2 min read - Hypothyroidism
A 64 years old female patient with hypertension and hyperlipidemia was attending her GP very frequently with various complaints. Her major complaints included myalgia, backache, constipation, malaise, epigastric pain, headache and loss of appetite.
On examination GP noted an abnormality in her hands. He could not pick up any other obvious abnormalities.
 |
| Picture from internet |
What is this abnormality?
This is carotenemia. You have to differentiate it from icterus, where the sclera is also yellow.
What are the common causes?
Primary carotenemia is when a patient develops this due to ingestion of food containing large amounts of carotenoids like carrot! When carotenoid intake is not excessive it's called secondary carotenemia, for which hypothyroidism is probably the commonest cause. Other causes include diabetes mellitus, hyperlipidemia and nephrotic syndrome.
What will you do?
In the setting of multiple complaints and carotenemia hypothyroidism is the likely cause. There are many other physical signs which will aid you to diagnose hypothyroidism. Out of them loss of lateral eyebrows, hoarse voice, dry skin and slow relaxing ankle jerks are favorite signs of physicians.
Check TSH and start treating.
Any other investigation you would consider?
Check bilirubin! All these nonspecific complaints can be due to hypercalcemia. Better check calcium levels as well.
Anything else?
Well, various diseases including but not limited to, polymyalgia rheumatica, poly/dermatomyositis, hematological or solid organ malignancies, paraprotenemias can give rise to similar complaints. If TSH is normal, or if there's no improvement within weeks of starting thyroxine, you will have to investigate along these lines.
Primary carotenemia is when a patient develops this due to ingestion of food containing large amounts of carotenoids like carrot! When carotenoid intake is not excessive it's called secondary carotenemia, for which hypothyroidism is probably the commonest cause. Other causes include diabetes mellitus, hyperlipidemia and nephrotic syndrome.
What will you do?
In the setting of multiple complaints and carotenemia hypothyroidism is the likely cause. There are many other physical signs which will aid you to diagnose hypothyroidism. Out of them loss of lateral eyebrows, hoarse voice, dry skin and slow relaxing ankle jerks are favorite signs of physicians.
 |
| Picture from internet |
Check TSH and start treating.
Any other investigation you would consider?
Check bilirubin! All these nonspecific complaints can be due to hypercalcemia. Better check calcium levels as well.
Anything else?
Well, various diseases including but not limited to, polymyalgia rheumatica, poly/dermatomyositis, hematological or solid organ malignancies, paraprotenemias can give rise to similar complaints. If TSH is normal, or if there's no improvement within weeks of starting thyroxine, you will have to investigate along these lines.
Comments
Post a Comment