A 71 years old woman, affected by ischemic heart disease from the age of 50 and by chronic constipation was admitted to the emergency department for drowsiness, intense dyspnea and acute abdominal distension. Laparotomy evidenced a megacolon. Because of the age and sex of the patient the congenital form of the megacolon was ruled out. No one of the more common causes of megacolon was recognized, but a severe hypothyroldism and Hashimoto's thyroiditis was discovered. Treatment with levothyroxine caused a progressive improvement of the general condition of the patient and of the megacolon so that the authors hypothesize that the intestinal pseudo-occlusion was caused by the hypothyroidism. In this paper the authors make a thorough analysis of the literature about the association between hypothyroidism and megacolon. Although many hypothesis have been put forward about the possible pathogenetic association between these two diseases, until now no definitive result has been reached. The authors, moreover, hypothesize that the pleural and pericardial effusion and the peculiar metabolic state characterized by plasma hyponatremia and hyposmolarity, with a constant urinary hyperosmolarity, were also caused by hypothyroidism; in fact the clinical and metabolic conditions improved after levothyroxine therapy. In the end the authors discuss if it is preferable to use tetraiodothyronine or triIodothyronine for the treatment of intense hypothyroidism in a patient in critical clinical state.

Aged↗

PubMedDate not supplied

[Thyroid cancer and Hashimoto's thyroiditis].

In a 45 years old women affected by Hashimoto's thyroiditis appeared a thyroid nodule that at the cytologic and than at the histologic examination proved to be a papillar carcinoma. Concerning this problem the authors make a thorough analysis of the literature. Regarding the possible associations between these two diseases, they observe how there is an extreme discordance of opinions on considering statistically significant the relationship between thyroid cancer and Hashimoto's thyroiditis. They make the hypothesis that the association of these two diseases is not casual: several etiological factors could be considered, but the chronic stimulus of TSH on the thyroid tissue affected by the autoimmune disease and progressively hypofunctioning, could be the main factor responsible for the development of the neoplasia. Then they give some advice to recognise patients at high risk for thyroid carcinoma. The patients at higher risk for thyroid cancer are those that present a single or prevalent nodule; the growth of a nodule on suppressive treatment with levothyroxine is also a negative prognostic index. Patients with an enlarged gland without nodules or with nodular goiter without a prevalent nodule are at low risk for cancer.

Carcinoma, Papillary↗

PubMedDate not supplied

[Determination of urinary excretion of iodine in cordarone induced hyperthyroidism].

It is well known that amiodarone, an antiarrythmic drug containing iodine, can induce in some subjects thyroid function alterations: hyperthyroidism in patients resident in iodine-deficient areas and hypothyroidism in those with sufficient iodine intake. We attempted in this study to show the possibility to select the subjects at major risk of this iodine-induced hyperthyroidism, with a simple and inexpensive method such as urinary excretion iodine assay.

Adult↗