Rheumatologic manifestations of hypothyroidism

Rheumatologic manifestations are varied during the hypothyroidism. They can be articular, abarticular, muscular or osseous, consequences of an inappropriate hormonal secretion. Their diagnosis is easy when hypothyroidism is known, but they can be inaugural. Their evolution is favorable under substitute treatment.     

Rheumatologic manifestations of sarcoidosis

Sarcoidosis is a systemic granulomatous disease of unknown etiology. It has various clinical features. The most commonly affected organs are the lung, the lymph nodes, the eyes and the skin. Involvement of the musculoskeletal system is far less common and may be inaugural. Articular involvement is dominated by Lofgren syndrome and acute polyarthritis. Abarticular manifestations are often confounded with arthritis. Bone locations are dominated by sarcoidosis dactylitis and osteolysis. Muscular involvement is often unknown and can appear as 3 clinical features: spread form, myositique form or pseudotumoral form. Calcium balance disturbances are dominated by hypercalcemia which is often asymptomatique, but sometimes it reveal the sarcoidosis. Treatment of rheumatologic disorders often involves non steroidal antiinflammatory drugs, corticosteroids and methotrexate. Biological therapies such as the anti-TNFa and the anti-CD20 were showed to be effective in some case reports of severe and refractory disease.     

Rheumatologic manifestations of parvovirus B19 infection

Rheumatologic manifestations of parvovirus B19 infection is a recent individualization. They are rather frequent and varied and meet at the young adult's. Generally, it is responsible for acute, bilateral and symmetrical arthritis, usually involving distal joints and sometimes associated to signs caused by viral infections. Prolonged articular forms were discribed but are rare being able to sometimes feign a nocive rheumatoid arthritis because of their clinical aspect and of a seropositivity. Axial manifestations were also reported. The diagnosis of the recent infection by the parvovirus B19 can be confirmed by ELISA identification of specific IgM antibodies. The mechanism of the articular manifestations is still unknown and the link between parvovirus B19 and systemic vasculitis is questioned.     

Computed Tomography of Rheumatologic Disorders

Diseases of the spine and peripheral joints can be diagnosed noninvasively by this revolutionary imaging modality. CT has retrospectively demonstrated superiority over myelography and other imaging techniques in delineating various pathologic conditions—e.g., trauma, neoplasm, and infection—as well as arthropathy. Specific technical approaches are described in detail.     

Congenital hypothyroidism

This paper presents a case report of congenital hypothyroidism that illustrates some of the issues in screening for this disorder. Congenital hypothyroidism has several causes, the most common of which is thyroid dysgenesis. Most affected infants have no historical clues or physical findings to suggest diagnosis. Neonatal screening combining thyroxine and thyrotropin screening have resulted in increased detection, although false-negatives do occur, and the physician must carefully observe all newborns for the findings of congenital hypothyroidism. Early treatment improves the prognosis considerably. This paper reviews the pathophysiology, diagnosis, and treatment of congenital hypothyroidism.     

Pituitary hyperplasia in primary hypothyroidism

One case of primary hypothyroidism with hyperplasia of the pituitary gland was reported. This enlargement was decreased after hormone replacement therapy. Pituitary hyperplasia occurs secondarily to primary endocrine gland failure. Reactive enlargement of the pituitary gland must be differentiated from primary pituitary abnormalities in order to avoid unnecessary surgery.     

Cardiovascular effects of hypothyroidism

The clinical presentation of cardiac symptoms related to hypothyroidism is only rarely observed nowadays due to early diagnosis of hypothyroidism by easily available thyroid-stimulating hormone assays. A measurable abnormality of the left ventricle is the lengthened duration of contraction and relaxation, normalizing after restoration of euthyroidism. The ejection fraction and cardiac reserve are only slightly diminished in hypothyroidism. There is reversible diastolic disfunction. Pericardial effusion is a rare phenomenon. Diastolic hypertension due to hypothyroidism is the most frequent cause of endocrine hypertension. The relation between accelerated atherosclerosis and hypothyroidism is not definitively proven. Patients below age 65 and without cardiac risk factors can probably be treated with a full replacement dose of levothyroxin from the beginning. There is no increased risk of percutaneous transluminal coronary angioplasty or coronary artery bypass graft procedure in hypothyroid patients, either during or after the intervention.