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Benign Thyroid Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Hypothyroiidism is insufficient production and secretion of thyroid hormones. It affects females more frequently than males, with a peak incidence in the forties and fifties. The most common cause in iodine-replete regions is Hashimoto's thyroiditis, and iodine deficiency in nonreplete regions. Myxedema refers to accumulation of glycosaminoglycans in the dermis in the context of severe hypothyroidism. It is most easily identified in the lower leg, as pretibial myxedema.
Diseases of the Hair
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Rodney Sinclair, Wei-Liang Koh
Clinical presentation: For congenital localized hypertrichosis, this can be an isolated finding with a discrete circumscribed patch of increased terminal hairs, or associated with a congenital melanocytic nevus, Becker’s nevus, or underlying spinal dysraphism (faun tail sign at lumbosacral region). For congenital generalized hypertrichosis, patients rarely can present with increased body hair from birth, either lanugo hair (congenital hypertrichosis lanuginosa) or terminal hair (congenital hypertrichosis terminalis). This can be an isolated finding or associated with other congenital syndromes (e.g., Hurler syndrome, Cornelia de Lange syndrome). For acquired localized hyper-trichosis, this can be a feature in porphyria cutanea tarda. This can also occur in pretibial myxedema plaques, usually associated with Graves’s disease. Topical medications, for example, minoxidil, bimatoprost, and potent topical steroids, can induce hair growth. Repetitive rubbing/scratching and application of plaster cast can also result in localized hypertrichosis. For acquired generalized hypertrichosis, this condition can be associated with underlying malignancies (“malignant down,” reported rarely in gastrointestinal, lung, breast cancers), hypothyroidism, eating disorders (e.g., anorexia nervosa, bulimia), dermatomyositis, dystrophic epidermolysis bullosa, and certain drugs (e.g., minoxidil, phenytoin, cyclosporine).
Endocrinology
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Signs that may be elicited on examination include clammy hands, tachycardia, fine tremor, palmar erythema, lid lag, goitre and thyroid bruit. Graves’ disease is associated with pretibial myxoedema, thyroid acropachy and eye signs (see box).
Thyrotropin receptor antibodies and a genetic hint in antithyroid drug-induced adverse drug reactions
Published in Expert Opinion on Drug Safety, 2018
Lin-Chau Chang, Chien-Ching Chang, Pei-Lung Chen, Shun-Huo Wang, Yi-Hsuan Chen, Yung-Hsin Tsai, Shyang-Rong Shih, Wei-Yih Chiu, Cathy Shen-Jang Fann, Wei-Shiung Yang, Tien-Chun Chang
For the second-stage study, between 2016 and 2017, we actively recruited 45 patients with a medical history of carbimazole/methimazole-induced cutaneous reactions and/or hepatotoxicity and 137 GD controls from the outpatient department, and compared the genotyping results of individuals in these two groups. Also available for analysis were the TRAb titers of 37 patients with carbimazole/methimazole-induced cutaneous reactions and/or hepatotoxicity, who were recruited during the second-stage study. Given that TRAb titers could increase due to radioiodine treatment [22–24], we excluded the data of those titers that may have been affected by this treatment. In order to minimize the possibility of variation in the sensitivity of the TRAb assay and for comparison of different titers in different clinical manifestations, chart reviews were performed for individuals with records of TRAb titers assayed at the NTUH from March 2016 to June 2016. We identified the following four groups of individuals for comparison based on chart reviews: (1) 40 normal controls who visited the NTUH for health checkups and who had normal thyroid function, without goiters and/or other thyroid antibodies; (2) 40 patients who had Graves’ hyperthyroidism and might have other thyroid antibodies but did not have orbitopathy (ophthalmopathy) or typical skin manifestations of pretibial myxedema (PM) or ATD-induced cutaneous reactions and/or hepatotoxicity; (3) 31 patients who had Graves’ hyperthyroidism as well as orbitopathy confirmed by orbital computed tomography without contrast medium, and might have had other thyroid antibodies, but did not have typical skin manifestations of PM or ATD-induced cutaneous reactions and/or hepatotoxicity; and (4) seven patients who had Graves’ hyperthyroidism as well as orbitopathy confirmed by orbital computed tomography and typical skin manifestations of PM and might have had other thyroid antibodies, but did not have ATD-induced cutaneous reactions and/or hepatotoxicity. For the latter three groups, the included patients were followed until November 2016. All the study protocols were reviewed by the Institutional Review Board of the NTUH. Written informed consent was obtained from all actively enrolled participants but not from individuals whose data were only collected from chart reviews as per our protocol.
Clinical guide to eosinophilic fasciitis: straddling dermatology and rheumatology
Published in Expert Review of Clinical Immunology, 2022
EF is distinguished from systemic sclerosis by the absence in EF of three typical findings in systemic sclerosis – sclerodactyly, Raynaud’s phenomenon, and nailfold capillary changes, as well presence of anticentromere, anti- topoisomerase I, and anti-RNA polymerase III antibodies. In distinction, the face, hands, and feet are spared in EF [1,3]. Morphea profunda holds clinical and histological similarities with plaque-like EF [3,5]. While isomorphic morphea occurs in areas of skin friction (not so EF), the symmetrical morphea variant is distributed on the trunk and extremities alike EF and may be confused with EF. Moreover, EF and morphea may overlap. The toxic oil syndrome, caused by ingestion of adulterated rapeseed oil 1981 in Spain, was characterized by morphea-like skin lesions affecting the face, trunk, and extremities, along with myopathy, peripheral neuropathy, and arthralgia [8]. The eosinophilia–myalgia syndrome, which had epidemic proportions in 1989 was caused by ingestion of the dietary supplement L-5-hydroxytryptophan, unfortunately contaminated. Patients complained of severe myalgias. Morphea-like lesions were conspicuous. Visceral involvement was occasionally present. Blood eosinophilia was a frequent attribute [9]. Nephrogenic systemic fibrosis is a progressive multiorgan fibrosing condition developing 2 to 75 days after exposure to gadolinium-based contrast agents used for magnetic resonance imaging. Patients with advanced renal insufficiency are at higher risk. Prominent findings on physical examination are indurated papules and plaques, on the extremities, buttocks, and trunk, sparing the face [10]. Other fibrosing disorders, easily distinguished on physical examination from EF, are myxedema, scleredema, and palmar fasciitis. Pretibial myxedema is a cutaneous manifestation of Graves’ disease presenting as yellowish-brown papules, nodules and plaques on both shins; it may be refractory to control of underlying thyroid disease. Scleredema of Buschke is characterized by stiffness and hardening of the subcutaneous tissues on the upper back and posterior surface of the neck. Palmar fasciitis is a paraneoplastic syndrome manifesting as a painful swelling of the hands, caused by inflammation and sclerosis of the palmar fascia, tendon sheaths, small joints of the fingers, and flexion contractures.