Clinical profile and lipid abnormalities in subclinical and overt primary hypothyroidism

Background: Overt and subclinical hypothyroidism, affects metabolism of lipids particularly that of cholesterol, low density lipoprotein and triglyceride. Hypercholesterolemia predisposes to atherosclerosis and thereby increases cardiovascular risks.Methods: Hundred patients of primary  hypothyroidism of age more than 15 yrs were included. Five milliliters of venous blood was drawn in fasting state and serum obtained; thyroid function test (TFT) and fasting lipid profile were performed. Based on the TFT, patients were categorized as sub clinical or overt hypothyroidism. Clinical data, thyroid and lipid profiles obtained were analyzed and compared using statistical methods.Results: Seventy patients were females and thirty were males in the ratio of 2.3:1. Most common age group was 51-60years followed by 41-50years. Most common symptom was generalised weakness followed by weight gain, cold intolerance, constipation, hair loss, paraesthesia’s. Most common signs were myxoedema, delayed ankle reflex relaxation, dry and  coarse skin, bradycardia, non-pitting peripheral edema, madarosis, pallor, goiter. Patients with Overt hypothyroidism had significantly higher serum levels of total cholesterol(249.1±31.7 mg/dl), Triglycerides (191.5±68.5 mg/dl) and LDL cholesterol(167.7±31 mg/dl) than the Subclinical hypothyroidism with total cholesterol(202±19.8),triglycerides(155.6±35) and LDL cholesterol(129±21.1) but HDL cholesterol  level remains normal in both overt  (44.0±4.7) and subclinical  (43.1±4.4)hypothyroidism respectively.Conclusions: Patients with Overt hypothyroidism had significantly higher levels of Total cholesterol, Triglycerides (TG) and LDL cholesterol than the Subclinical hypothyroidism but HDL cholesterol level remains normal in both. So, concomitant estimation of lipid profile in hypothyroidism patients is needed for early intervention and prevention of cardiovascular morbidity and mortality

Complete Resolution of the Pituitary Mass Lesion and Improvement of Pituitary Function with Corticosteroid in Autoimmune Hypophysitis: A Case Report

BACKGROUND፡ Autoimmune hypophysitis is the consequence of an immune-mediated inflammation of the pituitary gland, which is rare, and most frequently occurs in females during postpartum periods. It usually responds well to corticosteroid treatment with reported resolution of the pituitary mass lesion.CASE REPORT: A 51 years male presented with a one-month history of lethargy, headache, nausea, proximal muscle weakness with intermittent flushing. He was a diabetic with metformin 500mg twice daily. No other remarkable medical history or family history of autoimmune disease. On examination, he had no neurological deficit with a normal visual field. His initial biochemical evaluation showed features of secondary hypothyroidism as evidenced by low free FT4 and suppressed TSH with normal electrolytes. The subsequent evaluation of his hormonal profile revealed panhypopituitarism. Contrast MRI of pituitary showed an enhanced homogenous mass and minimal stalk thickening with a dural tail and preserved posterior bright spot. He was managed with glucocorticoid 20 mg once daily for two weeks along with levothyroxine and testosterone replacement. After two weeks of treatment, he improved clinically. Repeat MRI imaging of the pituitary showed complete resolution of the homogenous mass.CONCLUSION: Although autoimmune hypophysitis is rare in males, a careful clinical history with necessary hormonal investigations is required for the suspicion about the inflammatory pituitary disorders This current case highlights glucocorticoid as the primary modality of treatment and the need for long-term follow-up with periodic clinical assessment