Endocrinologic Manifestations

• Goiter (see Goiter, [[Goiter]])
  • May occur substernally
  • Best detected by I131 scan
• Hyperhomocysteinemia (see Hyperhomocysteinemia, [[Hyperhomocysteinemia]])
  • Hypercoagulability (see Hypercoagulable States, [[Hypercoagulable States]])

Neuro Manifestations

• Fatigue
• Hyporeflexia: correlates with propensity for respiratory failure

Pulmonary Manifestations

Pleural Effusion (see Pleural Effusion-Transudate, [[Pleural Effusion-Transudate]] and Pleural Effusion-Exudate, [[Pleural Effusion-Exudate]])

• Physiology: probably due to transcapillary filtration of liquid and protein
• Diagnosis
  • Pleural Fluid: transudate, when effusion occurs at the same time as pericardial effusion
    • Isolated pleural effusions can be either transudate or exudate
• Clinical
  • Most cases of hypothyroidism-associated pleural effusion have a coexistent pericardial effusion (52% with pericardial effusion had a pleural effusion also)

Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]])

• Epidemiology: both hypothyroidism and hyperthyroidism have been found to be associated with pulmonary hypertension
  • In an echocardiographic study, more than 40% of patients with thyroid diseases had pulmonary hypertension
  • One case of biopsy-proven pulmonary veno-occlusive disease was reported in a patient with Hashimoto thyroiditis
  • Study of adult patients with pulmonary hypertension reported a 49% prevalence of autoimmune thyroid disease (both hypothyroidism and hyperthyroidism): possible common immunogenetic susceptibility
• Physiology: likely due to hypoventilation (with associated with altered CNS respiratory drive, partial neuropathic component, and partial myopathic components)

Obstructive Sleep Apnea (OSA) (see Obstructive Sleep Apnea, [[Obstructive Sleep Apnea]])

• OSA (may respond to thyroid hormone replacement alone in some cases): hypothyroidism may induce mucopolysaccharide and protein extravasation in the face, predisposing upper airway obstruction

Acute/Chronic Hypoventilation (see Acute Hypoventilation, [[Acute Hypoventilation]] and Chronic Hypoventilation, [[Chronic Hypoventilation]])

• Diagnosis
  • ABG: usually normal with hypothyroidism alone
    • Hypothyroidism + Obesity: moderate hypoxemia with hypercapnia
  • PFT’s: usually normal in presence of hypothyroidism alone
    • Hypothyroidism + Obesity: VC, TLC, RV, IC, and ERV may be decreased
    • MIP+MEP: inspiratory and expiratory muscle weakness
• Clinical: may manifest as failure to wean from ventilator

Cardiac Manifestations

Pericardial Effusion (see Pericardial Effusion, [[Pericardial Effusion]])

• Epidemiology
• Diagnosis
  • Pericardiocentesis: protein content ranges from 22-76 g/L
• Clinical
• Treatment

Hematologic Manifestations

• Anemia (see Anemia, [[Anemia]])