An unusual cause of orthopnoea-hashimoto's thyroiditis presenting as bilateral diaphragmatic palsy

Abstract We report a case of 36 yr old male without any comorbidities, who presented with a history of gradually progressive dyspnoea and orthopnoea for 6 months. Physical examination revealed bradycardia, paradoxical respiration suggestive of bilateral diaphragmatic palsy. Fluoroscopy demonstrated...

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Published inRespiratory medicine case reports Vol. 21; no. C; pp. 132 - 134
Main Authors Thulaseedharan, N.K., MBBS, MD(General Medicine), Geetha, P., MBBS, MD(General Medicine), Arathi, N., MBBS, MD(General Medicine), Shameer, V.K., MBBS, MD(General Medicine), Jayachandran, N.V., MBBS, MD(General Medicine), Subramaniam, Gomathy, MBBS, MD(Radiodiagnosis), Narayanan, Santhosh, MBBS, MD(General Medicine)
Format Journal Article
LanguageEnglish
Published England Elsevier Ltd 01.01.2017
Elsevier
Subjects
Case Report
Diaphragmatic palsy
hashimoto's thyroiditis
Hypothyroidism
Internal Medicine
Orthopnoea
Pulmonary/Respiratory
hashimoto's thyroiditis
Hypothyroidism
Diaphragmatic palsy
Orthopnoea
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Abstract Abstract We report a case of 36 yr old male without any comorbidities, who presented with a history of gradually progressive dyspnoea and orthopnoea for 6 months. Physical examination revealed bradycardia, paradoxical respiration suggestive of bilateral diaphragmatic palsy. Fluoroscopy demonstrated the presence of bilateral diaphragmatic paralysis. Etiological work up showed evidence of autoimmune hypothyroidism due to hashimoto's thyroiditis. Other possibilities were ruled out with appropriate tests. He was started on thyroxine and showed symptomatic improvement.
AbstractList We report a case of 36 yr old male without any comorbidities, who presented with a history of gradually progressive dyspnoea and orthopnoea for 6 months. Physical examination revealed bradycardia, paradoxical respiration suggestive of bilateral diaphragmatic palsy. Fluoroscopy demonstrated the presence of bilateral diaphragmatic paralysis. Etiological work up showed evidence of autoimmune hypothyroidism due to hashimoto's thyroiditis. Other possibilities were ruled out with appropriate tests. He was started on thyroxine and showed symptomatic improvement.
Abstract We report a case of 36 yr old male without any comorbidities, who presented with a history of gradually progressive dyspnoea and orthopnoea for 6 months. Physical examination revealed bradycardia, paradoxical respiration suggestive of bilateral diaphragmatic palsy. Fluoroscopy demonstrated the presence of bilateral diaphragmatic paralysis. Etiological work up showed evidence of autoimmune hypothyroidism due to hashimoto's thyroiditis. Other possibilities were ruled out with appropriate tests. He was started on thyroxine and showed symptomatic improvement.
Author Thulaseedharan, N.K., MBBS, MD(General Medicine)
Geetha, P., MBBS, MD(General Medicine)
Jayachandran, N.V., MBBS, MD(General Medicine)
Narayanan, Santhosh, MBBS, MD(General Medicine)
Subramaniam, Gomathy, MBBS, MD(Radiodiagnosis)
Shameer, V.K., MBBS, MD(General Medicine)
Arathi, N., MBBS, MD(General Medicine)
AuthorAffiliation a Department of Medicine, Govt. Medical College, Kozhikode, Kerala, India
b Department of Radiodiagnosis, Govt. Medical College, Kozhikode, Kerala, India
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Cites_doi 10.1016/S0009-9260(66)80128-9
10.1186/1750-1172-4-10
10.1136/thx.44.11.960
10.1016/j.nmd.2004.01.003
10.1164/rccm.166.4.518
10.1007/s00408-009-9140-z
10.1016/S0022-510X(99)00045-3
10.1164/ajrccm/147.4.1050
10.1016/S0022-5223(19)38936-6
10.1055/s-0029-1222445
10.1164/ajrccm/136.5.1276
10.4065/79.12.1563
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Issue C
Keywords hashimoto's thyroiditis
Hypothyroidism
Diaphragmatic palsy
Orthopnoea
Language English
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References Stojkovic, Latour, Viet (bib2) 2004; 14
Martinez, Bermudez-Gomez, Celli Chest (bib14) 1989 Nov; 96
Kleopa, Sherman, Neal (bib10) 1999; 164
Hill (bib12) 1993; 147
Alexander (bib6) 1966; 17
Celli, Rassulo, Corral (bib4) 1987; 136
Carratu, Spicuzza, Cassano (bib11) 2009; 4
Piehler, Pairolero, Gracey, Bernatez (bib3) 1982; 84
(bib7) 2002; 166
Crausman, Summerhill, McCool (bib13) 2009; 187
Kumar, Folger, Bolton (bib1) 2004; 79
Davis, Goldman, Loh, Casson (bib8) 1976; 45
Gibson (bib9) 1989; 44
Qureshi (bib5) 2009; 30
Kleopa (10.1016/j.rmcr.2017.04.016_bib10) 1999; 164
Alexander (10.1016/j.rmcr.2017.04.016_bib6) 1966; 17
Qureshi (10.1016/j.rmcr.2017.04.016_bib5) 2009; 30
(10.1016/j.rmcr.2017.04.016_bib7) 2002; 166
Crausman (10.1016/j.rmcr.2017.04.016_bib13) 2009; 187
Stojkovic (10.1016/j.rmcr.2017.04.016_bib2) 2004; 14
Hill (10.1016/j.rmcr.2017.04.016_bib12) 1993; 147
Kumar (10.1016/j.rmcr.2017.04.016_bib1) 2004; 79
Celli (10.1016/j.rmcr.2017.04.016_bib4) 1987; 136
Gibson (10.1016/j.rmcr.2017.04.016_bib9) 1989; 44
Davis (10.1016/j.rmcr.2017.04.016_bib8) 1976; 45
Martinez (10.1016/j.rmcr.2017.04.016_bib14) 1989; 96
Carratu (10.1016/j.rmcr.2017.04.016_bib11) 2009; 4
Piehler (10.1016/j.rmcr.2017.04.016_bib3) 1982; 84
References_xml – volume: 96
  start-page: 1059
  year: 1989 Nov
  end-page: 1063
  ident: bib14
  article-title: A reversible cause of diaphragmatic dysfunction
  publication-title: Hypothyroidism
  contributor:
    fullname: Celli Chest
– volume: 84
  start-page: 861
  year: 1982
  ident: bib3
  article-title: Unexplained diaphragmatic paralysis:a harbinger of malignant disease?
  publication-title: J. Thorac. Cardiovasc Surg.
  contributor:
    fullname: Bernatez
– volume: 164
  start-page: 82
  year: 1999
  ident: bib10
  article-title: Bipap improves survival and rate of pulmonary function decline in patients with ALS
  publication-title: J. Neurol. Sci.
  contributor:
    fullname: Neal
– volume: 147
  start-page: 1050
  year: 1993
  ident: bib12
  article-title: Noninvasive ventilation. Does it work,for whom and how?
  publication-title: Am. Rev. Respir. Dis.
  contributor:
    fullname: Hill
– volume: 79
  start-page: 1563
  year: 2004
  ident: bib1
  article-title: Dyspnoea as the predominant manifestation of bilateral phrenic neuropathy
  publication-title: Mayo Cl. Proc.
  contributor:
    fullname: Bolton
– volume: 166
  start-page: 518
  year: 2002
  ident: bib7
  article-title: ATS/ERS Statement on respiratory muscle testing
  publication-title: Am. J. Respir. Crit. Care Med.
– volume: 136
  start-page: 1276
  year: 1987
  ident: bib4
  article-title: Ventilatory muscle dysfunction in patients with bilateral idiopathic diaphragmatic paralysis:reversal by intermittent external negative pressure ventilation
  publication-title: Am Rev. Respir. Dis.
  contributor:
    fullname: Corral
– volume: 14
  start-page: 261
  year: 2004
  ident: bib2
  article-title: Vocal cord and diaphragm paralysis,as clinical features of a French family with autosomal recessive charcot marie tooth disease,associated with a new mutation in the GDAP 1 gene
  publication-title: Neuromuscul. Disord.
  contributor:
    fullname: Viet
– volume: 45
  start-page: 87
  year: 1976
  ident: bib8
  article-title: Diaphragm function and alveolar hypoventilation
  publication-title: Q. J. Med.
  contributor:
    fullname: Casson
– volume: 30
  start-page: 315
  year: 2009
  ident: bib5
  article-title: Diaphragm paralysis
  publication-title: Semin. Respir. Crit. Care Med.
  contributor:
    fullname: Qureshi
– volume: 187
  start-page: 153
  year: 2009
  ident: bib13
  article-title: Idiopathic diaphragmatic paralysis:Bell's palsy of the diaphragm?
  publication-title: Lung
  contributor:
    fullname: McCool
– volume: 17
  start-page: 79
  year: 1966
  ident: bib6
  article-title: Diaphragm movements and the diagnosis of diaphragmatic paralysis
  publication-title: Clin. Radiol.
  contributor:
    fullname: Alexander
– volume: 4
  start-page: 10
  year: 2009
  ident: bib11
  article-title: Early treatment with noninvasive positive pressure ventilation prolongs survival in amyotrophic lateral sclerosis patients with nocturnal respiratory insufficiency
  publication-title: Orphanet J. Rare Dis.
  contributor:
    fullname: Cassano
– volume: 44
  start-page: 960
  year: 1989
  ident: bib9
  article-title: Diaphragmatic paresis:pathophysiology,clinical features and investigations
  publication-title: Thorax
  contributor:
    fullname: Gibson
– volume: 17
  start-page: 79
  year: 1966
  ident: 10.1016/j.rmcr.2017.04.016_bib6
  article-title: Diaphragm movements and the diagnosis of diaphragmatic paralysis
  publication-title: Clin. Radiol.
  doi: 10.1016/S0009-9260(66)80128-9
  contributor:
    fullname: Alexander
– volume: 4
  start-page: 10
  year: 2009
  ident: 10.1016/j.rmcr.2017.04.016_bib11
  article-title: Early treatment with noninvasive positive pressure ventilation prolongs survival in amyotrophic lateral sclerosis patients with nocturnal respiratory insufficiency
  publication-title: Orphanet J. Rare Dis.
  doi: 10.1186/1750-1172-4-10
  contributor:
    fullname: Carratu
– volume: 44
  start-page: 960
  year: 1989
  ident: 10.1016/j.rmcr.2017.04.016_bib9
  article-title: Diaphragmatic paresis:pathophysiology,clinical features and investigations
  publication-title: Thorax
  doi: 10.1136/thx.44.11.960
  contributor:
    fullname: Gibson
– volume: 96
  start-page: 1059
  issue: 5
  year: 1989
  ident: 10.1016/j.rmcr.2017.04.016_bib14
  article-title: A reversible cause of diaphragmatic dysfunction
  publication-title: Hypothyroidism
  contributor:
    fullname: Martinez
– volume: 14
  start-page: 261
  year: 2004
  ident: 10.1016/j.rmcr.2017.04.016_bib2
  article-title: Vocal cord and diaphragm paralysis,as clinical features of a French family with autosomal recessive charcot marie tooth disease,associated with a new mutation in the GDAP 1 gene
  publication-title: Neuromuscul. Disord.
  doi: 10.1016/j.nmd.2004.01.003
  contributor:
    fullname: Stojkovic
– volume: 166
  start-page: 518
  year: 2002
  ident: 10.1016/j.rmcr.2017.04.016_bib7
  article-title: ATS/ERS Statement on respiratory muscle testing
  publication-title: Am. J. Respir. Crit. Care Med.
  doi: 10.1164/rccm.166.4.518
– volume: 187
  start-page: 153
  year: 2009
  ident: 10.1016/j.rmcr.2017.04.016_bib13
  article-title: Idiopathic diaphragmatic paralysis:Bell's palsy of the diaphragm?
  publication-title: Lung
  doi: 10.1007/s00408-009-9140-z
  contributor:
    fullname: Crausman
– volume: 164
  start-page: 82
  year: 1999
  ident: 10.1016/j.rmcr.2017.04.016_bib10
  article-title: Bipap improves survival and rate of pulmonary function decline in patients with ALS
  publication-title: J. Neurol. Sci.
  doi: 10.1016/S0022-510X(99)00045-3
  contributor:
    fullname: Kleopa
– volume: 147
  start-page: 1050
  year: 1993
  ident: 10.1016/j.rmcr.2017.04.016_bib12
  article-title: Noninvasive ventilation. Does it work,for whom and how?
  publication-title: Am. Rev. Respir. Dis.
  doi: 10.1164/ajrccm/147.4.1050
  contributor:
    fullname: Hill
– volume: 84
  start-page: 861
  year: 1982
  ident: 10.1016/j.rmcr.2017.04.016_bib3
  article-title: Unexplained diaphragmatic paralysis:a harbinger of malignant disease?
  publication-title: J. Thorac. Cardiovasc Surg.
  doi: 10.1016/S0022-5223(19)38936-6
  contributor:
    fullname: Piehler
– volume: 30
  start-page: 315
  year: 2009
  ident: 10.1016/j.rmcr.2017.04.016_bib5
  article-title: Diaphragm paralysis
  publication-title: Semin. Respir. Crit. Care Med.
  doi: 10.1055/s-0029-1222445
  contributor:
    fullname: Qureshi
– volume: 136
  start-page: 1276
  year: 1987
  ident: 10.1016/j.rmcr.2017.04.016_bib4
  article-title: Ventilatory muscle dysfunction in patients with bilateral idiopathic diaphragmatic paralysis:reversal by intermittent external negative pressure ventilation
  publication-title: Am Rev. Respir. Dis.
  doi: 10.1164/ajrccm/136.5.1276
  contributor:
    fullname: Celli
– volume: 45
  start-page: 87
  year: 1976
  ident: 10.1016/j.rmcr.2017.04.016_bib8
  article-title: Diaphragm function and alveolar hypoventilation
  publication-title: Q. J. Med.
  contributor:
    fullname: Davis
– volume: 79
  start-page: 1563
  year: 2004
  ident: 10.1016/j.rmcr.2017.04.016_bib1
  article-title: Dyspnoea as the predominant manifestation of bilateral phrenic neuropathy
  publication-title: Mayo Cl. Proc.
  doi: 10.4065/79.12.1563
  contributor:
    fullname: Kumar
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Snippet Abstract We report a case of 36 yr old male without any comorbidities, who presented with a history of gradually progressive dyspnoea and orthopnoea for 6...
We report a case of 36 yr old male without any comorbidities, who presented with a history of gradually progressive dyspnoea and orthopnoea for 6 months....
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Diaphragmatic palsy
hashimoto's thyroiditis
Hypothyroidism
Internal Medicine
Orthopnoea
Pulmonary/Respiratory
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Title An unusual cause of orthopnoea-hashimoto's thyroiditis presenting as bilateral diaphragmatic palsy
URI https://www.clinicalkey.es/playcontent/1-s2.0-S2213007117300758
https://dx.doi.org/10.1016/j.rmcr.2017.04.016
https://www.ncbi.nlm.nih.gov/pubmed/28480162
https://pubmed.ncbi.nlm.nih.gov/PMC5407574
https://doaj.org/article/0e17ab691c9c4d67ae5d5af51f6ac5d2
Volume 21
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