Unusual Manifestations Associated with Primary Hypothyroidism: Experience from A Tertiary Care Health Center

Abstract

Hypothyroidism is a commonly diagnosed endocrine disorder. Typical signs and symptoms of hypothyroidism include lethargy, cold intolerance, hoarseness, dry skin, constipation, delayed relaxation phase of deep tendon reflexes, and bradycardia. However, some patients may present with unusual signs and symptoms of hypothyroidism which can result in diagnostic confusion. Besides the usual clinical manifestations of primary hypothyroidism, some signs are very unusual and not commonly recorded. The treating physician may not be familiar with them. Hence, timely identification of these unusual presentations is very important for early intervention and treatment.

Keywords: Kocher-Debre-Semelaigne syndrome; Van Wyk-Grumbach syndrome; primary hypothyroidism.

Figure 1

Pseudohypertrophy of the calf muscles.

Figure 2

Hypothyroid ophthalmopathy.

Figure 3

Apical four chamber view shows right atrial and right ventricle diastolic collapse.

Figure 4

M-mode echo at the level of mitral valve in parasternal long axis shows diastolic right ventricle collapse.

Figure 5

Testicular volume >25 ml bilaterally, with no pubic hair in hypothyroid patient.

Figure 6

Magnetic resonance images showing non-specific white matter changes in primary hypothyroidism.

Figure 7

Magnetic resonance images showing non-specific white matter changes in primary hypothyroidism.

Figure 8

Magnetic resonance images showing pituitary hyperplasia in primary hypothyroidism.