Case Report
Primary hypothyroidism with exuberant dermatological manifestations
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"email" => array:1 [ 0 => "thadeumed@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Gustavo Baptista de Almeida" "apellidos" => "Faro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Márcia Gabrielle Bonfim" "apellidos" => "Cortes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Vitória Regina Pedreira de Almeida" "apellidos" => "Rego" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dermatology Service, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatology Service, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 611 "Ancho" => 905 "Tamanyo" => 61898 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dystrophic fingernails in quirodactyls.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Thyroid hormone effects on the skin.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Patients with hypothyroidism often have cutaneous manifestations such as dry, scaly and rough skin, which may become yellow due to the accumulation of carotene. Dry and brittle hair, thin hair, nail fragility, madarosis and facial edema are common. Edema on the lower limbs or generalized edema can occur, promoting ulcerations and with impact on healing.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">Male, 58-year-old, seller, referring nail dystrophy in all the quirodactyls (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and first on the halux (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>), bilaterally, two years ago. He also presented pallor on mucous membranes, periorbital edema (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), more exuberant on the right eye, skin of yellowish and fragile tonality, xeroderma, fissures in palms and plants, asthenia and dizziness with reports of falls. Laboratory investigation showed Hb<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10,7<span class="elsevierStyleHsp" style=""></span>g/dL, TSH<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>μU/mL, T4L<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.65<span class="elsevierStyleHsp" style=""></span>ng/dL (0.54–1.48<span class="elsevierStyleHsp" style=""></span>ng/dL), T3<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.25<span class="elsevierStyleHsp" style=""></span>ng/dL, the patient was diagnosed as primary hypothyroidism and received the prescription of levothyroxine. A significant improvement of the symptoms and of the skin was achieved after the first month of treatment (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Cutaneous manifestations are important as external markers of thyroid disease. Thyroid hormone receptors have been found in keratinocytes, fibroblasts, hair follicles and sebaceous glands. Genes responsive to thyroid hormones and elements of the hypothalamic–pituitary–thyroid axis were identified on the skin. Hypothyroidism reduces the activity of enzymes in the cholesterol sulfate cycle, causes changes in the skin barrier, affects the development of lamellar granules (Odland bodies),<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and promotes the accumulation of mucopolysaccharides and water in the dermis. The increased amount of carotene in the dermis induce a yellowish tone to the skin of the patient with hypothyroidism.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,5</span></a> There is also an increased capillary cycle time (anagen phase) and nail growth and a reduction in eccrine gland secretion.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> Hypothyroidism must be considered in the differential diagnosis of thickened and brittle nails and hair loss, although this extreme presentation is atypical.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> For the patient here reported, treatment with levothyroxine sodium was initiated, with significant improvement of symptoms and skin changes already observed at the first month. The presented results show the importance of the dermatologist in the diagnosis of systemic diseases.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors’ contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">Thadeu Santos Silva: Conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; critical review of the manuscript.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Gustavo Baptista de Almeida Faro: Elaboration and writing of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Márcia Gabrielle Bonfim Cortes: and planning of the study; obtaining, analysis, and interpretation of the data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Vitória Regina Pedreira de Almeida Rego: of the final version of the manuscript; elaboration and writing of the manuscript; effective participation in research orientation; critical review of the literature.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1418416" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1297625" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Financial support" ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Authors’ contributions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-07" "fechaAceptado" => "2019-07-11" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1297625" "palabras" => array:5 [ 0 => "Hypothyroidism" 1 => "Thyroid diseases" 2 => "Thyroid gland" 3 => "Thyroid hormones" 4 => "Thyroxine" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Thyroid hormone has effects on the skin. Patients with hypothyroidism have changes such as dry, scaly and rough skin. Increase carotene in the dermis becomes a yellowish tone to the skin of the patient with hypothyroidism. There is an increase in capillary cycle (anagen phase) and nail growth and a reduction in eccrine gland secretion. It is a case of primary hypothyroidism with nail manifestations associated with dermatologic disorders and successful treatment with levothyroxine. Receptors for thyroid hormone have already been found in keratinocytes, fibroblasts, hair follicles and sebaceous glands. Genes responsive to thyroid hormones and elements of the hypothalamic–pituitary–thyroid axis were identified on the skin. This report highlights the importance of cutaneous manifestations as markers of thyroid disease.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Silva TS, Faro GBA, Cortes MGB, Rego VRPA. Primary hypothyroidism with exuberant dermatological manifestations. An Bras Dermatol. 2020;95.</p>" ] 1 => array:2 [ "etiqueta" => "⋆⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Universidade Federal da Bahia, Salvador, BA, Brazil.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 611 "Ancho" => 905 "Tamanyo" => 61898 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dystrophic fingernails in quirodactyls.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1067 "Ancho" => 905 "Tamanyo" => 105553 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dystrophic fingernails on toes and malleolar edema.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1256 "Ancho" => 905 "Tamanyo" => 124161 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Desquamation and nail pigmentation in the hallux.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1247 "Ancho" => 905 "Tamanyo" => 156017 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Myxedematous facies, pallor and periorbital edema.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 631 "Ancho" => 905 "Tamanyo" => 83746 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Significant improvement of lesions after 30 days of hormone replacement.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thyroid hormone action on skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 21 | 9 | 30 |
| 2024 October | 88 | 73 | 161 |
| 2024 September | 133 | 91 | 224 |
| 2024 August | 136 | 110 | 246 |
| 2024 July | 129 | 108 | 237 |
| 2024 June | 114 | 77 | 191 |
| 2024 May | 87 | 65 | 152 |
| 2024 April | 84 | 89 | 173 |
| 2024 March | 85 | 64 | 149 |
| 2024 February | 92 | 83 | 175 |
| 2024 January | 65 | 46 | 111 |
| 2023 December | 64 | 65 | 129 |
| 2023 November | 75 | 70 | 145 |
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| 2023 September | 67 | 70 | 137 |
| 2023 August | 65 | 37 | 102 |
| 2023 July | 61 | 43 | 104 |
| 2023 June | 58 | 37 | 95 |
| 2023 May | 54 | 34 | 88 |
| 2023 April | 49 | 29 | 78 |
| 2023 March | 71 | 66 | 137 |
| 2023 February | 58 | 33 | 91 |
| 2023 January | 45 | 47 | 92 |
| 2022 December | 58 | 41 | 99 |
| 2022 November | 61 | 61 | 122 |
| 2022 October | 92 | 57 | 149 |
| 2022 September | 48 | 65 | 113 |
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| 2022 July | 37 | 54 | 91 |
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| 2022 April | 46 | 45 | 91 |
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| 2022 February | 25 | 57 | 82 |
| 2022 January | 53 | 69 | 122 |
| 2021 December | 36 | 54 | 90 |
| 2021 November | 42 | 57 | 99 |
| 2021 October | 60 | 81 | 141 |
| 2021 September | 36 | 41 | 77 |
| 2021 August | 47 | 49 | 96 |
| 2021 July | 48 | 48 | 96 |
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| 2021 May | 65 | 75 | 140 |
| 2021 April | 275 | 271 | 546 |
| 2021 March | 99 | 90 | 189 |
| 2021 February | 37 | 21 | 58 |
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| 2020 December | 32 | 19 | 51 |
| 2020 November | 18 | 20 | 38 |
| 2020 October | 8 | 11 | 19 |
| 2020 September | 13 | 17 | 30 |
| 2020 August | 8 | 11 | 19 |
| 2020 July | 24 | 12 | 36 |
| 2020 June | 14 | 11 | 25 |
| 2020 May | 9 | 11 | 20 |
| 2020 April | 0 | 4 | 4 |
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