Is It Prudent to Screen the Thyroid before Initiating Treatment for Acromegaly?
Journal Title: Journal of Advances in Medicine and Medical Research - Year 2016, Vol 16, Issue 9
Abstract
Aim: To present a case of acromegaly with coexisting thyrotoxicosis and to emphasize the relevance of screening the screening the thyroid before initiating treatment for thyrotoxicosis. Presentation of the Case: A 55-year-old lady presented with palpitations, and weight loss of two months’ duration. She also noted her fingers and toes had swollen up, inability to incise properly since two years. Upon examination, she had morphological features clinically diagnostic of acromegaly. Her thyroid was enlarged was on investigation found to have biochemical evidence of thyrotoxicosis. Fine needle aspiration cytology of the thyroid yielded colloid goiter. Insulin like growth factor-1 was elevated. Serum growth hormone after an oral glucose tolerance test was elevated. Magnetic resonant imaging (MRI) of the brain revealed a hypo enhancing focal lesion of size 11X10X12 mm at the pituitary region with delayed contrast enhancement suggestive of pituitary adenoma. Patient was started on anti-thyroid medications and referred to higher centre, and is awaiting surgery for pituitary adenoma. Discussion: Among patients with acromegaly the incidence of thyroid diseases is around 78% and it has the most common presentation being nodular thyroid disease as the initial presentation. It is uncommon to see patients presenting with symptoms of thyrotoxicosis initially, who had florid morphological features of acromegaly. The prevalence of toxic nodular goiter to the tune of 14.3% in acromegaly. Goiters seen in acromegaly were euthyroid or autonomous, are due to the elevated growth hormone levels independent of TSH action. In about 13 to 17%, thyroidectomies were performed before acromegaly was diagnosed. When patients with acromegaly presents with a weight loss should arouse the possibilities of thyroid cancer or hyperthyroidism. Conclusion: Screening the thyroid is important, as inadvertent thyroidectomies were performed before acromegaly was diagnosed. When acromegaly co-exists with thyroid dysfunction, the burden of cardiovascular abnormality should be addressed especially, to reduce the morbidity and mortality rate.
Authors and Affiliations
C. Rajasekharan, K. V. Vysakha, S. Aswanikumar, N. S. Sibi
Keywords
Related Articles
- EP ID EP341441
- DOI 10.9734/BJMMR/2016/25626
- Views 76
- Downloads 0
In vitro Efficacy of Newly Formulated Oil Pulling against Oral Malodor Related Microbiota
Introduction: Oral malodor or bad breath is an unpleasant breath exhaled from the oral cavity and becomes physical, social and psychological impacts on affected individuals. Metabolic products, especially volatile sulfur...
Headache Attributed to Acute Ischemic Stroke in Chinese Patients: A Single Center Study
Aims: In this pilot study we aimed to investigate prevalence, characteristics and possible mechanisms of headache in acute ischemic stroke from a Chinese tertiary hospital. Methodology: Five hundred and fifteen patients...
Effect of Adjuvant Chemoradiotherapy on Survival of Gastric Cancer Patients: Single Center Experience from the Southeast Region of Turkey
Background/Aim: Gastric cancer causes the second highest number of cancer related deaths. The purpose of this study is to evaluate the survival of patients who are T3, T4, lymph node positive postoperatively and have und...
Aging, Fitness, and Marathon Times in a 91 Year-old Man Who Competed in 627 Marathons
Aging is associated with a decline in maximal aerobic capacity (VO2max) that may be attenuated by chronic endurance exercise. This case study chronicles the changes in marathon times in a 91 year old man who completed 62...
Evaluation of Diagnostic Quality of Chest Radiographs Seen in a Nigerian Teaching Hospital
Chest radiograph is an invaluable tool to the physicians and surgeons for the assessment of the airways, lungs, mediastinum, heart, pleura and chest walls. Radiographs of poor diagnostic quality could lead to poor diagno...