Intestinal obstruction and hypothyroidism.

Cole, Percival P.; Petrie, J C; Bewsher, P. D.

doi:10.1136/bmj.3.5671.655-f

Cited by 10 publications

(5 citation statements)

References 1 publication

(1 reference statement)

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“…Similar case reports have been published, including a case of small bowel obstruction complicated by volvulus that was resolved by exploratory laparotomy and nonintensive thyroid replacement (12), a case of sigmoid volvulus as a complication of chronic constipation in a setting of myxedema coma that was resolved following exploratory laparotomy and levothyroxine replacement (13), and a patient with myxedema features complicated by volvulus who recovered after surgery and levothyroxine replacement (14).…”

Section: Discussionmentioning

confidence: 64%

Sigmoid Volvulus In Myxedema Megacolon

Zelada

Huachin

Villena

2017

AACE Clinical Case Reports

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Objective: To report a case of myxedema megacolon complicated with sigmoid volvulus that was successfully managed with surgery and intensive thyroid hormone replacement therapy (THRT).Methods: The clinical presentation, laboratory and imaging results, treatment of the myxedema megacolon episode, and post-surgical evolution with THRT are presented.Results: We present the case of a 17-year-old woman with history of congenital hypothyroidism, chronic constipation, and irregular treatment with levothyroxine, who was admitted to the emergency room following 7 days of abdominal pain, nausea, and vomiting. She presented with marked abdominal distention and without bowel sounds. An abdominal computerized tomography scan showed a severe colon enlargement. Thyroid-stimulating hormone (TSH) was 222 µIU/mL, total thyroxine was <1 µg/dL, and total triiodothyronine was <40 ng/dL. Exploratory laparotomy was performed. Sigmoid volvulus was found and sigmoidectomy was performed. No evidence of colonic obstruction was found, but her clinical condition did not improve. After 1 month of mixed replacement therapy with levothyroxine 150 µg/day plus liothyronine 25 µg/day, intestinal movements were re-established and she was discharged asymptomatic with a TSH level of 0.15 µIU/mL.Conclusion: Myxedema megacolon is a rare clinical manifestation of hypothyroidism that, when complicated by sigmoid volvulus, is diagnostically and clinically challenging. History of constipation, thyroid disease, signs and symptoms of hypothyroidism, poor treatment compliance, or lack of improvement after abdominal surgery should raise suspicion to identify these patients due to the high risk of anesthetic and post-surgery complications. In our case, a dual combination of levothyroxine plus liothyronine resulted in clinical and biochemical recovery. (AACE Clinical Case Rep. 2017;3:e144-e147) Abbreviations: CH = congenital hypothyroidism; GI = gastrointestinal; GIT = gastrointestinal tract; IV = intravenously; NR = normal range; THRT = hormone replacement therapy; TSH = thyroid-stimulating hormone

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Section: Discussionmentioning

confidence: 64%

Sigmoid Volvulus In Myxedema Megacolon

Zelada

Huachin

Villena

2017

AACE Clinical Case Reports

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“…Hirschsprung disease and hypothyroidism are two diseases generally considered in the differential diagnosis of bowel hypomotility and pseudo-obstruction in neonates [ 4 ]. While isolated constipation is not likely to be caused by hypothyroidism [ 10 ], severe constipation mimicking Hirschsprung disease may occur in children with CH in association with growth failure and developmental delay as here demonstrated [ 5 – 7 ].…”

Section: Discussionmentioning

confidence: 85%

Untreated Congenital Hypothyroidism Mimicking Hirschsprung Disease: A Puzzling Case in a One-Year-Old Child

Tahan

Siviero-Miachon

Soares

et al. 2018

Case Reports in Pediatrics

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Congenital hypothyroidism is a clinical emergency due to its potential risk of mental retardation. Constipation might be present in hypothyroid children. However, Hirschsprung disease is rarely associated with congenital hypothyroidism. Herein, a case of congenital hypothyroidism in a one-year-old child mimicking Hirschsprung disease is described. Adequate treatment with levothyroxine sodium tablets controlled intestinal dysmotility that mimicked congenital intestinal aganglionosis due to the critical influence of thyroid hormones on bowel motility.

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“…Patients with chronic constipation and abdominal distension should be considered with the diagnosis of hypothyroidism in 1969 [ 21 ]. Goto et al [ 22 ] compared the daily stool volume of rats between the hypothyroidism group and sham-operated group.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of early postoperative bowel obstruction for patients undergoing selective colorectal surgeries

et al. 2021

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Objective Postoperative bowel obstruction was one of the most severe complications in patients who received colorectal surgeries. This study aimed to explore risk factors of early postoperative obstruction and to construct a nomogram to predict the possibility of occurrence. Methods The records of 1437 patients who underwent elective colorectal surgery in Peking University People’s Hospital from 2015 to 2020 were retrospectively collected. Risk factors of early postoperative bowel obstruction were identified by logistic regression analysis and a nomogram was then constructed. Bootstrap was applied to verify the stability of the model. Results COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were identified as independent risk factors and were put into a nomogram for predicting early postoperative bowel obstruction. The nomogram showed robust discrimination, with the area under the receiver operating characteristic curve was 0.894 and was well-calibrated. Conclusion A nomogram including independent risk factors of COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were established to predict the risk of early postoperative bowel obstruction.

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Intestinal obstruction and hypothyroidism.

Cited by 10 publications

References 1 publication

Sigmoid Volvulus In Myxedema Megacolon

Sigmoid Volvulus In Myxedema Megacolon

Untreated Congenital Hypothyroidism Mimicking Hirschsprung Disease: A Puzzling Case in a One-Year-Old Child

Risk factors of early postoperative bowel obstruction for patients undergoing selective colorectal surgeries

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