We present a case of an extensive aortic dissection (AD) identified in a woman with atypical symptoms. Transthoracic echocardiography (TTE) allowed the identification of an intimal flap in multiple locations and resulted in rapid diagnosis and treatment. In most cases, CT angiography is the imaging modality of choice for diagnosis of AD. TTE is rapid and accurate and can be used in kidney failure. Our case highlights the important role of bedside echocardiography in the diagnosis of AD, especially in the patient with a typical symptoms in whom this diagnosis of AD may not be entertained and actually missed leading to negative and possibly deadly consequences.
Background & Objective: Thyroid hormones have an important role in the regulation of lipid metabolism. Subclinical hypothyroidism (SCH), defined as a mild increase in thyroid-stimulating hormone (TSH) and normal level of thyroxine (T4), could be associated with altered lipid profile. The current study aimed at assessing the association between SCH and changes in lipid profile. Methods: Data of 53 patients with SCH and 53 euthyroid cases were collected from Besat Hospital in Hamadan, Iran, in 2013. The age range of the cases was 18 to 60 years, and the groups were matched in terms of gender, age, and body mass index (BMI). SCH was defined as a TSH value of 4.2 to 10 mU/L, and normal T4 as 0.8 to 2.8 ng/dL. Control cases had a normal TSH ranging from 0.5 to 4.2 mU/L. The total serum cholesterol (TCHOL), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels in both groups were examined and the results were recorded. Results: Participants with SCH had significantly higher LDL and lower HDL levels than the control group regardless of age group and gender (P-value <0.001), but there was no difference in TG and TCHOL levels (P-value <0.05). The prevalence of dyslipidemia and SCH was only significant in females (P-value =0.009). Totally, there was significant correlation between the prevalence of dyslipidemia and SCH regardless of gender (P-value =0.04). Conclusion: SCH is associated with dyslipidemia, and biochemical screening for thyroid dysfunction is recommended in all patients with dyslipidemia.
COVID-19 infection has been found to precipitate hypercoagulability and transiently increase antiphospholipid antibodies. However, it is yet to be determined how likely these transient changes contribute to thrombotic events and antiphospholipid syndrome. We present a case in which antiphospholipid antibodies were detected in the presence of significant thromboses. The patient was subsequently treated for suspected catastrophic antiphospholipid syndrome following COVID-19 infection.
Background: Oral tablets of levothyroxine (L-T4) are the standard of care for the treatment of Hypothyroidism and are recommended by current professional guidelines. However, patients with malabsorption syndromes, intolerance to excipients or dyes in tablets, or the intake of certain medications or foods may not be adequately controlled on these tablets. The use of liquid soft gel capsules (Tirosint) has been reported to be of value in such circumstances. Case Report: A 29 year old woman underwent total thyroidectomy followed by 124.5 mCi 131 I therapy at another facility for a right sided 3.7cm PTC with tall cell features. 12 ipsilateral central nodes were positive for cancer. Post therapy WBS was negative for evidence of distant metastases. She was placed onto branded L-T4 treatment but over the next 2 years, in spite of carefully documented adherence to her medication regimen, and with daily doses increasing from 0.1 to 0.3mg, TSH levels were unstable varying from 0.03 to 3.13μIU/ml and then 3 months later rose progressively further to 130μIU/ml. Her clinical Hypothyroidism became critical requiring emergent use of IV L-Thyroxine by her physicians who added L-T3 20μ/d to her L-T4 0.3mg but her TSH did not go below 98.54. She sought care at our institution. Issues of proper technique of medication administration were explained and emphasized with which the patient insisted she was fully compliant. Nevertheless, and in spite of a further increase in the daily L-T4 dose to 0.35mg, TSH remained excessive at 86.94. Treatment was then changed to Tirosint soft gel capsules alone starting at 0.3mg and then decreasing progressively to 0.2mg daily as her TSH reduced to 4.39 (6 months) and has remained in the range of 0.011 to 0.057 over the next 3 years. Other than Vitamin D and the temporary use of Depo-Provera, the patient denied the use of any other medications or supplements. Discussion: L-T4 tablets have long been the preferred and recommended treatment form for Hypothyroidism by professional societies. (1, 2) However, reports have appeared noting poor and inconstant response to this treatment in occasional patients such as those with malabsorption syndromes such as following bariatric surgery (3) or with gastroparesis (4), or with the concomitant intake of other medications such as proton pump inhibitors (5) or foods such as coffee (6). In such circumstances, it has been reported that use of liquid L-T4 or liquid soft gel capsules containing no excipients beyond glycerin and gelatin results in improved absorption of L-T4 with better and more stable control of thyroid biochemistry including TSH. (3, 4, 5, 6, 7) We present a case of a patient with Papillary Thyroid Cancer who, following total thyroidectomy and 131 I therapy, had variable and inadequate TSH suppression with development of clinical unresponsiveness to standard branded L-T4 treatment. Switching therapy to a soft gel product has enabled stable control of TSH
The antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitides are a group of small-vessel vasculitides that results in inflammation of the small blood vessels. It has a diverse range of clinical manifestations that commonly involve not only the upper airways, lungs, and kidneys but also the eyes, skin, joints, nerves, and, potentially, many other sites. This diversity is why ANCA-associated vasculitides can have such a wide scope of clinical presentations and disease severity. Entities in this group of diseases include granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (formerly known as Churg–Strauss syndrome). Skin involvement is a common clinical feature in all three forms of ANCA-associated vasculitis, with various manifestations.
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