1/6. Pretibial myxedema as the initial manifestation of Graves' disease.Pretibial myxedema (PM) is a localized thickening of the pretibial skin due to accumulation of acid mucopolysacharides (glycosaminoglycans). Its pathogenesis is still under investigation. Pretibial myxedema, exophthalmus and thyroid acropachy are the dassic extrathyroidal manifestations of Graves' disease. Almost invariably, PM follows the onset of ophthalmopathy, developing after the diagnosis and treatment of hyperthyroidism. Pretibial myxedema preceding Graves' ophthalmopathy is rare. We report the case of a 28-year-old Greek woman, who presented with multiple, asymptomatic nodules and plaques of the lower legs in the absence of other physical findings. Histopathologic examination revealed deposition of mucopolysacharides in the lower dermis. Laboratory investigation showed elevated serum T3 and T4 and depressed TSH levels. In our patient, pretibial myxedema was the earliest manifestation, leading to the diagnosis of Graves' disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. The many faces of hypothyroidism: a review of two inpatient populations.Unusual presentations of acute hypothyroidism often go unrecognized and delay the onset of effective therapy. We reviewed admissions of two different patient populations at the University of Louisville Hospital and the veterans Affairs Medical Center to evaluate the extent and profiles of such patients admitted for acute care. We found that although these hospitals differed in gender and age profiles, similarities existed for their admissions and delay in diagnosis for hypothyroidism. These similarities were related to unusual clinical presentation including myxedematous states, which were not usually recognized, and psychiatric conditions that were also commonly complicated by hypothyroidism. In all cases, the history, physical examinations, and thyroid-stimulating hormone test were essential in recognizing acute hypothyroidism so as to institute effective therapy with thyroid replacement early in the course of the disorder.- - - - - - - - - - ranking = 11.688404512284keywords = physical examination, physical (Clic here for more details about this article) |
3/6. Delayed healing of mandibular fracture in idiopathic myxedema.Lack of adequate amount of thyroid hormone may interfere with healing. A patient in whom a fracture of the mandible failed to heal in the 2 years following surgical treatment is presented. When thyroid hormone supplementation was introduced, the fracture progressed to union. The physical findings of hypothyroidism and the role of thyroid hormone in healing are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/6. Evolution of cardiorespiratory variables in myxedema coma--a case report.Normalization of hemodynamic, oxygen transport and oxygen consumption indices occurred within a week of treatment in a patient with myxedema coma. Ventilatory weaning and extubation was achieved using aminophylline, physical therapy and pleural drainage. Before extubation, naloxone was administered without any significant ventilatory improvement or change in endorphin levels.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Biochemical victims: false negative diagnosis through overreliance on laboratory results--a personal report.The increasing tendency of doctors to base diagnosis on the results of laboratory investigations entails a corresponding decrease in the exercise of clinical judgment. This state of affairs can have harmful consequences for patients suffering from biochemically atypical forms of disorder, who may acquire functional psychiatric labels when they are in fact suffering from organic physical disorders. The author's personal experience of this invidious predicament is described. Although hypothyroidism was correctly diagnosed on clinical grounds within a few months of presentation, laboratory results were inconclusive and three years and three specialist consultations were to elapse before replacement therapy was obtained, and then only through unofficial channels. The handling of this case illustrates some unfortunate trends in contemporary medical practice with important implications for the health of patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Pretibial myxedema with Graves' disease: a case report and review of Japanese literature.We report a case of pretibial myxedema with Graves' disease in an 18-year-old Japanese woman. The physical examination revealed waxy indurated plaques with prominent hair follicle openings and nonpitting edema disseminated on her lower legs. histology from an edematous lesion revealed that the dermis was markedly thickened with abundant mucin, especially hyaluronic acid, and the collagen fibers in this portion were splitting up into fibrils. We also reviewed 112 cases of pretibial myxedema reported in the Japanese literature.- - - - - - - - - - ranking = 11.688404512284keywords = physical examination, physical (Clic here for more details about this article) |