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    "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&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Patients with hypothyroidism often have cutaneous manifestations such as dry&#44; scaly and rough skin&#44; which may become yellow due to the accumulation of carotene&#46; Dry and brittle hair&#44; thin hair&#44; nail fragility&#44; madarosis and facial edema are common&#46; Edema on the lower limbs or generalized edema can occur&#44; promoting ulcerations and with impact on healing&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;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&#44; 58-year-old&#44; seller&#44; referring nail dystrophy in all the quirodactyls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and first on the halux &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#44; bilaterally&#44; two years ago&#46; He also presented pallor on mucous membranes&#44; periorbital edema &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#44; more exuberant on the right eye&#44; skin of yellowish and fragile tonality&#44; xeroderma&#44; fissures in palms and plants&#44; asthenia and dizziness with reports of falls&#46; Laboratory investigation showed Hb<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#44;7<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; TSH<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>&#956;U&#47;mL&#44; T4L<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65<span class="elsevierStyleHsp" style=""></span>ng&#47;dL &#40;0&#46;54&#8211;1&#46;48<span class="elsevierStyleHsp" style=""></span>ng&#47;dL&#41;&#44; T3<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;25<span class="elsevierStyleHsp" style=""></span>ng&#47;dL&#44; the patient was diagnosed as primary hypothyroidism and received the prescription of levothyroxine&#46; A significant improvement of the symptoms and of the skin was achieved after the first month of treatment &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</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&#46; Thyroid hormone receptors have been found in keratinocytes&#44; fibroblasts&#44; hair follicles and sebaceous glands&#46; Genes responsive to thyroid hormones and elements of the hypothalamic&#8211;pituitary&#8211;thyroid axis were identified on the skin&#46; Hypothyroidism reduces the activity of enzymes in the cholesterol sulfate cycle&#44; causes changes in the skin barrier&#44; affects the development of lamellar granules &#40;Odland bodies&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and promotes the accumulation of mucopolysaccharides and water in the dermis&#46; The increased amount of carotene in the dermis induce a yellowish tone to the skin of the patient with hypothyroidism&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;5</span></a> There is also an increased capillary cycle time &#40;anagen phase&#41; and nail growth and a reduction in eccrine gland secretion&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a> Hypothyroidism must be considered in the differential diagnosis of thickened and brittle nails and hair loss&#44; although this extreme presentation is atypical&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> For the patient here reported&#44; treatment with levothyroxine sodium was initiated&#44; with significant improvement of symptoms and skin changes already observed at the first month&#46; The presented results show the importance of the dermatologist in the diagnosis of systemic diseases&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#8217; contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">Thadeu Santos Silva&#58; Conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analysis&#44; and interpretation of the data&#59; critical review of the manuscript&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Gustavo Baptista de Almeida Faro&#58; Elaboration and writing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">M&#225;rcia Gabrielle Bonfim Cortes&#58; and planning of the study&#59; obtaining&#44; analysis&#44; and interpretation of the data&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Vit&#243;ria Regina Pedreira de Almeida Rego&#58; of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; effective participation in research orientation&#59; critical review of the literature&#46;</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&#46;</p></span></span>"
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Case Report
Primary hypothyroidism with exuberant dermatological manifestations
Thadeu Santos Silvaa,
Autor para correspondência
thadeumed@gmail.com

Corresponding author.
, Gustavo Baptista de Almeida Farob, Márcia Gabrielle Bonfim Cortesb, Vitória Regina Pedreira de Almeida Regob
a Dermatology Service, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
b Dermatology Service, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil
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    "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&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Patients with hypothyroidism often have cutaneous manifestations such as dry&#44; scaly and rough skin&#44; which may become yellow due to the accumulation of carotene&#46; Dry and brittle hair&#44; thin hair&#44; nail fragility&#44; madarosis and facial edema are common&#46; Edema on the lower limbs or generalized edema can occur&#44; promoting ulcerations and with impact on healing&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;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&#44; 58-year-old&#44; seller&#44; referring nail dystrophy in all the quirodactyls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and first on the halux &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#44; bilaterally&#44; two years ago&#46; He also presented pallor on mucous membranes&#44; periorbital edema &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#44; more exuberant on the right eye&#44; skin of yellowish and fragile tonality&#44; xeroderma&#44; fissures in palms and plants&#44; asthenia and dizziness with reports of falls&#46; Laboratory investigation showed Hb<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#44;7<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; TSH<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>&#956;U&#47;mL&#44; T4L<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65<span class="elsevierStyleHsp" style=""></span>ng&#47;dL &#40;0&#46;54&#8211;1&#46;48<span class="elsevierStyleHsp" style=""></span>ng&#47;dL&#41;&#44; T3<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;25<span class="elsevierStyleHsp" style=""></span>ng&#47;dL&#44; the patient was diagnosed as primary hypothyroidism and received the prescription of levothyroxine&#46; A significant improvement of the symptoms and of the skin was achieved after the first month of treatment &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</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&#46; Thyroid hormone receptors have been found in keratinocytes&#44; fibroblasts&#44; hair follicles and sebaceous glands&#46; Genes responsive to thyroid hormones and elements of the hypothalamic&#8211;pituitary&#8211;thyroid axis were identified on the skin&#46; Hypothyroidism reduces the activity of enzymes in the cholesterol sulfate cycle&#44; causes changes in the skin barrier&#44; affects the development of lamellar granules &#40;Odland bodies&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and promotes the accumulation of mucopolysaccharides and water in the dermis&#46; The increased amount of carotene in the dermis induce a yellowish tone to the skin of the patient with hypothyroidism&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;5</span></a> There is also an increased capillary cycle time &#40;anagen phase&#41; and nail growth and a reduction in eccrine gland secretion&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a> Hypothyroidism must be considered in the differential diagnosis of thickened and brittle nails and hair loss&#44; although this extreme presentation is atypical&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> For the patient here reported&#44; treatment with levothyroxine sodium was initiated&#44; with significant improvement of symptoms and skin changes already observed at the first month&#46; The presented results show the importance of the dermatologist in the diagnosis of systemic diseases&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#8217; contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">Thadeu Santos Silva&#58; Conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analysis&#44; and interpretation of the data&#59; critical review of the manuscript&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Gustavo Baptista de Almeida Faro&#58; Elaboration and writing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">M&#225;rcia Gabrielle Bonfim Cortes&#58; and planning of the study&#59; obtaining&#44; analysis&#44; and interpretation of the data&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Vit&#243;ria Regina Pedreira de Almeida Rego&#58; of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; effective participation in research orientation&#59; critical review of the literature&#46;</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&#46;</p></span></span>"
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Informação do artigo
ISSN: 03650596
Idioma original: Inglês
DOI:10.1016/j.abd.2019.07.010
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Prêmio Bernardo Gontijo
Prêmio Bernardo Gontijo
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