Subclinical Hypothyroidism, Its Manifestations and Management a Case Report

Introduction: Thyroid states can be associated with psychiatric manifestations, be it hypothyroid, hyperthyroid or even euthyroid. The effect of depression is significant in subclinical hypothyroidism. Sometimes, its signs and symptoms are indistinguishable from Major Depressive Disorder. Our immunological system and early embryologic origins also play a role in the coexistence of other comorbidities like Pernicious Anemia. Case: A 35-year-old Hispanic female presented with significant low mood, somnolence, weight gain, increased hunger, cold intolerance and epigastric pain. It is important to note the variety of clinical manifestations of our hypothyroidism patient to understand its associations and help us with a better approach to treatment. Discussion: Standard approaches to treatment of Subclinical Hypothyroidism will depend mostly on laboratory findings such as TSH levels and free T4. Individualized therapy chosen for our patient was based on his mood symptoms, laboratory findings and coexistence of Pernicious Anemia. The use of daily 0.025 mg of levothyroxine, 10 mg of escitalopram oxalate and weekly injections of cyanocobalamin were treatments of choice. Conclusion: During follow up of our patient, we can conclude that Levothyroxine and Escitalopram Oxalate were able to improve hypothyroidism symptoms, reduce thyroglobulin and peroxidase antibodies and improve mood symptoms including cognitive functions. In addition to this, weekly cyanocobalamin injections were integrated into the management. As parietal cell antibodies decreased, gastrointestinal symptoms also disappeared. By addressing the concerns of our patient, we improved quality of care, and this is reflected in the patient’s wellbeing in physical and psychological.

Infertility and ovarian failure in celiac disease

Unexplained infertility in females may be a devastating event for the reproductive-aged female.However,infertility may be due to ovarian failure associated with celiac disease,an immune-mediated disorder that may have few or no symptoms and can be successfully treated.In some prospective serologically-based studies,over 4% of infertile females may prove to have celiac disease.Serological screening for celiac disease is relatively inexpensive and involves testing for antibodiesto tissue transglutaminase.If positive,a small intestinal biopsy should be done to confirm the diagnosis.The initial treatment for this disorder is a gluten-free diet.To date,a number of reports have indicated that this treatment for celiac disease may result in successful pregnancy,in spite of prolonged periods of infertility.Celiac disease,when untreated,may also lead to several adverse events following pregnancy including increased risk of recurrent abortions,low birthweight and impaired fetal growth.Recent molecular and pathological studies from different laboratories suggest that altered placental function may be due to binding to cells in the trophoblast by tissue transglutaminase antibodies impairing embryo implantation and leading to failure of early pregnancy or retarded intrauterine growth.