ABSTRACT
INTRODUCTION: Factitious thyrotoxicosis includes all causes of thyrotoxicosis from the short or long-term ingestion of thyroid hormone, of which one of the complications is atrial fibrillation. CASE PRESENTATION: A woman, 71 years old, complained of chest palpitations. She had a medical history of thyroidectomy, hypertension, and dyslipidemia. In addition, she took Levothyroxine, amlodipine and simvastatin regularly. On physical examination, the general status was weak, with vital signs showing blood pressure (BP) of 170/100 mmHg, heart rate (HR) of 130-150 bpm, irregular rhythm, respiratory rate (RR) of 20×/min, axillary temperature of 36.8 °C, and oxygen saturation (SpO2) 98 % with room air. The abnormal laboratory found were significant increase in total T4, total T3, FT4, and low levels of TSH. The first electrocardiogram (ECG) showed AF and Burch Watorfsky's score was 45. The AF was treated with a loading dose of amiodarone 150 mg in 10 min and decreased gradually. She had received a high-calorie, protein and low-salt diet of 2100 kcal/day, termination Levothyroxine usage, propranolol of 10 mg/8 h, amlodipine of 5 mg/day, and lisinopril of 5 mg/day. Treatment for AF was continued with a maintenance dose of amiodarone IV 300 mg in 6 h, then 600 mg in 18 h, warfarin tablet 2 mg/day (according to treatment from a cardiologist), and atorvastatin 20 mg/day at night. After 6 days of treatment, the patient experienced improvement and continued discharge. The patient improved on an outpatient basis and was monitored periodically. DISCUSSION: Monitored treatment of thyrotoxicosis and AF management with 3 principles can minimize complication severity. CONCLUSION: Early, effective and monitored treatment of thyrotoxicosis is vital to manage AF in achieving a better outcome.
ABSTRACT
Background: Micropenis usually has a series of causative factors that must be identified to determine the treatment modality. Case presentation: A 24-years-old Indonesian male complained of a small penis since infancy. The patient has a short penis size (3 cm), no pubic hair, small scrotum, both testes cannot hide palpable, and tanner scale 2. The hormonal examination includes testosterone hormone of 14.94 ng/dL, luteinizing hormone of 14.89 mUI/mL, and follicle-stimulating hormone of 67.51 mUI/mL. Ultrasound showed no testicular location and only a prostate-like appearance of a size of 0.6 × 2.07 cm on the abdomen. The patient will receive therapy but was constrained by the COVID-19 pandemic. Discussion: diagnosis of micropenis and gonadotropin hormone disorders must be detected early and receive treatment immediately for better results. Conclusion: Micropenis is a medical diagnosis that depends on proper examination and management, and early diagnosis is essential to improve prognosis.
