The Effects of Corticosteroid and Nonsteroid Anti-Inflammatory Therapies on Permanent Hypothyroidism Occurring After the Subacute Thyroiditis.

OBJECTIVE: Subacute thyroiditis(SAT) is an acute inflammatory, self-limited, and destructive disease of the thyroid gland. Although it is a temporary disease, it has permanent consequences. We aim to investigate the influences of the treatment choice on permanent hypothyroidism occurring after SAT and whether there are predictive factors for the development of permanent hypothyroidism. METHODS: We retrospectively investigated 57 SAT patients admitted to our tertiary hospital between 2017 and 2019. After excluding 6 patients, demographic, clinical, laboratory, and imaging findings of 36 patients treated with NSAIDs and 15 patients treated with corticosteroids were compared. The median duration of follow-up was 4 (3.5-5.5) years. RESULTS: Permanent hypothyroidism occurred in 16 patients (31.4%) of 51 patients. It developed at a significantly higher rate in NSAID users (p=0.019). There was no significant difference in the occurrence of transient hypothyroidism and recurrence (p=0.472, p=0.082). The early maximum TSH values were strongly associated with permanent hypothyroidism. The Odds Ratio (OR) value was 2.59 (95% CI = 1.26 - 5.33, p=0.009), Nagelkerke R2 = 0.821. The early maximum TSH level had a predictive value, with an AUC of 0.966 for post-SAT permanent hypothyroidism (p<0.001). The cutoff values for the early maximum TSH were 9.07uIU/ml (81.3% sensitivity, 100% specificity), and 7.05 uIU/ml (87.5% sensitivity, 94.3% specificity). CONCLUSION: Corticosteroid therapy is significantly effective in preventing permanent hypothyroidism from developing after SAT. The early maximum TSH values are an indicator for the prediction of the development of permanent hypothyroidism.

A case of Madelung's disease accompanied by Klinefelter's syndrome.

UNLABELLED: Madelung's disease is a rare fat metabolism disorder characterised by benign multiple symmetric, encapsulated lipomatosis. The exact cause of the disease is unknown; it may be associated with chronic alcoholism and mutations in mitochondrial DNA (A8344G), but there have been cases without these factors reported in the literature. A 29-year-old man with a 6-year history of diabetes mellitus was admitted to our hospital for poorly regulated diabetes and decreased libido. He was not an alcohol consumer. His family history was unremarkable. Physical examination revealed that he had a eunuchoid body shape. There was a symmetric excess fat accumulation in his submandibular, deltoid, nuchal, suprapubic and inguinal areas. He was diagnosed with Madelung's disease, and imaging studies supported the diagnosis. Hormonal evaluation revealed a hypergonadotropic hypogonadism. Karyotype analysis revealed a 47,XXY mutation. Genetic research showed no mitochondrial DNA mutation. Metabolic disorders, such as diabetes mellitus, hyperlipidaemia, hyperuricaemia and liver disease, endocrine gland diseases, such as hypothyroidism, and neurological diseases, such as polyneuropathy and cognitive disorders, may accompany Madelung's disease. The present study represents the first reported case of Madelung's disease accompanied by Klinefelter's syndrome. LEARNING POINTS: Madelung's disease is a rare fat metabolism disorder characterised by benign multiple symmetric and encapsulated lipid accumulation.The exact cause of the disease is unknown.Metabolic disorders, such as diabetes mellitus, hyperlipidaemia, hyperuricaemia and liver disease, endocrine gland diseases, such as hypothyroidism, and neurological diseases, such as polyneuropathy and cognitive disorders, may accompany Madelung's disease.