Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Electrolyte disorders in hypothyroidism are frequently subtle and rarely observed in clinical practice. A 50-year-old woman was admitted to the emergency room with complaints of nausea, weakness, and lethargy. Her medical history revealed total thyroidectomy two years earlier. She was commenced on L-thyroxine after the surgery. However, the patient stopped the treatment for three months. Thyroid function tests showed free T3 0.80 pg/ml (n: 1.8-4.2), free T4 <0.20 ng/dl (n: 0.8-1.9), TSH 56.84 microU/ml (n: 0.4-4.0). Her biochemical and laboratory investigations were normal, except for a plasma sodium value of 114 mmol/L (n: 135-145). Hypertonic saline treatment with L-thyroxine was immediately started. Symptomatic hyponatremia caused by hypothyroidism was the direct consequence of cessation of L-thyroxine treatment. The patient was followed up for a year and still using L-thyroxine (0.1 mg). In conclusion, it should be kept in mind that life-threatening hyponatremia may occur in patients with total thyroidectomy-induced hypothyroidism; L-thyroxine should be immediately started if stopped for any reason.
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PMID:Life-threatening hyponatremia due to cessation of L-thyroxine. 1462 Jul 14

A 178-kg, 14-yr-old captive female American black bear (Ursus americanus) was examined because of lethargy, inappetance, obesity, and alopecia. Serum chemistry and complete blood count values were within normal limits. Based on serum levels for total thyroxine (T4), free T4 by equilibrium dialysis (fT4ED), and canine thyroid-stimulating hormone concentrations, using assays validated for domestic dogs, hypothyroidism was diagnosed presumptively, and therapy with levothyroxine sodium (0.022 mg/kg p.o. b.i.d.) was initiated. Haircoat, body weight, appetite, and activity level improved within 30 days. The levothyroxine dose was decreased twice (to 0.018 mg/kg p.o. b.i.d. and then to 0.011 mg/kg p.o. b.i.d.) during the course of treatment based on monitoring of serum T4 and fT4ED concentrations. After euthanasia for severe refractory lameness, postmortem examination revealed bilateral thyroid lobe enlargement and a fluid-filled cyst within the right lobe. Histologically, colloid goiter was present in both lobes, and a follicular cystadenoma had replaced one third of the cranial pole of the right lobe. The goiter and cystadenoma likely contributed to the hypothyroid condition in this bear and fT4ED was a more sensitive indicator of hypothyroidism than was T4. The recommended canine dosage of levothyroxine may be too high for the treatment of hypothyroidism in American black bears; 0.011 mg/kg p.o. b.i.d. may be a more appropriate dosage.
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PMID:Thyroid cystadenoma, colloid goiter, and hypothyroidism in an American black bear (Ursus americanus). 1519 79

The aim of this study was to assess the prevalence of Antimicrosomal Antibodies AMA, thyroid function and the occurrence of hypothyroidism symptoms in patients with Multiple Sclerosis (MS). Clinical examination was carried out in 21 MS patients; thyroid-stimulating hormone (TSH), thyroxine (T4), free T4 and AMA were measured. Mean age was 41.05 years. Hypothyroidism symptoms included fatigue, weakness, lethargy and paresthesia. AMA were found in four patients (19%). Three categories of disease duration were considered: <60 months (3 patients AMA+; 7 AMA-), 60-120 months (8 patients AMA-), and >120 months (1 patient AMA+; 2 AMA-). Two patients presented decreased free T4 levels, but there was no associated decrease in T4 and TSH levels. In two patients, a mild increase in TSH levels was observed: one presented normal T4 levels (subclinical hypothyroidism) and the other one had low free T4 levels (classical hypothyroidism). We conclude that AMA measurement and thyroid function tests should become part of the routine assessment of MS patients, in view of the inaccuracy currently observed in the assessment of clinical hypothyroidism as a result of the superposition of hypothyroidism and MS signs and symptoms.
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PMID:[Prevalence of antimicrosomal antibodies in patients with multiple sclerosis]. 1533 29

Cyclic vomiting syndrome (CVS), characterized by severe discrete episodes of nausea, vomiting, and lethargy, is a fairly common, disabling, predominately-childhood condition most often associated with migraine and dysautonomic features. Our group recently reported that children with CVS and additional neuromuscular disease manifestations demonstrate strong maternal inheritance of multiple disease manifestations and abnormal urine organic acids, suggesting the presence of predisposing mitochondrial DNA (mtDNA) sequence variants. In order to determine if maternal inheritance is present in CVS in general, a clinical interview was administered regarding 80 unrelated individuals with CVS ascertained randomly from the database of the Cyclic Vomiting Syndrome Association (CVSA). Disease manifestations consistent with potential mitochondrial dysfunction were far more common in matrilineal (sharing the same mtDNA sequence) versus in non-matrilineal relatives, including mothers versus fathers (P = 3 x 10(-9)) and maternal versus paternal grandmothers (P = 2 x 10(-6)). Maternal inheritance is suggested in 52% of the 23 subjects with two or more neuromuscular abnormalities ("CVS+") and in 54% of the 44 subjects without any neuromuscular abnormalities ("CVS-"). In both the CVS+ and CVS- sub-groups, subjects, and affected matrilineal relatives of all ages suffer at a far higher incidence from several dysautonomic-related conditions, including migraine and irritable bowel, as well as depression and hypothyroidism, while neuromuscular and cognitive disorders such as hypotonia and ADHD are common only in affected children. We conclude that mtDNA sequences predispose towards the development of protean disease manifestations in CVS patients ascertained through a disease-specific association, as well as among their matrilineal relatives, whether or not neuromuscular disease is present in the proband. Since CVS was absent in all but one matrilineal relative of our probands, CVS is apparently a rare clinical presentation in individuals carrying the predisposing mtDNA sequences. The four conditions reported most frequently among the matrilineal relatives of our cases, migraine, depression, irritable bowel, and hypothyroidism, are known to segregate together in families, and our findings suggest that a common predisposing genetic factor is likely present on the mtDNA.
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PMID:Maternal inheritance in cyclic vomiting syndrome. 1564 22

A 56-year-old man with unstable angina underwent urgent coronary artery bypass grafting. The patient required reintubation and prolonged ventilation because of persistent drowsiness and hypotension. The patient was weaned off the ventilator and extubated; however, he remained drowsy and lethargic. Neurologic examination, electroencephalogram, and computed tomography scan of the brain did not show any organic cause of his depressed neurologic status. His metabolic profile revealed severe hypothyroidism. The patient responded well to oral thyroxine. We report the unusual manner in which hypothyroidism presented in the patient. A high index of suspicion is required to diagnose and treat this complication.
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PMID:Severe hypothyroidism after coronary artery bypass grafting. 1603 38

We present a case of a malnourished 68-year old man with occult hypothyroidism who presented with malaise, pyrexia, tongue swelling, oral ulceration and dysphagia after a 6-month period of increasing lethargy and failing self-care. Severe necrotic oral ulcerative lesions were accompanied by cutaneous purpura, blood-filled blisters and bedsores. It was concluded that the patient's clinical condition reflected necrotizing stomatitis on a background of malnutrition with scorbutic skin lesions and hypothyroidism. The patient made a good recovery with scrupulous oral hygiene, debridement, intravenous metronidazole and nutritional support. Healing occurred with marked fibrosis and trismus, which has slowly improved with mouth-opening exercises. Necrotizing stomatitis is more commonly encountered in malnourished children in developing countries, and may subsequently result in devastating facial defects and death. Patients in the developed world with poor oral hygiene, malnourishment and immunosuppression are also at risk, but early diagnosis and treatment is life-saving and reduces subsequent disability.
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PMID:Necrotizing stomatitis in the developed world. 1668 79

The case of a 63-year-old woman who presented with status epilepticus, coma and hypoventilation is reported. A primary neurological cause was considered. Hypothermia led to further investigations and a diagnosis of severe hypothyroidism. The neurological complications of hyperthyriodism include alteration in mental status with slowness, decreased concentration and lethargy, headache, cranial nerve palsies, dysarthria, hoarseness, myopathy, neuropathy, reflex changes, ataxia, and psychotic episodes. Our patient suffered from a rare consequence of severe hypothyroidism presenting with status epilepticus and she died despite treatment. To our knowledge this is the second patient to be reported with myxoedema coma with this kind of presentation. Despite therapeutic options, there is a high mortality rate.
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PMID:Status epilepticus caused by a myxoedema coma. 1712 58

An 18-month-old boxer was presented for investigation of profound lethargy, and primary hypothyroidism was diagnosed. A strong antithyroglobulin antibody titre was also present, indicating lymphocytic (immune-mediated) thyroiditis as the cause of hypothyroidism. A concurrent protein-losing glomerulonephropathy was also detected, although the aetiology could not be determined at initial presentation. Thyroid replacement and dietary therapy were prescribed. The dog improved clinically for approximately 12 months when it was re-presented with poorly controlled hypothyroidism and renal failure. Postmortem examination confirmed the presence of lymphocytic-plasmacytic thyroiditis, in conjunction with membranoproliferative glomerulonephritis and renal failure.
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PMID:Lymphocytic-plasmacytic thyroiditis and glomerulonephritis in a boxer. 1684 77

Iatrogenic hyperadrenocorticism is an extremely rare condition in cats. Twelve cats with a medical history of progressive skin lesions and long-term treatment with corticosteroids were retrospectively studied. Noncutaneous signs in the cats were variable and included anorexia, lethargy, polydipsia, polyuria, and atrophy of the thigh muscles. Laboratory abnormalities included leukocytosis, elevated alanine aminotransferase levels, and hyperglycemia. Transient diabetes mellitus was a secondary complication in four cats, and transient hypothyroidism was suspected in four cats. The mean time for regression of signs was 4.9 months after corticosteroid withdrawal.
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PMID:Iatrogenic hyperadrenocorticism in 12 cats. 1708 87

A bitch, with a history of prolonged postweaning galactorrhea, dermatitis and lethargy, was examined because of an extended anestrus and the development of spontaneous galactorrhea. A diagnosis of hypothyroidism was made based on the history, a subnormal T(4) level and the response to a therapeutic trial of thyroxine replacement. A possible pathogenesis for the spontaneous galactorrhea is discussed.
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PMID:Anestrus and spontaneous galactorrhea in a hypothyroid bitch. 1742 55


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