides de ratas adultas / Effect of the hypothyroidism-castration association on the bone and parathyroids from adult female rats

O efeito do hipotireoidismo sobre o metabolismo ósseo e as paratireóides na deficiência ou suficiência dos esteróides ovarianos foi estudado em 32 ratas Wistar, com 2 meses de idade, distribuídas em 4 grupos de 8: eutireóideo não castrado (ENC), eutireóideo castrado (EC), hipotireóideo não castrado (HNC) e hipotireóideo castrado (HC). Após 120 dias de tratamento, as ratas foram sacrificadas e o plasma colhido para dosagem de T4 livre. Foi evidenciada hipertrofia das paratireóides somente no grupo HNC. As ratas do grupo HNC apresentaram osteopenia de maior extensão e intensidade, decorrente do menor crescimento, da inibição da aposição e do aumento da reabsorção ósseas. Nas ratas EC, a osteopenia foi causada por menor aposição e aumento da reabsorção ósseas. Embora a osteopenia na associação hipotireoidismo-castração tenha sido quase sempre mais intensa em relação à das ratas EC, sua intensidade, quando comparada à osteopenia dos animais HNC, foi variável e dependente do sítio ósseo estudado. Apesar de causar necrose dos ossos de maior metabolismo, a associação hipotireoidismo-castração não potencializou a osteopenia decorrente da ação isolada do hipotireoidismo até os 120 dias de tratamento.

Hipotireoidismo congênito / Cretinism

O hipotireoidismo congênito é a deficiência parcial ou completa dos hormônios tireóideos presente ao nascimento. Sua prevalência é de um para cada quatro mil nascidos vivos e é apontada como a maior causa de retardo mental prevenível em todo o mundo. Devido ao seu quadro clínico extremamente variável, é de suma importância a realização de exames de rastreamento neonatal. O diagnóstico precoce e a rápida instituição de reposição hormonal são cruciais ao adequado desenvolvimento e crescimento dos indivíduos acometidos

Hiperprolactinemia em el hipotiroidismo subclínico / Hyperprolactinemia in subclinical hypothyroidism

En su gran mayoría los enfermos portadores de hipotiroidismo subclínico (HScl) son asintomáticos. Sin embargo, hemos tenido la oportunidad de entrevistar a enfermas con dicha patología, con manifestaciones clínicas y bioquímicas del sector lactotrófico adenohipofisario. Para explicar nuestros hallazgos seleccionamos a cinco mujeres con hipotiroidismo estadio I y seis en estadio II, comprobando que a medida que se profundiza la enfermedad, más se altera el eje gonadotrófico. Al resultar tan escasa la información bibliográfica diseñamos una sistemática de estudio de los diversos ejes neuroendocrinos en esta afección, con el fin de excluir otra noxa asociada.

Dyshormonogenetic goitre with clear cell change resembling parathyroid adenoma--a case report.

Dyshormonogenesis is a rare cause of goitre. It is manifestation of mutation in genes controlling the proteins involved in synthesis of thyroid hormones. Though there is wide spectrum of biochemical and clinical presentation, pathological features are similar in all defects. Nonencapsulated nodules with minimal regressive changes and lack of lymphocytic infiltration are important diagnostic features. Clear cell change as seen in this case is common and needs to be differentiated from parathyroid adenoma. Hypercellularity with cellular atypia should not lead to misdiagnosis of malignancy.

Patologías Endocrinas y metabólicas: diabetes mellitus, hipotiroidismo, hiperplasia suprarrenal congenita / Endocrine diseases and metabolic: diabetes mellitus, hypothyroidesm, adrenal hyperplasia congenital

Las anormalidades de la diferenciación sexual y el desarrollo, siempre en combinación con hipertensión o pérdida de sal, son los marcados clínicos de la Hiperplasia Suprarrenal Congénita. El diagnóstico debe hacerse tan rápido como sea posible, con el propósito de iniciar el tratamiento y detener los efectos de la anomalía enzimática. El diagnóstico y una decisión racional en la asignación del sexo dependerá de la determinación del sexo genético, la determinación hormonal de la enzima deficiente y de la valoracción del potencial del paciente para su actividad sexual futura y fertilidad. Es necesario y urgente que el médico reconozca, en el recién nacido, los signos clínicos de ambiguedad genital así como la pérdida de sal, característicos de la HSC, y refiera estos pacientes al endocrinólogo pediatra para una evaluación completa. En caso de que esta evaluación no sea posible hacerla en forma inmediata, sugerimos tomar una muestra de sangre al paciente (aproximadamente 8 cc. sin anticoagulante) centrifugarla y guardar el suero congelado e iniciar el tratamiento substitutivo, para luego gestionar la consulta con el especialista. Recordemos que el diagnóstico precoz conlleva a la instauración del tratamiento adecuado, que corregirá los síntomas específicos causados por la deficiencia enzimática que, junto con el control adecuado, resultará en un crecimiento y desarrollo normales del paciente

Pseudohypo thyroidism in patients with hepatosplenic bilharziasis

Twenty male patients with ascitis due to hepatosplenic bilharziasis were studied for the clinical evaluation of their thyroid function and quantitative estimation of serum thyroid homones T3 and T4 using enzyme immunological test. All were clinically euthyroid. Both hormones were significantly lower in the patients group compared to a control group of twenty male. The results were discussed