Thyroid disease is defined as a condition of malfunction of thyroid.
Hyperthyroidism is a condition in which the thyroid gland is over active
and produces too much thyroid hormones. Hypothyroidism is a condition
in which the thyroid gland is under active and produces very little
thyroid hormones.
D.1. Misdiagnosis
1. Normal aging process and to the patient’s other health conditions
A diagnosis of hypothyroidism in the elderly can easily be overlooked if
we rely exclusively on its clinical presentation because this may be
highly non-specific, since the signs and symptoms of the disease are
common to other diseases typical of old age, and even to the normal
aging process. There is a report of a case of primary hypothyroidism
that was diagnosed late because the correlated signs and symptoms
(asthenia, bradycardia, pleural effusions, hyponatremia, worsening renal
and respiratory insufficiency, hoarseness) had previously been
attributed to the normal aging process and to the patient’s other health
conditions (Parkinson’s disease, PD; chronic obstructive pulmonary
disease, COPD)(40).
2. Reversal deterioration of renal function
There are a report of two patients with elevated serum creatinine levels
due to primary autoimmune hypothyroidism, with complete recovery of
creatinine clearance after thyroid hormone substitution therapy are
presented. The first patient was a young male whose laboratory tests
suggested acute renal failure, and the delicate clinical presentation of
reduced thyroid function. The second patient was an elderly woman with a
history of a long-term signs and symptoms attributed to ageing,
including the deterioration of renal function, with consequently delayed
diagnosis of hypothyroidism, according to the study by the Military
Medical Academy, Clinic of Endocrinology(41).
3. Respiratory failure
There is a report of a 36 years male, admitted to the hospital for
progressive respiratory failure. Chest X ray and CT scan were normal. On
admission, a severe bradycardia and slow intellectual activity were
noted. Serum thyroid function tests showed a TSH over 150 microU/ml and
T3 of 75 ng/ml. Thyroid substitution therapy was associated with a
progressive improvement of respiratory function, according to the study
by the Servicio de Medicina del Hospital(42).
4. Brain stem infarct
Myxedema coma is the extreme form of untreated hypothyroidism. There is
report of a patient with myxedema coma which was initially misdiagnosed
as a brain stem infarct. The diagnosis of myxedema coma was often missed
or delayed due to various clinical findings and concomitant medical
condition and precipitating factors. It is more difficult to diagnose
when a patient has no medical history of hypothyroidism, according to
the study by the Hallym University(43).
5. Statin intolerance
There is a report of a case of Hypothyroidism misdiagnosed initially as
statin intolerance, according to the study by Krieger EV, and Knopp
RH(44).
6. Hypercholesterolaemia and simvastatin-induced myositis
There is a report of report of a 50-year-old woman who presented with
hypertension. She was given simvastatin for hypercholesterolaemia. The
creatine kinase level was 3180 U/L at the 3-month follow-up visit, which
was thought to be due to simvastatin treatment. Although treatment was
discontinued, the creatine kinase level 4 months later remained higher
than 3000 U/L. Echocardiography revealed mild pericardial effusion and
normal left ventricular function; the electromyogram was also normal.
The patient subsequently showed signs and symptoms suggestive of
hypothyroidism, which was confirmed by measurements of the concentration
of thyroid-stimulating hormone (>100 mU/L) and free thyroxine (<2
pmol/L)(45)
D.2. Diagnosis
If you are experience certain symptoms of above and/or have had
previous thyroid problems or goiter. , your doctor may suspect that you
have underactive thyroid. Your doctor may order blood test to measure
the level of TSH and the level of the thyroid hormone thyroxine and
triiodothyronine, depending to the stage of the diseases. According to
the study by the College of Medicine, Mayo Clinic, hypothyroidism is the
result of inadequate production of thyroid hormone or inadequate action
of thyroid hormone in target tissues. Primary hypothyroidism is the
principal manifestation of hypothyroidism, but other causes include
central deficiency of thyrotropin-releasing hormone or
thyroid-stimulating hormone (TSH), or consumptive hypothyroidism from
excessive inactivation of thyroid hormone. Subclinical hypothyroidism is
present when there is elevated TSH but a normal free thyroxine
level(46).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/17933284
(40) http://www.ncbi.nlm.nih.gov/pubmed/21640396
(41) http://www.ncbi.nlm.nih.gov/pubmed/22500378
(42) http://www.ncbi.nlm.nih.gov/pubmed/15379058
(43) http://www.ncbi.nlm.nih.gov/pubmed/20808690
(44) http://www.ncbi.nlm.nih.gov/pubmed/19581652
(45) http://www.ncbi.nlm.nih.gov/pubmed/11177166
(46) http://www.ncbi.nlm.nih.gov/pubmed/22443971
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