Hypothyroidism presenting as destructive arthropathy of the fingers

Gerster, J C; Quadri, Pablo; Saudan, Y

doi:10.1136/pgmj.61.712.157

Cited by 13 publications

(2 citation statements)

References 7 publications

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“…В некоторых случаях имеется деструктивная артропатия. Подобное поражение в основном затрагивает коленные, межфаланговые и (реже) дистальные межфаланговые суставы кистей, возможно, как результат инфильтрации костной ткани гиалуронатом [19][20][21]. При биопсии выявляется утолщение синовиальной оболочки без признаков воспаления.…”

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Rheumatic manifestations of hypothyroidism

Теплова¹,

Eremeeva²,

Байкова³

et al. 2017

RJTAO

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The rheumatic manifestations of endocrine diseases are well-known. The endocrine system has a complex effect on the structure and function of musculoskeletal tissues. The symptoms of locomotor apparatus injuries often come to the forefront in the clinical picture of an endocrine disease. It is therefore important to put endocrine diseases, including hypothyroidism, arthropathy, myopathy, etc., in a range of differential diagnoses of musculoskeletal system lesions. It should be remembered that changes in the locomotor system are able to partially or completely regress when endocrine disorders are adequately and long compensated for. The paper describes a clinical case in which, despite an obvious diversity of the typical clinical presentations of hypothyroidism, the main complaint was pain in the joints and muscles. In this connection, the female patient was initially misdiagnosed. This could be avoided if there was alertness to endocrine arthropathies and myopathies.

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unclassified

Rheumatic manifestations of hypothyroidism

Теплова¹,

Eremeeva²,

Байкова³

et al. 2017

RJTAO

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“…The authors suggested a relation between hypothyroidism and destructive arthritis with chondrocalsinosis [9]. In vitro, it was demonstrated that TSH have a strong mitogenic effect on chondrocytes [10], but there is no evidence about the effects of this hormone on articular cartilage in vivo.…”

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confidence: 99%

Empty sella syndrome presented with arthritis

Zinnuroğlu

Yılmaz

2010

Rheumatol Int

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Primary empty sella is defined as the extension of the subarachnoid space toward the intrasellar region, in the absence of pituitary surgery or radiation therapy [1]. Patients with an empty sella may occasionally present symptoms like abnormal endocrine functions, cerebrospinal fluid leakage, and visual field defects [2-4]. Recent reviews outlined the possible relationship between hypothyroidism and autoimmune rheumatological conditions [5,6]. However, there is no evidence of hypopituitarism and rheumatological disorders. We present here an unusual case with primary and partial empty sella presented with symptomatic hypopituitarism and arthritis without any evidence of autoimmune origin.A 57-year-old woman presented with swelling in the knees and pain in the ankles. She had progressive severe fatigue and inability to stand and walk due to pain and fatigue. There was severe effusion and warmth in bilateral knee joints. She also had pain in bilateral ankles without any sign of arthritis. She was hospitalized and the initial laboratory studies showed that the free T3 (0 ng/mg, unmeasurable) and free T4 (0.06 ng/ml) levels were severely decreased. TSH was within normal levels (0.872 IU/ml) but close to the lower normal border. There was mild hypocalcemia (7.9 mg/dl). Morning serum cortisol (3.4 mcg/dl) level was slightly decreased. Prolactin (9.1 ng/ml), FSH (1.17 mIU/ml), LH (0.04 IU/ml), growth hormone (3.3 ng/ml) and ACTH (31.8 pg/ml) levels, blood glucose (66 mg/dl), renal and liver functions, Na (144 mmol/dl) and K (4.5 mmol/dl) were normal. Sedimentation rate was 54 mm/h and C-reactive protein (CRP) was (???) with Latex agglutination test. Brucella agglutination with Rose Bengal test, rheumatoid factor, anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-Tg) and anti-thyroid microsomal (anti-M) antibodies were negative. There was no sign of infection during the hospitalization and within the 3 months prior to the onset of the symptoms. In addition, the microscopy and culture of throat swab, urine, and stool were negative.Thyroid ultrasonography was normal. Hypophysis magnetic resonance imaging (MRI) revealed a maximum 3 mm thickness of the middle and left lateral part of the hypophysis gland which was consistent with a partial empty sella. Additionally, the infundibular stalk was deviated to the right side. Lesions, which were isointense on T1 and T2 sequences and hypointense following the administration of radiographic contrast media in the right anterior part of the gland were compatible with microadenomas (Fig. 1).The patient was commenced on prednisolon 10 mg, levothyroxine 0.1 mg, diclophenac sodium 150 mg daily. Prednisolon and levotroxine was increased gradually up to the desired dosages. Additionally, cold therapy was used to suppress the pain and the inflammatory findings in the knees and ankles. Arthritis and fatigue improved significantly within the second week of the treatment. Diclophenac sodium was stopped in the second week. There was no sign of any inflammation by clinical examinations ...

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