BackgroundTendinitis can be a presenting complaint in hypothyroidism, with symptomatic relief being obtained by appropriate management of the primary thyroid deficiency. To the best of our knowledge no other cases of spontaneous rupture of the long head of the biceps tendon during uncontrolled hypothyroidism have yet been reported.Case presentationThis case report describes an unusual case of spontaneous rupture of the long head of the biceps tendon in a 48-year-old white woman with severe hypothyroidism. She described experiencing a sudden sharp pain and an audible pop in her right shoulder while using her personal computer. On physical examination she was positive for Yergason’s sign and a subsequent magnetic resonance imaging scan showed complete rupture of the long head of her biceps tendon. Laboratory tests revealed significantly elevated thyrotropin levels (>100 μIU/ml) and very low levels of both triiodothyronine (0.17 ng/ml) and free thyroxine (0.18 ng/dl). She was switched to a different thyroxin regimen with a progressive dosage increment. She declined surgical re-anchorage of the tendon but despite the discreet Popeye sign, her overall strength and shoulder function were satisfactory. After 2 months, she was found to be clinically euthyroid, having normal thyroid function tests (thyrotropin 2.95 μIU/mL, free thyroxine 1.07 ng/dl). At her last follow-up visit, 1 year post-injury, she reported nearly normal shoulder function in her daily activities and had a constant shoulder score of 93 points.ConclusionsThe role of thyroid hormones in the synthesis and degeneration of collagen and in the proliferation and apoptosis of human tenocytes is discussed, providing a possible mechanism whereby hypothyroidism may lead to tendon tears. This report may have a greater impact among different subspecialties as it presupposes a high degree of awareness from internists, endocrinologists and orthopedic surgeons.
Objectives
To compare the work of breathing in the prone and supine positions in convalescent prematurely born infants.
Working Hypothesis
The work of breathing would be lower in the prone compared to the supine position.
Study Design
Prospective observational cohort study.
Patient‐Subject Selection
Consecutive preterm infants breathing unsupported in room air with a gestational age of 28–34 weeks in a tertiary neonatal intensive care unit were studied before discharge from neonatal care.
Methodology
The diaphragmatic pressure time product (PTPdi) was used to assess the work of breathing, calculated as the integration of transdiaphragmatic pressure over the inspiratory time. The PTPdi was measured in prone, supine, and supine with 45° head‐up tilt (supine‐tilt) positions.
Results
The mean (SD) PTPdi was lower in the prone (259 [68] cm H2O*s/min) compared with the supine position (320 [78] cm H2O*s/min, p= .005). The mean (SD) PTPdi was lower in the supine‐tilt position (262 [76] cm H2O*s/min) compared with the supine position (p = .032). The PTPdi was not different between the prone and supine‐tilt positions (p = .600). The difference in PTPdi between prone and supine was not independently associated with gestational age (standardized coefficient = 0.262, adjusted p= .335), birth weight (standardized coefficient = −0.249, adjusted p= .394) or postmenstrual age at study (standardized coefficient = −0.025, adjusted p= .902).
Conclusions
In convalescent preterm neonates, the work of breathing may be lower in the prone and supine‐tilt positions, compared with supine.
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