Bone mineral density and bone turnover markers in patients on long-term suppressive levothyroxine therapy for differentiated thyroid cancer

PURPOSE: Current management for patients with differentiated thyroid cancer includes near total thyroidectomy and radioactive iodine therapy followed by administration of supraphysiological doses of levothyroxine (L-T4). Although hyperthyroidism is a well known risk factor for osteoporosis, the effects of L-T4 treatment on bone mineral density (BMD) in patients with thyroid cancer do not appear to be as significant as with endogenous hyperthyroidism. In this study, we evaluated the impact of long-term suppressive therapy with L-T4 on BMD and bone turn over markers in Korean female patients receiving L-T4 suppressive therapy. METHODS: We enrolled 94 female subjects (mean age, 50.84 +/- 11.43 years) receiving L-T4 after total or near total thyroidectomy and radioactive iodine therapy for thyroid cancer (mean follow-up period, 12.17 +/- 4.27 years). The subjects were divided into three groups by thyroid stimulating hormone (TSH) level (group 1 with TSH level 0.17 microIU/mL) and four groups by quartile of free T4 level. L-T4 dosage, BMD (examined by dual-energy x-ray absorptiometry), and bone turnover markers were evaluated according to TSH and free T4 levels. RESULTS: No significant decrease was detected in BMD or bone turnover markers according to TSH level or free T4 level. Also, the prevalence of osteoporosis and osteopenia was not different among groups. CONCLUSION: Long-term L-T4 suppressive therapy after thyroid cancer management did not affect bone density or increase the prevalence of osteoporosis even though TSH levels were supraphysiologically suppressed.

Hypersensitivity myocarditis confirmed by cardiac magnetic resonance imaging and endomyocardial biopsy

Myocarditis often occurs due to viral infections and postviral immune-mediated responses. Hypersensitivity myocarditis is a rare form of myocarditis. Numerous drugs can induce myocarditis, which is typically reversible after withdrawal of the causative agent. Here, we report a case of hypersensitivity myocarditis that was probably triggered by amoxicillin and that resolved completely with heart failure management as well as discontinuation of the drug. A 68-year-old woman presented with acute chest pain mimicking acute coronary syndromes, but the coronary angiography was normal. A recent history of taking medications, skin rash, and peripheral eosinophilia suggested a diagnosis of hypersensitivity myocarditis, which was confirmed by cardiac magnetic resonance imaging and endomyocardial biopsy.

A Case of Rheumatoid Arthritis with Chronic Eosinophilic Pneumonia Associated with Eosinophilic Pleural Effusion

We describe a 48-year-old man with family history of rheumatoid arthritis (RA) affected by chronic eosinophilic pneumonia (CEP) with severe peripheral eosinophilia. CEP might develop as a complication of longstanding active RA. The patient with 5 months history of seropositive RA and chronic respiratory symptoms, alveolar and blood eosinophilia, peripheral pulmonary infiltrates and pleural effusion on chest imaging. The lung may be involved as an extraarticular manifestation of RA. However, CEP is not recognized as a typical lung manifestation of RA, and the two diseases rarely coexist. The effusion was an eosinophil predominant exudates and was characterized by low pH, and glucose level and high lactic dehydrogenase. The patient responded rapidly to combination of steroids and disease modifying anti-rheumatic drugs.

A Case of Dermatomyositis Presenting with Rhabdomyolysis

Rhabdomyolysis is caused by injury to skeletal muscle and it involves leakage of intracellular contents into the plasma. Rhabdomyolysis is an extremely rare manifestation of dermatomyositis. Dermatomyositis is a rare idiopathic inflammatory myopathy that is characterized by chronic inflammation of skeletal muscles and skin, resulting in muscle weakness. A 20 year old Korean male soldier presented with acute muscle pain, weakness and skin rashes over the face, neck and anterior chest. He received military training with carrying a radio set one week previouslyago. The patient was treated for rhabdomyolysis. However, the patient's symptoms did not improve. Muscle biopsy results suggested the diagnosis of rhabdomyolysis. Nevertheless, the features of skin and muscle inflammation raised the possibility of dermatomyositis. High dose steroid treatment was started, and then the symptoms and signs of muscle inflammation were improved. Rhabdomyolysis as the presenting sign of dermatomyositis has not been reported in Korea. Thus, we report on this case with a literature review.