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Kazama I, Mori Y, Baba A, et al. Pitting type of pretibial edema in a patient with silent thyroiditis successfully treated by angiotensin ii receptor blockade. Am J Case Rep. 2014;15:111-4doi: 10.12659/AJCR.889854.
Kazama, I., Mori, Y., Baba, A., & Nakajima, T. (2014). Pitting type of pretibial edema in a patient with silent thyroiditis successfully treated by angiotensin ii receptor blockade. The American journal of case reports, 15111-4. https://doi.org/10.12659/AJCR.889854
Kazama, Itsuro, et al. "Pitting type of pretibial edema in a patient with silent thyroiditis successfully treated by angiotensin ii receptor blockade." The American journal of case reports vol. 15 (2014): 111-4. doi: https://doi.org/10.12659/AJCR.889854
Kazama I, Mori Y, Baba A, Nakajima T. Pitting type of pretibial edema in a patient with silent thyroiditis successfully treated by angiotensin ii receptor blockade. Am J Case Rep. 2014 Mar 14;15:111-4. doi: 10.12659/AJCR.889854. eCollection 2014. PMID: 24665353; PMCID: PMC3962324.
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Am J Case Rep. 2014 Mar 14;15:111-4. doi: 10.12659/AJCR.889854. eCollection 2014.

Pitting type of pretibial edema in a patient with silent thyroiditis successfully treated by angiotensin ii receptor blockade.

The American journal of case reports

Itsuro Kazama, Yoko Mori, Asuka Baba, Toshiyuki Nakajima

Affiliations

  1. Department of Physiology I, Tohoku University Graduate School of Medicine, Sendai, Japan.
  2. Mori Yoko Clinic, Sendai, Japan.
  3. Department of Internal Medicine, Iwakiri Hospital, Sendai, Japan.

PMID: 24665353 PMCID: PMC3962324 DOI: 10.12659/AJCR.889854

Abstract

PATIENT: Female, 56 FINAL DIAGNOSIS: Thyroiditis - silent Symptoms: Palpitations • pretibial pitting edema • short of breath • sweating

MEDICATION: - Clinical Procedure: - Specialty: Endocrinology and Metabolic.

OBJECTIVE: Unknown etiology.

BACKGROUND: Hyper- or hypothyroidism sometimes causes pretibial myxedema characterized by non-pitting infiltration of a proteinaceous ground substance. However, in those patients, the "pitting" type of pretibial edema as a result of increased sodium and fluid retention or vascular hyper-permeability rarely occurs, except in cases complicated by heart failures due to severe cardiomyopathy or pulmonary hypertension.

CASE REPORT: A 56-year-old woman developed bilateral pretibial pitting edema, followed by occasional sweating, palpitations, and shortness of breath, which persisted for more than 2 months. The diagnosis of hyperthyroidism due to silent thyroiditis was supported by elevated levels of free thyroxine (T4) and triiodothyronine (T3), with a marked decrease in thyroid-stimulating hormone (TSH), and the negative results for TSH receptor antibodies with typical findings of destructive thyrotoxicosis. Despite her "pitting" type of pretibial edema, a chest radio-graph demonstrated the absence of cardiomyopathy or congestive heart failure. Oral administration of angiotensin II receptor blocker (ARB) was initiated for her systolic hypertension, with a relatively higher elevation of plasma renin activity compared to that of the aldosterone level. Although the symptoms characteristic to hyperthyroidism, such as increased sweating, palpitations and shortness of breath, slowly improved with a spontaneous resolution of the disease, ARB quickly resolved the pretibial pitting edema shortly after the administration..

CONCLUSIONS: In this case, increased activity of the renin-angiotensin-aldosterone system stimulated by thyroid hormone was likely responsible for the patient's pitting type of edema. The pharmacological blockade of the renin-angiotensin-aldosterone system was thought to be effective for the quick resolution of the symptom.

Keywords: Hyperthyroidism; Renin-Angiotensin System; Thyroiditis

References

  1. Mol Pharmacol. 1999 Apr;55(4):625-31 - PubMed
  2. Arch Intern Med. 1976 Apr;136(4):441-3 - PubMed
  3. J Clin Endocrinol Metab. 1994 May;78(5):1026-7 - PubMed
  4. Eur J Endocrinol. 1997 Jun;136(6):656-60 - PubMed
  5. Gynecol Obstet Invest. 2013;76(3):163-70 - PubMed
  6. Tex Heart Inst J. 2005;32(2):244-5 - PubMed
  7. J Clin Invest. 2003 Jul;112(1):76-82 - PubMed
  8. J Clin Endocrinol Metab. 1997 Jan;82(1):306-8 - PubMed
  9. Immunopharmacol Immunotoxicol. 2012 Oct;34(5):874-8 - PubMed
  10. Horm Metab Res. 2010 Jan;42(1):65-9 - PubMed
  11. J Med Case Rep. 2012 Aug 30;6:258 - PubMed
  12. Am J Physiol Renal Physiol. 2003 Sep;285(3):F558-64 - PubMed
  13. N Engl J Med. 2003 Jun 26;348(26):2646-55 - PubMed
  14. Am J Physiol. 1997 Feb;272(2 Pt 1):E227-32 - PubMed
  15. Horm Metab Res. 1989 Sep;21(9):514-8 - PubMed
  16. Hormones (Athens). 2002 Apr-Jun;1(2):104-12 - PubMed
  17. Endocr J. 2005 Oct;52(5):537-42 - PubMed
  18. N Engl J Med. 1994 Jun 16;330(24):1731-8 - PubMed
  19. Endocr Rev. 1983 Fall;4(4):378-88 - PubMed
  20. Medicine (Baltimore). 1994 Jan;73(1):1-7 - PubMed
  21. N Engl J Med. 2008 Jun 12;358(24):2594-605 - PubMed
  22. Am J Med. 1992 Jul;93(1):61-8 - PubMed
  23. Reprod Sci. 2008 Jul;15(6):598-603 - PubMed
  24. Clin Endocrinol (Oxf). 2008 Aug;69(2):311-7 - PubMed
  25. J Am Soc Nephrol. 2010 Jul;21(7):1093-6 - PubMed
  26. N Engl J Med. 1982 Nov 4;307(19):1165-70 - PubMed
  27. J Clin Endocrinol Metab. 2007 May;92(5):1736-42 - PubMed
  28. Endocr Rev. 1989 Aug;10(3):366-91 - PubMed
  29. Heart Lung Circ. 2012 Mar;21(3):163-5 - PubMed

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