Aim: To present a patient with all manifestations of long-term unsubstituted hypothyroidism-from alopecia to myxedema megacolon.
Case: Sixty-one-old year women was admitted in ICU due to disturbance of consciousness, respiratory failure and electrolyte imbalance. Sopor, expressed alopecia, dry, flaky, pail skin, generalized edema, lung stasis and pericardial friction. A laboratory parameters pointed to the presence of normocytic normochromic anemia, hyponatremia, acidosis and hypoxia, and hormonal analyzes expressed in primary hypothyroidism. In the immunological findings of elevated double-spiral DNA. Visualization techniques proved the presence of pleural effusion and atelectasis of the left lung parenchyma, the presence of pericardial effusion, a small amount of fluid in the abdomen, as well as expressed enlarged and filled with air both flexure and transverse section of the colon, and multi chemical changes in white matter of the brain. The patient was intubated, applied mechanical ventilation. We started substitution with levothyroxine, diuretics, corticosteroids and other sympthomatic therapy. She was treated with enema various times, repeatedly performed bronchoscopy treatment on four occasions, and tracheotomy was made. The treatment led to an improvement in the sense of lowering the parameters of inflammation, improving the acid-base parameters and reexpansion of the lung parenchyma, and general condition of the patient was getting better.
Discussion and conclusion: The lack of treatment of hypothyroidism can lead to serious consequences in all organ systems. Since the autoimmune process has never antigen completely sensitive, there is a possibility of affection more target tissues in autoimmune process and mutually overlapping signs and symptoms of various autoimmune diseases. Elevated levels of double-spiral DNA in combination with the presence of and criteria indicate the presence of lupus disease.
28 - 31 May 2016
European Society of Endocrinology